Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)
Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)
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DOI：
10.1136/amiajnl-2012-001555
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发表时间：
2013-05-01
影响因子：
6.4
通讯作者：
Lambert, Bruce L.
中科院分区：
文献类型：
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作者：
Galanter, William;Falck, Suzanne;Lambert, Bruce L.
目的确定基于适应症的计算机医嘱录入警报是否能拦截患者用药错误。材料和方法在一家为住院和门诊患者提供服务的学术医疗中心，我们开发并实施了一个临床决策支持系统，当某些药物在问题清单上没有适当编码的适应症时，该系统可以提示临床医生确定适应症。在所有触发的警报中，我们识别了开始服药但未完成的每个实例，并且在固定的时间间隔内，相同的处方者为不同的患者下了相同的药物订单。我们仔细审查了每个实例，以确定它们是否可能被截获错误。结果6年期间共发出127 320次报警，截获错误患者32次，截获率为0.25 / 1000次。开处方者的地点和开处方者的类型都不影响拦截率。姓氏相同的病人没有被截获的错误，但在59%的被截获的错误中，开处方的人在第一次开处方时打开了两个病人的病历。先前已经显示了与问题列表链接的指示警报，以改进问题列表的完成。这一分析显示了另一个好处，即拦截错误患者的用药错误。结论：基于适应症的警报产生了每1000个警报中0.25个错误患者用药错误拦截率。这些警报可以单独实施，也可以与其他策略结合使用，以减少患者用药错误。
Objective To determine whether indication-based computer order entry alerts intercept wrong-patient medication errors.Materials and methods At an academic medical center serving inpatients and outpatients, we developed and implemented a clinical decision support system to prompt clinicians for indications when certain medications were ordered without an appropriately coded indication on the problem list. Among all the alerts that fired, we identified every instance when a medication order was started but not completed and, within a fixed time interval, the same prescriber placed an order for the same medication for a different patient. We closely reviewed each of these instances to determine whether they were likely to have been intercepted errors.Results Over a 6-year period 127 320 alerts fired, which resulted in 32 intercepted wrong-patient errors, an interception rate of 0.25 per 1000 alerts. Neither the location of the prescriber nor the type of prescriber affected the interception rate. No intercepted errors were for patients with the same last name, but in 59% of the intercepted errors the prescriber had both patients' charts open when the first order was initiated. Discussion Indication alerts linked to the problem list have previously been shown to improve problem list completion. This analysis demonstrates another benefit, the interception of wrong-patient medication errors.Conclusions Indication-based alerts yielded a wrong-patient medication error interception rate of 0.25 per 1000 alerts. These alerts could be implemented independently or in combination with other strategies to decrease wrong-patient medication errors.