对儿科中与技术相关的处方错误的表现和机制的纵向研究
Magdalena Z Raban1, Erin Fitzpatrick1, Alison Merchant1
1Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales 2109, Australia.
Journal of the American Medical Informatics Association : JAMIA
|September 11, 2024
概括
在计算机化供应商订单输入 (CPOE) 系统中,与技术相关的错误 (TREs) 在实施后的四年内持续存在. 新的工作流仍然是主要的机制,只有有限的临床决策支持可用于减轻这些持久的TRE.
科学领域:
- 医疗信息学 医疗信息学
- 患者安全 患者安全
- 电子健康记录电子健康记录
背景情况:
- 计算机化提供者订单输入 (CPOE) 系统是现代医疗保健不可或缺的一部分,旨在提高效率并减少错误.
- 然而,CPOE的实施可能会引入新类型的技术相关错误 (TREs).
- 了解TREs的长期轨迹和缓解策略的有效性对于系统优化至关重要.
研究的目的:
- 在CPOE实施后的三个时间点分析技术相关错误 (TREs) 和它们的潜在机制的变化.
- 评估可用于缓解TREs的临床决策支持 (CDS),CPOE后五年.
主要方法:
- 一个回顾性分析的1315处方错误从35,322订单在三个时间点 (立即,1年和4年后CPOE) 在一个儿科医院.
- 使用技术相关错误机制分类来识别和编码TRE.
- 在实施五年后,评估了CDS可用于减轻已识别的TRE的可用性.
主要成果:
- TREs占处方错误的32.5%,每100个订单的调整率为1.49TREs.
- 在CPOE1年后,TRE率下降了40%,但在CPOE4年后与基线没有显著差异.
- "CPOE所需的新工作流"是所有时间点中最常见的TRE机制.
- 临床决策支持仅可用于缓解32.7%的TRE.
结论:
- 与CPOE系统相关的技术相关错误在实施后的四年内在儿科环境中持续存在.
- 与实施后的立即时期相比,TRE的比例没有显著下降.
- 需要提高注意力和改进CDS才能充分实现CPOE系统的安全益处.
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