A trial of automated decision support alerts for contraindicated medications using computerized physician order entry
A trial of automated decision support alerts for contraindicated medications using computerized physician order entry
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DOI：
10.1197/jamia.m1727
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发表时间：
2005-05-01
影响因子：
6.4
通讯作者：
Polikaitis, A
中科院分区：
文献类型：
--
作者：
Galanter, WL;Didomenico, RJ;Polikaitis, A
背景：自动化临床决策支持在减少用药差错方面显示出了希望；然而，临床医生经常不遵守警报。由于肾功能不全是用药差错的常见来源，作者研究了一项旨在减少住院患者因肾功能不全而服用禁忌药物的警报试验。方法：为每一名住院患者处方用药建立最低安全肌酐清除。当一名患者的肌酐清除量估计低于药物的最低安全肌酐清除量时，就会出现建议取消的警报。在警示实施后14个月和之前4个月，对肌酐清除低于药物最低安全清除的患者进行了药物治疗研究。此外，患者的年龄、性别、肾功能不全程度、每天的时间和家政人员培训的持续时间对家政人员遵守警报的可能性的影响进行了检验。结果：患者在实施警报后接受至少一剂违禁药物的可能性从89%降至47%(p<；0.0001)。对家政人员看到的警示的分析显示，男性患者的警示依从性较高(57%比38%，P=0.02)，随着培训时间的延长，警示依从性增加(P=0.04)，肾功能恶化的患者警示依从性增加(P=0.007)。结论：警示有效地减少了因肾功能不全而禁用的药物的订购和使用。男性患者对警报的依从性更高，随着家政人员培训时间的延长而增加，肾功能障碍越严重的患者越多。
Background: Automated clinical decision support has shown promise in reducing medication errors; however, clinicians often do not comply with alerts. Because renal insufficiency is a common source of medication errors, the authors studied a trial of alerts designed to reduce inpatient administration of medications contraindicated due to renal insufficiency.Methods: A minimum safe creatinine clearance was established for each inpatient formulary medication. Alerts recommending cancellation appeared when a medication order was initiated for a patient whose estimated creatinine clearance was less than the minimum safe creatinine clearance for the medication. Administration of medications in patients with creatinine clearances less than the medication's minimum safe clearance were studied for 14 months after, and four months before, alert implementation. In addition, the impact of patient age, gender, degree of renal dysfunction, time of day, and duration of housestaff training on the likelihood of housestaff compliance with the alerts was examined.Results: The likelihood of a patient receiving at least one dose of contraindicated drug after the order was initiated decreased from 89% to 47% (p < 0.0001) after alert implementation. Analysis of the alerts seen by housestaff showed that alert compliance was higher in male patients (57% vs. 38%, p = 0.02), increased with the duration of housestaff training (p = 0.04), and increased in patients with worsening renal function (p = 0.007).Conclusion: Alerts were effective in decreasing the ordering and administration of drugs contraindicated due to renal insuffiency. Compliance with the alerts was higher in male patients, increased with the duration of housestaff training, and increased in patients with more severe renal dysfunction.