Review Paper: The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review
Review Paper: The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review
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综述论文：电子处方对用药错误和药物不良事件的影响：系统综述
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
U. Siebert
中科院分区：
文献类型：
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作者：
E. Ammenwerth;P. Schnell;C. Machan;U. Siebert
本系统评价的目的是分析计算机医嘱输入系统（CPOE）对用药错误和药物不良事件（ADE）的相对风险降低。我们包括对照现场研究和前后测试研究，评估所有类型的CPOE系统，药物和临床环境。我们在证据表中列出了结果，计算了95%置信区间的风险比，并对分类因素进行了亚组分析，如护理水平、患者组、药物类型、系统类型、系统功能、对照组类型、研究设计和检测错误的方法。在分析对用药错误率影响的25项研究中，23项显示相对风险显着降低13%至99%。9项研究中有6项分析了对潜在ADE的影响，结果显示相对风险显著降低35%至98%。7项研究中有4项分析了对ADE的影响，结果显示相对风险显著降低30%至84%。报告质量和研究质量往往不足以排除主要的偏倚来源。对国产系统的研究，比较电子处方与手写处方的研究，以及使用手动图表审查来检测错误的研究似乎显示出比其他研究更高的相对风险降低。总之，电子处方似乎可以降低用药错误和ADE的风险。然而，研究在其设置，设计，质量和结果方面存在很大差异。为了进一步改善健康信息学的证据基础，需要更多的随机对照试验（RCT），特别是要覆盖更广泛的临床和地理环境。此外，卫生信息学评价研究的报告质量必须得到大幅提高。
The objective of this systematic review is to analyse the relative risk reduction on medication error and adverse drug events (ADE) by computerized physician order entry systems (CPOE). We included controlled field studies and pretest-posttest studies, evaluating all types of CPOE systems, drugs and clinical settings. We present the results in evidence tables, calculate the risk ratio with 95% confidence interval and perform subgroup analyses for categorical factors, such as the level of care, patient group, type of drug, type of system, functionality of the system, comparison group type, study design, and the method for detecting errors. Of the 25 studies that analysed the effects on the medication error rate, 23 showed a significant relative risk reduction of 13% to 99%. Six of the nine studies that analysed the effects on potential ADEs showed a significant relative risk reduction of 35% to 98%. Four of the seven studies that analysed the effect on ADEs showed a significant relative risk reduction of 30% to 84%. Reporting quality and study quality was often insufficient to exclude major sources of bias. Studies on home-grown systems, studies comparing electronic prescribing to handwriting prescribing, and studies using manual chart review to detect errors seem to show a higher relative risk reduction than other studies. Concluding, it seems that electronic prescribing can reduce the risk for medication errors and ADE. However, studies differ substantially in their setting, design, quality, and results. To further improve the evidence-base of health informatics, more randomized controlled trials (RCTs) are needed, especially to cover a wider range of clinical and geographic settings. In addition, reporting quality of health informatics evaluation studies has to be substantially improved.