Guided medication dosing for inpatients with renal insufficiency
Guided medication dosing for inpatients with renal insufficiency
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DOI：
10.1001/jama.286.22.2839
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发表时间：
2001-12-12
影响因子：
120.7
通讯作者：
Bates, DW
中科院分区：
文献类型：
--
作者：
Chertow, GM;Lee, J;Bates, DW
临床药物处方实践可能没有考虑肾功能不全对某些药物处置的影响。决策辅助工具可能有助于优化处方行为，减少医疗差错。目的确定一个系统应用程序，调整药物关闭和频率在肾功能不全患者，当合并与计算机化的订单输入系统，改善药物处方和患者的结果。连续4个2个月的时间间隔，包括对照组（通常的计算机化订单输入）与干预交替进行（计算机化订单输入加决策支持系统），1997年9月，1998年4月，在一家城市三级护理教学医院收治的17828名成年人的连续样本中评估了结果。用于肾功能不全患者处方药物的时间计算机化决策支持系统。在干预期间，向订单输入用户显示调整后的剂量列表、默认剂量和默认频率，并提供注释，说明已根据肾功能不全进行调整。在控制期间，这些建议的调整不透露给订单输入用户，和未调整的参数显示。主要结果测量率的适当处方的剂量和频率，住院时间，医院和药房的费用，和肾功能的变化，比较干预期间与对照期间住院的肾功能不全患者。结果共7490例患者，发现有一定程度的肾功能不全在该组中，97151张医嘱是关于肾清除或肾毒性药物，其中14440张（15%）至少有1个剂量参数根据肾功能修改了伊利计算机。在干预期和对照期，按剂量划分的适当处方比例分别为67%和54%（P <0.05）。
Context Usual drug-prescribing practices may not consider the effects of renal insufficiency on the disposition of certain drugs. Decision aids may help optimize prescribing behavior and reduce medical error.Objective To determine if a system application for adjusting drug close and frequency in patients with renal insufficiency, when merged with a computerized order entry system, improves drug prescribing and patient outcomes.Design, Setting, and Patients Four consecutive 2-month intervals consisting of control (usual computerized order entry) alternating with intervention (computerized order entry plus decision support system), conducted in September 1997-April 1998 with outcomes assessed among a consecutive sample of 17 828 adults admitted to an urban tertiary care teaching hospital.Intervention Real-time computerized decision support system for prescribing drugs in patients with renal insufficiency. During intervention periods, the adjusted dose list, default dose amount, and default frequency were displayed to the order-entry user and a notation was provided that adjustments had been made based on renal insufficiency. During control periods, these recommended adjustments were not revealed to the order-entry user, and the unadjusted parameters were displayed.Main Outcome Measures Rates of appropriate prescription by dose and frequency, length of stay, hospital and pharmacy costs, and changes in renal function, compared among patients with renal insufficiency who were hospitalized during the intervention vs control periods.Results A total of 7490 patients were found to have some degree of renal insufficiency. In this group, 97 151 orders were written on renally cleared or nephrotoxic medications, of which 14440 (15%) had at least 1 dosing parameter modified Ely the computer based on renal function. The fraction of prescriptions deemed appropriate during the intervention vs control periods by dose was 67% vs 54% (P