A Computer Prescribing Order Entry-Clinical Decision Support system designed for neonatal care: results of the "preselected prescription' concept at the bedside
A Computer Prescribing Order Entry-Clinical Decision Support system designed for neonatal care: results of the "preselected prescription' concept at the bedside
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DOI：
10.1111/jcpt.12474
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发表时间：
2017-02-01
影响因子：
2
通讯作者：
Gouyon, J. B.
中科院分区：
文献类型：
--
作者：
Gouyon, B.;Iacobelli, S.;Gouyon, J. B.
众所周知，新生儿重症监护室（NICU）是所有医院病房中药物剂量错误的风险最高的。NICU也有最复杂的处方模式。目前建议将处方过程计算机化，以降低NICU中可预防药物不良反应（pADE）的风险。然而，计算机处方订单输入-临床决策支持（C.P.O.E./ C.D.S.）系统已在NICU研究不足，其技术兼容性与新生儿specificities一直limited.ObjectivesWe成立了一个性能研究的预选处方的药物新生儿，这限制了作用的处方选择的药物及其indication.MethodsA单29床新生儿病房使用这种新生儿C.P.O.E./ CD在18个月期间，所有住院新生儿的所有处方都纳入了一个系统。根据适应症、胎龄、体重和出生后年龄预先选择药物处方。治疗方案由专门为新生儿设计的处方参考（330种药物）提供。预先选定的处方还提供了护士准备和给药的完整信息。允许开处方者修改预选处方，但当处方超出推荐范围时，警报会发出警告。将各处方线的主要临床特征和所有项目存储在数据仓库中，从而使本研究得以进行。妊娠24 ~ 42周的新生儿共使用处方52392条，对应65种药物，约304%的新生儿至少使用过一种非处方药;在所有药物处方中，有10%的处方超出了每日剂量的推荐范围。C.P.O.E./ CD系统目前可以根据剂量规则在新生儿重症监护病房中提供完整的预选处方，这些规则针对新生儿，也符合当地的具体情况（治疗方案和药物配方）。处方者的作用仅限于药物及其适应症的选择。处方者仍然保留修改处方中每一项的可能性，所有其他处方项都由C.P.O.E.计算。系统在这些情况下，处方者很少修改预选处方，超范围处方率低。需要一个多中心的研究，以确认和扩展这些observation.ConclusionsThis研究表明，预选处方在新生儿重症监护病房和低利率的范围外的处方的可行性。预先选择的处方可以在降低NICU剂量错误率方面发挥关键作用。
What is knownThe neonatal intensive care units (NICUs) are at the highest risk of drug dose error of all hospital wards. NICUs also have the most complicated prescription modalities. The computerization of the prescription process is currently recommended to decrease the risk of preventable adverse drug effects (pADEs) in NICUs. However, Computer Prescribing Order Entry-Clinical Decision Support (C.P.O.E./C.D.S.) systems have been poorly studied in NICUs, and their technical compatibility with neonatal specificities has been limited.ObjectivesWe set up a performance study of the preselected prescription of drugs for neonates, which limited the role of the prescriber to choosing the drugs and their indications.MethodsA single 29 bed neonatal ward used this neonatal C.P.O.E./C.D.S. system for all prescriptions of all hospitalized newborns over an 18-month period. The preselected prescription of drugs was based on the indication, gestational age, body weight and post-natal age. The therapeutic protocols were provided by a formulary reference (330 drugs) that had been specifically designed for newborns. The preselected prescription also gave complete information about preparation and administration of drugs by nurses. The prescriber was allowed to modify the preselected prescription but alarms provided warning when the prescription was outside the recommended range. The main clinical characteristics and all items of each line of prescription were stored in a data warehouse, thus enabling this study to take place.ResultsSeven hundred and sixty successive newborns (from 24 to 42weeks' gestation) were prescribed 52392 lines of prescription corresponding to 65 drugs; About 304% of neonates had at least one out of licensed prescription; A prescription out of the recommended range for daily dose was recorded for 10% of all drug prescriptions.What is new?The C.P.O.E./C.D.S. systems can currently provide a complete preselected prescription in NICUs according to dose rules, which are specific to newborns and also comply with local specificities (therapeutic protocols and formulation of drugs). The role of the prescriber is limited to the choice of drugs and their indications. The prescriber still retains the possibility of modifying each item of the prescription, with all other prescription items being calculated by the C.P.O.E. system. In these conditions, the prescribers rarely modified the preselected prescription and the rate of out of range prescription was low. A multicentric study is required to confirm and extend these observations.ConclusionsThis study showed the feasibility of preselected prescription in NICUs and a low rate of out of range prescriptions. The preselected prescription could play a key role in lowering the dose error rate in NICUs.