Medication discrepancies in integrated electronic health records
Medication discrepancies in integrated electronic health records
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DOI：
10.1136/bmjqs-2012-001301
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发表时间：
2013-02-01
影响因子：
5.4
通讯作者：
Simon, Steven R.
中科院分区：
文献类型：
--
作者：
Linsky, Amy;Simon, Steven R.
用药差异与药物不良事件有关。电子健康记录(EHR)可以减少差异，特别是在与药房配药相结合的情况下。我们确定了具有EHR-药房联系的国家医疗系统中差异的发生率，以表征所涉及的药物并确定与差异相关的因素。方法我们在2010年4月至2011年7月对退伍军人事务部波士顿医疗系统的门诊患者进行了回顾性队列研究。主要结果是存在任何药物差异或特定类型的差异：佣金-存在于记录中但不是由患者服用；遗漏-不存在于记录中；重复-存在多次；或剂量或频率的改变-存在但与记录不同。结果62名患者(60%)至少有一种药物差异。委托、遗漏、重复和更改的发生率分别为36%、27%、11%和19%。涉及的药物因类型不同而不同，但非阿片类止痛药和草药疗法在委托和遗漏中很常见。在调整后的分析中，服药数量的增加与更多的佣金(OR 1.2；95%CI 1.1至1.3)和重复(OR 1.2；95%CI 1.1至1.4)和较少的遗漏(OR 0.9；95%CI 0.8至1.0)相关。服药次数越多的患者越有可能出现错误和重复，但不太可能出现遗漏错误。我们的发现强调，仅依靠电子病历不能确保准确的药物清单，并强调有必要与患者彻底审查用药情况，以充分利用电子病历的全部潜力。
Introduction Medication discrepancies are associated with adverse drug events. Electronic health records (EHRs) may reduce discrepancies, especially if integrated with pharmacy dispensing. We determined the prevalence of discrepancies within a national healthcare system with EHR-pharmacy linkage to characterise the medications involved and to identify factors associated with discrepancies.Methods We conducted a retrospective cohort study of ambulatory care patients at Veterans Affairs Boston Healthcare System, April 2010-July 2011. The primary outcome was the presence of any medication discrepancy or specific types of discrepancies: commission-present in the record but not taken by patient; omission-not present in the record; duplication-present more than once; or alteration in dose or frequency-present but taken differently than documented.Results Sixty-two patients (60%) had at least one medication discrepancy. Prevalence of commissions, omissions, duplications and alterations were 36%, 27%, 11% and 19%, respectively. The involved medications differed by type of discrepancy, but non-opioid analgesics and herbal therapies were common among commissions and omissions. In adjusted analyses, an increasing number of medications was associated with more commissions (OR 1.2; 95% CI 1.1 to 1.3) and duplications (OR 1.2; 95% CI 1.1 to 1.4) and fewer omissions (OR 0.9; 95% CI 0.8 to 1.0).Discussion In a system with a well established EHR linked to pharmacy dispensing, medication discrepancies occurred in 60% of ambulatory clinic patients. Patients with a greater number of medications were more likely to have errors of commission and duplication, but less likely to have errors of omission. Our findings highlight that relying on EHRs alone will not ensure an accurate medication list and stress the need to review medication taking thoroughly with patients to capitalise on the full potential of EHRs.