The impact of computerized provider order entry on medication errors in a multispecialty group practice
The impact of computerized provider order entry on medication errors in a multispecialty group practice
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DOI：
10.1197/jamia.m3285
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发表时间：
2010-01-01
影响因子：
6.4
通讯作者：
Sullivan, Sean D.
中科院分区：
文献类型：
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作者：
Devine, Emily Beth;Hansen, Ryan N.;Sullivan, Sean D.
目的：通过减少用药错误和随后的药物不良事件（ADEs），计算机化的医生处方输入（Cl）已被证明可以提高患者的安全性。证明这些好处的研究主要是在住院环境中进行的，在门诊环境中较少。目的是评估基本的门诊CPOE系统对用药错误和相关不良事件的影响。设计本研究采用准实验、前测后测的方法，在一个以社区为基础的多专业卫生系统中进行，该系统不隶属于学术医疗中心。干预是一个基本的CPOE系统，具有有限的临床决策支持能力。实施CPOE系统前（n=5016手写处方）与实施后（n=5153电子处方）处方的比较。主要结局是错误的发生；次要结局是错误的类型和严重程度。结果：错误率从18.2%下降到8.2%，调整后的赔率降低了70% （OR: 0.30, 95% CI 0.23 ~ 0.40）。减少最多的是难以辨认的错误（97%），使用不适当的缩写（94%）和信息缺失（85%）。校正后不造成伤害的错误几率（潜在不良事件）降低了57% （OR 0.43: 95% Cl 0.38 - 0.49）。导致伤害（可预防的ade）的错误数量的减少在统计学上没有显著性，可能是由于这一类的错误很少。结论：在社区环境中建立基本的CPOE系统与大多数类型和严重程度的用药错误的显著减少有关。
Objective Computerized provider order entry (Cl has been shown to improve patient safety by reducing medication errors and subsequent adverse drug events (ADEs). Studies demonstrating these benefits have been conducted primarily in the inpatient setting, with fewer in the ambulatory setting. The objective was to evaluate the effect of a basic, ambulatory CPOE system on medication errors and associated ADEs.Design This quasiexperimental, pretest-post-test study was conducted in a community-based, multispecialty health system not affiliated with an academic medical center. The intervention was a basic CPOE system with limited clinical decision support capabilities.Measurement Comparison of prescriptions written before (n=5016 handwritten) to after (n=5153 electronically prescribed) implementation of the CPOE system. The primary outcome was the occurrence of error(s); secondary outcomes were types and severity of errors.Results Frequency of errors declined from 18.2% to 8.2%-a reduction in adjusted odds of 70% (OR: 0.30, 95% CI 0.23 to 0.40). The largest reductions were seen in adjusted odds of errors of illegibility (97%), use of inappropriate abbreviations (94%) and missing information (85%). There was a 57% reduction in adjusted odds of errors that did not cause harm (potential ADEs) (OR 0.43: 95% Cl 0.38 to 0.49). The reduction in the number of errors that caused harm (preventable ADEs) was not statistically significant, perhaps due to few errors in this category.Conclusions A basic CPOE system in a community setting was associated with a significant reduction in medication errors of most types and severity levels.