Electronic health records and adverse drug events after patient transfer.
Electronic health records and adverse drug events after patient transfer.
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DOI：
10.1136/qshc.2009.033050
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发表时间：
2010-10
影响因子：
--
通讯作者：
Fried T
中科院分区：
文献类型：
--
作者：
Boockvar KS;Livote EE;Goldstein N;Nebeker JR;Siu A;Fried T
我们的目的是检查与没有电子健康记录（EHR）的系统相比，患者转移时用药错误和药物不良事件（ADE）的频率。我们假设，这些事件的频率将在EHR系统中较低，因为更好的信息交换跨站点的护理。回顾性随访了1999-2005年间在纽约和康涅狄格州的7家疗养院和3家医院之间转移的469例患者。比较了2组患者：美国退伍军人事务部（VA）患者（有EHR）和非VA患者（无EHR），采用以下指标：1）疗养院/医院转移时的药物处方差异; 2）高风险药物差异; 3）根据成对医生和药剂师评分员的结构化病历审查，由药物差异引起的ADE。用药差异导致的ADE总发生率为0.20/住院事件。在控制了人口统计学和临床协变量后，VA组和非VA组之间的药物差异无显著性差异（平均差异0.02; 95%CI −0.81至0.85），高风险用药差异（-0.18; 95%CI-0.22至0.58），或发生由用药差异引起的ADE（比值比0.96; 95%CI 0.18至5.01）。在有和没有EHR的情况下，在治疗中心之间转移时药物差异或药物差异引起的ADE的发生率没有差异。减少这些问题可能需要专门的计算机工具，以促进药物审查。
Our objective was to examine the frequencies of medication error and adverse drug events (ADEs) at the time of patient transfer in a system with an electronic health record (EHR) as compared to a system without an EHR. We hypothesized that the frequencies of these events would be lower in the EHR system because of better information exchange across sites of care. 469 patients transferred between 7 nursing homes and 3 hospitals in New York and Connecticut between 1999-2005 were followed retrospectively. 2 groups of patients were compared: U.S. Veterans Affairs (VA) patients, with an EHR, and non-VA patients, without an EHR, on the following measures: 1) Medication prescribing discrepancies at nursing home/hospital transfer; 2) High-risk medication discrepancies; and 3) ADEs caused by medication discrepancies according to structured medical record review by pairs of physician and pharmacist raters. The overall incidence of ADE caused by medication discrepancies was 0.20 per hospitalization episode. After controlling for demographic and clinical covariates, there were no significant differences between VA and non-VA groups in medication discrepancies (mean difference 0.02; 95%CI −0.81 to 0.85), high-risk medication discrepancies (−0.18; 95%CI −0.22 to 0.58), or occurrence of an ADE caused by a medication discrepancy (odds ratio 0.96; 95%CI 0.18 to 5.01). There was no difference, with and without an EHR, in the occurrence of medication discrepancies or ADEs caused by medication discrepancies at the time of transfer between sites of care. Reducing such problems may require specialized computer tools to facilitate medication review.