Guided medication dosing for elderly emergency patients using real-time, computerized decision support
Guided medication dosing for elderly emergency patients using real-time, computerized decision support
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DOI：
10.1136/amiajnl-2011-000124
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发表时间：
2012-01-01
影响因子：
6.4
通讯作者：
Bates, David W.
中科院分区：
文献类型：
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作者：
Griffey, Richard T.;Lo, Helen G.;Bates, David W.
目的评价急诊科实时计算机化决策支持工具指导老年人给药对医生处方行为和药物不良事件（ADEs）的影响。前瞻性对照试验为期26周。在研究期间，决策支持工具的状态依次为OFF（7/17/06-8/29/06）、ON（8/29/06-10/ 10/06）、OFF（10/10/06-11/28/06）和ON（11/28/06-1/16/07）。在>= 65的患者中，他们被要求服用某些苯二氮卓类药物、阿片类药物、非甾体类药物或镇静催眠药，计算机应用程序要么调整剂量，要么建议使用不同的药物。医生可以接受或拒绝建议。主要结果比较了ON和OFF期间符合建议的用药顺序。次要结局包括入院率、出院患者在急诊科的住院时间、10倍给药单、使用第二种药物逆转原药物、以及使用先前验证的明确图表回顾的ade率。结果在1548次就诊中，1407例患者下单2398次。大多数（49/53;92.5%）替代药物的建议被拒绝。在ON（403/1283; 31.4%）期间，与OFF（256/1115; 23%）期间一致的给药顺序较多
Objective To evaluate the impact of a real-time computerized decision support tool in the emergency department that guides medication dosing for the elderly on physician ordering behavior and on adverse drug events (ADEs).Design A prospective controlled trial was conducted over 26 weeks. The status of the decision support tool alternated OFF (7/17/06-8/29/06), ON (8/29/06-10/ 10/06), OFF (10/10/06-11/28/06), and ON (11/28/06-1/16/07) in consecutive blocks during the study period. In patients >= 65 who were ordered certain benzodiazepines, opiates, non-steroidals, or sedative-hypnotics, the computer application either adjusted the dosing or suggested a different medication. Physicians could accept or reject recommendations.Measurements The primary outcome compared medication ordering consistent with recommendations during ON versus OFF periods. Secondary outcomes included the admission rate, emergency department length of stay for discharged patients, 10-fold dosing orders, use of a second drug to reverse the original medication, and rate of ADEs using previously validated explicit chart review.Results 2398 orders were placed for 1407 patients over 1548 visits. The majority (49/53; 92.5%) of recommendations for alternate medications were declined. More orders were consistent with dosing recommendations during ON (403/1283; 31.4%) than OFF (256/1115; 23%) periods (p