電子化藥物交互作用系統於病人安全之應用

Improving Patient Safety through Computerized Drug-Drug Interaction Alerts System for Physicians

葉明莉(Min-Li Yeh)

指導教授 ： 徐建業

共同指導教授 ： 李友專(Yu-Chuan Li)

臺北醫學大學/醫學院/醫學科學研究所/博士(2013年)

https://doi.org/10.6831/TMU.2013.00028

摘要

無資料

關鍵字

藥物交互作用 ； 病人安全 ； 警示系統 ； 忽略

並列摘要

Background
Adverse drug reactions (ADR) increase morbidity and mortality; potential drug-drug interactions (DDI) increase the probability of ADR. Studies have demonstrated that
computerized drug-interaction alert systems might reduce medication errors and potential adverse events. However, the relatively high override rates obscure the benefits of alert
systems, which result in barriers for availability. It is important to understand the frequency at which physicians override computerized drug interaction alert systems and the reasons for overriding reminders.
Methods and Materials
All the DDI records of outpatient prescriptions from a tertiary university hospital from 2005 and 2006 detections by the computerized drug interaction alert system (DIAS) are
included in the study. The DIAS is a JAVA language software that was integrated into the computerized physician order entry system. The alert window is displayed when DDIs occur
during order entries, and physicians choose the appropriate action according to the DDI alerts. There are 7 response choices are obligated in representing overriding and acceptance: (1)necessary order and override; (2) expected DDI and override; (3) expected DDI with modified dosage and override; (4) no DDI and override; (5) too busy to respond and override; (6)unaware of the DDI and accept; and (7) unexpected DDI and accept. The responses were collected for analysis.
Results
A total of 11,084 DDI alerts of 1,243,464 outpatient prescriptions were present, 0.89% of all computerized prescriptions. The overall rate for accepting was 8.5%, but most of the alerts were overridden (91.5%). Physicians of family medicine and gynecology-obstetrics were more willing to accept the alerts with acceptance rates of 20.8% and 20.0% respectively (p <0.001). Information regarding the recognition of DDIs indicated that 82.0% of the DDIs were
aware by physicians, 15.9% of DDIs were unaware by physicians, and 2.1% of alerts were ignored. The percentage of total alerts declined from 1.12% to 0.79% during twenty four months’ study period, and total overridden alerts also declined (from 1.04% to 0.73%).
Conclusions
We explored the physicians’ behavior by analyzing responses to the DDI alerts. Although the override rate is still high, the reasons why physicians may override DDI alerts
were well analyzed and most DDI were recognized by physicians. Nonetheless, the trend of total overrides is in decline, which indicates a learning curve effect from exposure to DIAS. By analyzing the computerized responses provided by physicians, efforts should be made to
improve the efficiency of the DIAS, and pharmacists, as well as patient safety staffs, can catch physicians’ appropriate reasons for overriding DDI alerts, improving patient safety.

並列關鍵字

drug-drug interaction ； patient safety ； alert system ； override

參考文獻

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