Effect of computerized physician order entry and a team intervention on prevention of serious medication errors
Effect of computerized physician order entry and a team intervention on prevention of serious medication errors
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DOI：
10.1001/jama.280.15.1311
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发表时间：
1998-10-21
影响因子：
120.7
通讯作者：
Seger, DL
中科院分区：
文献类型：
--
作者：
Bates, DW;Leape, LL;Seger, DL
背景-不良药物事件(ADE)是住院期间伤害的重要且代价高昂的原因。目的：-评估两种干预措施的有效性，以防止未被拦截的严重用药错误，所述干预措施被定义为导致或可能导致ADE且在到达患者之前未被拦截的那些。设计-在阶段1(基线)和阶段2(实施干预之后)之间的前后比较，以及在阶段2中，在物理计算机顺序录入(POE)和POE加团队干预的组合之间的随机比较。设置。-大型三级护理医院。参与者-用于阶段1和2的比较，所有患者在6个月的时间里在三级护理医院的6个内外科病房中分层随机抽样，在第二阶段进行随机比较，所有患者都住进相同的病房，并在随后的9个月期间随机选择2个额外的病房。干预。-针对所有病房的医生计算机订单录入系统(POE)和包括改变药剂师角色的基于团队的干预，对一半的病房实施。主要结果衡量标准。-未截获严重用药错误。结果-比较阶段1和2之间的相同单元，未截获的严重用药错误减少了55%，从每1000个病人日10.7个事件降至每1000个4.86个事件(P=0.01)。在用药过程的所有阶段都出现了下降。可预防的ADE下降了17%，从4.69下降到3.88(P=.37)，而未被拦截的潜在ADE下降了84%，从每1000患者日的5.99下降到0.98(P=0.002)。当将仅使用POE与POE加团队干预相结合进行比较时，团队干预没有赋予POE额外的好处。结论-医生计算机订单输入将未截获的严重用药差错率降低了一半以上，尽管对于潜在的ADE来说，这一下降幅度大于实际导致ADE的错误。
Context.-Adverse drug events (ADEs) are a significant and costly cause of injury during hospitalization.Objectives.-To evaluate the efficacy of 2 interventions for preventing nonintercepted serious medication errors, defined as those that either resulted in or had potential to result in an ADE and were not intercepted before reaching the patient.Design.-Before-after comparison between phase 1 (baseline) and phase 2 (after intervention was implemented) and, within phase 2, a randomized comparison between physican computer order entry (POE) and the combination of POE plus a team intervention.Setting.-Large tertiary care hospital.Participants.-For the comparison of phase 1 and 2, all patients admitted to a stratified random sample of 6 medical and surgical units in a tertiary care hospital over a 6-month period, and for the randomized comparison during phase 2, all patients admitted to the same units and 2 randomly selected additional units over a subsequent 9-month period.Interventions.-A physician computer order entry system (POE) for all units and a team-based intervention that included changing the role of pharmacists, implemented for half the units.Main Outcome Measure.-Nonintercepted serious medication errors.Results.-Comparing identical units between phases 1 and 2, nonintercepted serious medication errors decreased 55%, from 10.7 events per 1000 patient-days to 4.86 events per 1000 (P=.01). The decline occurred for all stages of the medication-use process. Preventable ADEs declined 17% from 4.69 to 3.88 (P=.37), while nonintercepted potential ADEs declined 84% from 5.99 to 0.98 per 1000 patient-days (P=.002). When POE-only was compared with the POE plus team intervention combined, the team intervention conferred no additonal benefit over POE.Conclusions.-Physician computer order entry decreased the rate of nonintercepted serious medication errors by more than half, although this decrease was larger for potential ADEs than for errors that actually resulted in an ADE.