Clinicians' Assessments of Electronic Medication Safety Alerts in Ambulatory Care
Clinicians' Assessments of Electronic Medication Safety Alerts in Ambulatory Care
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DOI：
10.1001/archinternmed.2009.300
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发表时间：
2009-09-28
影响因子：
--
通讯作者：
Weissman, Joel S.
中科院分区：
文献类型：
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作者：
Weingart, Saul N.;Simchowitz, Brett;Weissman, Joel S.
背景：虽然具有药物相互作用和过敏警报的电子处方系统有望提高门诊护理中的用药安全性，但临床医生经常忽视这些安全功能。我们对受访者对电子处方系统的满意度、他们对警报的看法以及他们对警报导致的行为变化的看法进行了研究。方法：对使用商业电子处方系统的 300 名马萨诸塞州门诊护理临床医生进行随机抽样调查。结果：共有 184 名受访者完成了调查（61%）。受访者表示，电子处方提高了护理质量（78%），防止了医疗错误（83%），并提高了患者满意度（71%）和临床医生效率（75%）。此外，35% 的处方医生表示，电子警报导致他们在过去 30 天内修改了具有潜在危险的处方。他们认为警报还导致了临床护理的其他变化：向患者提供有关潜在反应的咨询（49％的受访者），在医学参考文献中查找信息（44％），以及改变患者的监测方式（33％）。总共有 63% 的临床医生表示，为了响应警报，上个月除了停止或修改警报处方外，还采取了其他行动。尽管有这些好处，但只有不到一半的受访者对药物相互作用和过敏警报感到满意（47%）。问题包括因停药而触发的警报 (58%)、未能考虑到适当药物组合的警报 (46%) 以及警报量过多 (37%)。结论：尽管临床医生对电子处方警报的质量持批评态度，但警报可能会导致患者管理方面出现临床上重大的变化，而这种变化根据“接受”率而言并不明显。
Background: While electronic prescribing (e-prescribing) systems with drug interaction and allergy alerts promise to improve medication safety in ambulatory care, clinicians often override these safety features. We undertook a study of respondents' satisfaction with e-prescribing systems, their perceptions of alerts, and their perceptions of behavior changes resulting from alerts.Methods: Random sample survey of 300 Massachusetts ambulatory care clinicians who used a commercial e-prescribing system.Results: A total of 184 respondents completed the survey (61%). Respondents indicated that e-prescribing improved the quality of care delivered (78%), prevented medical errors (83%), and enhanced patient satisfaction (71%) and clinician efficiency (75%). In addition, 35% of prescribers said that electronic alerts caused them to modify a potentially dangerous prescription in the last 30 days. They suggested that alerts also led to other changes in clinical care: counseling patients about potential reactions (49% of respondents), looking up information in medical references (44%), and changing the way a patient was monitored (33%). Altogether, 63% of clinicians reported taking action other than discontinuing or modifying an alerted prescription in the previous month in response to alerts. Despite these benefits, fewer than half of respondents were satisfied with drug interaction and allergy alerts (47%). Problems included alerts triggered by discontinued medications (58%), alerts that failed to account for appropriate drug combinations (46%), and excessive volume of alerts (37%).Conclusion: Although clinicians were critical of the quality of e-prescribing alerts, alerts may lead to clinically significant modifications in patient management not readily apparent based on "acceptance" rates.