Int J Med Inform - Impact of a clinical decision support system for high-alert medications on the prevention of prescription errors.

Tópicos

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Resumo

JECTIVE: To evaluate the impact of a high-alert medication clinical decision support system called HARMLESS on point-of-order entry errors in a tertiary hospital.METHOD: HARMLESS was designed to provide three kinds of interventions for five high-alert medications: clinical knowledge support, pop-ups for erroneous orders that block the order or provide a warning, and order recommendations. The impact of this program on prescription order was evaluated by comparing the orders in 6 month periods before and after implementing the program, by analyzing the intervention log data, and by checking for order pattern changes.RESULT: During the entire evaluation period, there were 357,417 orders and 5233 logs. After HARMLESS deployment, orders that omitted dilution fluids and exceeded the maximum dose dropped from 12,878 and 214 cases to 0 and 9 cases, respectively. The latter nine cases were unexpected, but after the responsible programming error was corrected, there were no further such cases. If all blocking interventions were seen as errors that were prevented, this meant that 4137 errors (3584 of which were 'dilution fluid omitted' errors) were prevented over the 6-month post-deployment period. There were some unexpected order pattern changes after deployment and several unexpected errors emerged, including intramuscular or intravenous push orders for potassium chloride (although a case review revealed that the drug was not actually administered via these methods) and an increase in pro re nata (PRN; administer when required) orders for most drugs.CONCLUSION: HARMLESS effectively implemented blocking interventions but was associated with the emergence of unexpected errors. After a program is deployed, it must be monitored and subjected to data analysis to fix bugs and prevent the emergence of new error types.

Resumo Limpo

jectiv evalu impact highalert medic clinic decis support system call harmless pointoford entri error tertiari hospitalmethod harmless design provid three kind intervent five highalert medic clinic knowledg support popup erron order block order provid warn order recommend impact program prescript order evalu compar order month period implement program analyz intervent log data check order pattern changesresult entir evalu period order log harmless deploy order omit dilut fluid exceed maximum dose drop case case respect latter nine case unexpect respons program error correct case block intervent seen error prevent meant error dilut fluid omit error prevent month postdeploy period unexpect order pattern chang deploy sever unexpect error emerg includ intramuscular intraven push order potassium chlorid although case review reveal drug actual administ via method increas pro re nata prn administ requir order drugsconclus harmless effect implement block intervent associ emerg unexpect error program deploy must monitor subject data analysi fix bug prevent emerg new error type

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