The safety and effectiveness of hospital e-prescribing systems: a controlled time series study

开药错误是国际上一个重大的公共卫生问题。在美国，每年有超过77万人在医院因药物不良事件而受伤或死亡。在澳大利亚，2%的医院患者因用药失误而受到伤害或死亡。随着医疗护理强度的增加、复杂和有效药物方案的使用以及住院患者年龄和病情的日益严重，这些错误的风险每年都在上升。据信，电子处方系统可以显著减少错误发生的次数，从而减少对患者的伤害。没有研究表明，这些系统可以减少对患者造成伤害的处方错误。令人担忧的是，来自海外的轶事证据表明，使用电子处方系统会引入新类型的错误。这与越来越多的科学研究相一致，这些研究表明，个人的决策可能会受到计算机产生的信息的显著影响，从而导致新类型的错误。该项目的目的是进行一项受控时间序列研究，以评估两种电子处方系统的安全性和有效性，以减少澳大利亚医院的处方错误。这项研究将比较引入这些系统之前和之后的错误率。此外，这项研究将首次集中于测量系统使用可能导致的新类型错误，并调查计算机使用如何影响临床医生的决策。这项研究将提供有关这些系统的有效性和安全性的关键信息，这些系统正被引入澳大利亚的医院。与其他医疗干预措施不同的是，在患者使用之前需要进行严格的安全测试，电子处方系统没有最低安全要求。这项研究的数据迫切需要制定建议，以确保澳大利亚电子处方系统的安全。

Prescribing errors represent a significant public health issue internationally. In the US over 770,000 people are harmed or die each year in hospitals as a result of adverse drug events. In Australia 2% of hospital patients experience harm or death due to medication errors. The risk of these errors is rising each year with the increased intensity of medical care, use of complex and potent drug regimens and the increasing age and severity of hospital patients. Electronic prescribing systems are believed to significantly reduce the number of errors which occur and reduce harm to patients as a result. No studies have demonstrated that these systems result in reducing prescribing errors that cause harm to patients. Alarmingly, anecdotal evidence from overseas suggests that use of electronic prescribing systems introduces new types of errors. This is consistent with a growing body of scientific research which suggests that individuals' decision-making may be significantly influenced by information generated by a computer, resulting in new types of errors. The aim of this project is to undertake a controlled time series study to assess the safety and effectiveness of two electronic prescribing systems to reduce prescribing errors in Australian hospitals. The study will compare error rates before and after the introduction of the systems. In addition, the study will be the first to focus on measuring new types of errors that may result from system use and to investigate how computer use influences clinicians' decision-making. This study will provide critical information about the effectiveness and safety of these systems which are being introduced into Australian hospitals. Unlike other medical interventions, which require stringent safety testing before use with patients, there are no minimum safety requirements for electronic prescribing systems. The data from this study is urgent in developing recommendations to ensure the safety of electronic prescribing systems for Australia.