Medication administration discrepancies persist despite electronic ordering.
Medication administration discrepancies persist despite electronic ordering.
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DOI：
10.1197/jamia.m2359
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发表时间：
2007-11-01
影响因子：
6.4
通讯作者：
Miller, Randolph A.
中科院分区：
文献类型：
--
作者：
FitzHenry, Fern;Peterson, Josh F.;Miller, Randolph A.
背景：高达 38% 的住院患者用药错误发生在给药阶段 尽管计算机化医疗服务提供者订单输入 (CPOE) 系统可以减少处方错误，但它并不能防止给药错误或时间差异。本研究确定了 CPOE 用药医嘱与实际给药时间的匹配程度。方法：在一家设有 CPOE 但缺乏电子用药管理图表的 658 个床位的学术医院，作者从 1999-2003 年 CPOE 历史日志文件中随机选择了符合条件用药医嘱的成年患者。回顾性手动图表审核比较了预期（来自 CPOE）和实际的用药时间。结果包括：剂量遗漏、命令和图表给药之间的中位滞后时间、未经授权的剂量、错误的剂量错误以及护士服药计划转移的比率。结果：在 6019 个经审计的给药机会中，有 756 个（12.6%）发生了剂量遗漏；只有 313 个遗漏（占机会的 5.2%）无法解释。错误剂量和意外剂量的发生率分别为 0.1% 和 0.7%。从预期首次剂量到实际绘制的给药时间的中位滞后时间为 27 分钟 (IQR 0-127)。 10.7% 的定期重复用药医嘱中，护理人员从有序用药安排改为交替用药安排。图表审查确定了剂量遗漏、延迟和剂量转移的原因。结论：住院 CPOE 指令清晰易读，并以电子方式传送给护士和药房。尽管如此，基于病房的药物管理并不总是按顺序进行。即使在实施 CPOE 和条形码药物管理之后，药物管理差异也可能持续存在，除非采取建议的干预措施来解决诸如确定药物管理的真正紧迫性、避免重叠的重复药物订单以及开发改变给药计划的安全方法等问题。
Background: Up to 38% of inpatient medication errors occur at the administration stage Although they reduce prescribing errors, computerized provider order entry (CPOE) systems do not prevent administration errors or timing discrepancies. This study determined the degree to which CPOE medication orders matched actual dose administration times.Methods: At a 658-bed academic hospital with CPOE but lacking electronic medication administration charting, authors randomly selected adult patients with eligible medication orders from historical 1999-2003 CPOE log files. Retrospective manual chart audits compared expected (from CPOE) and actual timing of medication administrations. Outcomes included: dose omissions, median lag times between ordered and charted administrations, unauthorized doses, wrong dose errors, and the rate of nurses' medication schedule shifting.Results: Dose omissions occurred in 756 of 6019 (12.6%) audited administration opportunities; only 313 of the omissions (5.2% of opportunities) were unexplained. Wrong doses and unexpected doses occurred for 0.1% and 0.7% of opportunities, respectively. Median lag from expected first dose to actual charted administration time was 27 minutes (IQR 0-127). Nursing staff shifted from ordered to alternate administration schedules for 10.7% of regularly scheduled recurring medication orders. Chart review identified reasons for dose omissions, delays, and dose shifting.Conclusion: Inpatient CPOE orders are legible and conveyed electronically to nurses and the pharmacy. Nonetheless, ward-based medication administrations do not consistently occur as ordered. Medication administration discrepancies are likely to persist even after implementing CPOE and bar-coded medication administration unless recommended interventions are made to address issues such as determining the true urgency of medication administration, avoiding overlapping duplicative medication orders, and developing a safe means for shifting dosing schedules.