J Am Med Inform Assoc - Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE).

Tópicos

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Resumo

JECTIVE: To determine whether indication-based computer order entry alerts intercept wrong-patient medication errors.MATERIALS AND METHODS: At an academic medical center serving inpatients and outpatients, we developed and implemented a clinical decision support system to prompt clinicians for indications when certain medications were ordered without an appropriately coded indication on the problem list. Among all the alerts that fired, we identified every instance when a medication order was started but not completed and, within a fixed time interval, the same prescriber placed an order for the same medication for a different patient. We closely reviewed each of these instances to determine whether they were likely to have been intercepted errors.RESULTS: Over a 6-year period 127 320 alerts fired, which resulted in 32 intercepted wrong-patient errors, an interception rate of 0.25 per 1000 alerts. Neither the location of the prescriber nor the type of prescriber affected the interception rate. No intercepted errors were for patients with the same last name, but in 59% of the intercepted errors the prescriber had both patients' charts open when the first order was initiated.DISCUSSION: Indication alerts linked to the problem list have previously been shown to improve problem list completion. This analysis demonstrates another benefit, the interception of wrong-patient medication errors.CONCLUSIONS: Indication-based alerts yielded a wrong-patient medication error interception rate of 0.25 per 1000 alerts. These alerts could be implemented independently or in combination with other strategies to decrease wrong-patient medication errors.

Resumo Limpo

jectiv determin whether indicationbas comput order entri alert intercept wrongpati medic errorsmateri method academ medic center serv inpati outpati develop implement clinic decis support system prompt clinician indic certain medic order without appropri code indic problem list among alert fire identifi everi instanc medic order start complet within fix time interv prescrib place order medic differ patient close review instanc determin whether like intercept errorsresult year period alert fire result intercept wrongpati error intercept rate per alert neither locat prescrib type prescrib affect intercept rate intercept error patient last name intercept error prescrib patient chart open first order initiateddiscuss indic alert link problem list previous shown improv problem list complet analysi demonstr anoth benefit intercept wrongpati medic errorsconclus indicationbas alert yield wrongpati medic error intercept rate per alert alert implement independ combin strategi decreas wrongpati medic error

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