Wrong-Patient Orders in Obstetrics.
Wrong-Patient Orders in Obstetrics.
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产科中错误的患者医嘱。
DOI：
10.1097/aog.0000000000004474
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发表时间：
2021
影响因子：
7.2
通讯作者：
Goffman,Dena
中科院分区：
文献类型：
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作者：
Kern-Goldberger,AdinaR;Kneifati-Hayek,Jerard;Fernandes,Yelstin;Applebaum,JoR;Schechter,ClydeB;Adelman,JasonS;Goffman,Dena
目的：比较产科病房患者与内外科病房收治的育龄妇女的错误医嘱发生率。方法：这是一项于 2016 年 1 月 1 日至 2018 年 12 月 31 日在纽约大型卫生系统进行的观察性研究。主要结果是使用国家质量论坛认可的错误患者撤回和重新医嘱措施确定的差点错误医嘱。研究期间为符合条件的患者下的所有电子订单都是从卫生系统数据仓库中回顾性提取的，分析单位是订单会话（单个临床医生在 60 分钟内为患者下的连续订单）。使用多级逻辑回归模型来估计比值比 (OR) 和 95% CI，比较产科和内科手术单位总体以及按临床医生类型和医嘱时间定义的亚组中撤回和重新订购事件的概率。 结果：总体而言，在研究期间共安排了 1,329,463 个医嘱疗程，包括 676,643 个产科医嘱疗程（来自 45,436 名患者）和652,820 次医疗手术预约（来自 12,915 名患者）。产科单位每 100,000 次医嘱疗程中有 79.5 起撤回并重新预约事件的发生率显着高于一般内外科人群每 100,000 次医嘱疗程 42.3 次的撤回和重新预约事件发生率（OR 1.98，95% CI 1.64-2.39）。与高级临床医生相比，主治医生和住院工作人员的产科撤回和重新排序事件发生率明显更高。白班和夜班之间的错误率没有显着差异。结论：与内外科病房相比，产科病房更容易出现医嘱错误。应在产科中探索在其他高风险专业中减少这些事件的系统策略，以提供更安全的产妇护理。
OBJECTIVE:To compare rates of wrong-patient orders among patients on obstetric units compared with reproductive-aged women admitted to medical–surgical units.METHODS:This was an observational study conducted in a large health system in New York between January 1, 2016, and December 31, 2018. The primary outcome was near-miss wrong-patient orders identified using the National Quality Forum–endorsed Wrong-Patient Retract-and-Reorder measure. All electronic orders placed for eligible patients during the study period were extracted retrospectively from the health system data warehouse, and the unit of analysis was the order session (consecutive orders placed by a single clinician for a patient within 60 minutes). Multilevel logistic regression models were used to estimate odds ratios (ORs) and 95% CIs comparing the probability of retract-and-reorder events in obstetric and medical–surgical units, overall, and in subgroups defined by clinician type and order timing.RESULTS:Overall, 1,329,463 order sessions were placed during the study period, including 676,643 obstetric order sessions (from 45,436 patients) and 652,820 medical–surgical order sessions (from 12,915 patients). The rate of 79.5 retract-and-reorder events per 100,000 order sessions in obstetric units was significantly higher than the rate in the general medical–surgical population of 42.3 per 100,000 order sessions (OR 1.98, 95% CI 1.64–2.39). The obstetric retract-and-reorder event rate was significantly higher for attending physicians and house staff compared with advanced practice clinicians. There were no significant differences in error rates between day and night shifts.CONCLUSION:Order errors occurred more frequently on obstetric units compared with medical–surgical units. Systems strategies shown to decrease these events in other high-risk specialties should be explored in obstetrics to render safer maternity care.