Electronic prescribing in an ambulatory care setting: a cluster randomized trial
Electronic prescribing in an ambulatory care setting: a cluster randomized trial
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DOI：
10.1111/j.1365-2753.2011.01657.x
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发表时间：
2012-08-01
影响因子：
2.4
通讯作者：
Zwarenstein, Merrick
中科院分区：
文献类型：
--
作者：
Dainty, Katie N.;Adhikari, Neill K. J.;Zwarenstein, Merrick
基本原理、目的和目的--因药物不良事件而导致的用药错误会对患者和卫生系统造成重大损害。导致可预防的不良药物事件的用药差错最常发生在订购阶段。电子处方可能会防止此类错误，但其影响尚未得到严格评估。方法采用整群随机对照的方法，在学术医院门诊开展临床试验，评价商品化电子处方软件系统对总处方错误率的影响。次要结果包括从社区药房到医生诊所要求澄清的回电次数。结果26名医生使用电子处方系统，在有电子处方系统的44个干预周内开出处方1980张(其中7.6%为电子处方，其余为手写处方)，在关闭系统的22个对照周内开出处方973张(1.4%为电子处方，前一干预周开出，但延迟发放)。总处方错误率干预周为118/1980(6.0%)，对照周为57/973(5.9%)(P=0.91)。在干预期间，要求澄清的电话(n=83，每周1.89)多于对照周(n=32，每周1.45；P<；0.001)。结论电子处方系统的实施对总处方差错没有影响，提高了回复率。尽管有密集的用户支持，但在干预周内使用电子系统开出的处方很少。考虑到成本、培训要求、工作流程重新设计和监管障碍，需要对门诊患者对临床重要结果的处方进行额外的评估。
Rationale, aims and objectives Medication-prescribing errors with adverse drug events impose substantial harms on patients and health systems. Medication errors resulting in preventable adverse drug events most commonly occur at the ordering stage. Electronic prescribing may prevent such errors but its impact has not been rigorously evaluated. Methods We conducted a pragmatic cluster randomized controlled trial in academic hospital ambulatory clinics to evaluate the effects of a commercially available electronic prescribing software system on total prescription error ratio. Secondary outcomes included the number of callbacks for clarification from community pharmacies to physicians' clinics. Results Twenty-six physicians used the electronic prescribing system, writing 1980 prescriptions during 44 intervention weeks when the electronic prescribing system was available (7.6% of these were electronic, the remainder handwritten) and 973 prescriptions during 22 control weeks while the system was switched off (1.4% electronic, prescribed in the previous intervention week, but issued with delay). The total prescription error rate was 118/1980 (6.0%) in intervention weeks and 57/973 (5.9%) in control weeks (P = 0.91). During the intervention period more callbacks requesting clarification were made to clinic administrators (n = 83, 1.89 per week) than during control weeks (n = 32, 1.45 per week; P < 0.001). Conclusion Implementation of the electronic prescribing system had no impact on total prescription error, and increased the callback rate. In spite of intensive user support, few prescriptions in intervention weeks were made using the electronic system. Given the costs, training requirements, workflow redesigns and regulatory hurdles, additional evaluations of outpatient prescribing on clinically important outcomes are needed.