兒科醫令警示系統於預防藥物疏失之成效

Impact of Computerized Physician Order Entry with Alert System on Preventing Pediatric Medication Errors

侯靜怡(Jing-Yi Hou)

指導教授 ： 陳香吟

臺北醫學大學/藥學院/藥學研究所/碩士(2011年)

摘要

兒童並不是成熟的個體，其獨特的藥品動態學及藥物藥效學，與成人相比明顯的不同。因此兒童使用藥物有其獨特性，也容易因藥物疏失而受到傷害。曾有研究指出，潛在性藥物不良反應在兒童的發生率比成人高於三倍。兒童也因為一些危險因子，例如短時間內體重改變快速、以體重計算劑量及缺乏溝通等因素，使得兒童更容易面臨藥物疏失的發生。

　　本研究為橫斷性研究，研究時間為2010年及2011年一月至三月，對象為北市某醫學中心門診所有18歲以下看診兒童。研究目的是建置一個以兒科為主的電子醫令警示系統，並評估其成效。當醫師開立藥品劑量時，系統評估劑量是否於合理範圍，若是高於或低於系統所設置的建議劑量，會予以警示並同時提供建議劑量。

　　結果顯示系統建置前，兒科總處方筆數共72431筆，以系統回溯篩選劑量錯誤筆數偵測筆數共4051筆，醫師處方劑量錯誤發生率為5.6%；系統建置後兒科總處方筆數共80532筆，劑量錯誤筆數共3131筆，醫師處方劑量錯誤發生率為3.9% (p<0.001)。系統建置前，實際偵測到劑量錯誤筆數為16筆，劑量錯誤偵測率僅0.022% ；系統建置後，劑量錯誤實際偵測率增加為3.9% (p<0.001)。另因系統警示而醫師修改劑量使劑量錯誤減少為2698筆，於是至病人端之劑量錯誤發生率由系統建置前5.6%減少為3.4% (p<0.001)。且劑量錯誤減少率也由建置前0.39%至建置後13.4% (p<0.001)。在嚴重度方面，於系統上線前，藥師發藥時共發現2筆潛在致命性錯誤；系統建置後，因經由系統警示14筆致命性錯誤及11筆嚴重錯誤，醫師均已接受系統警示修正，故藥師審查處方時，已無致命性及嚴重錯誤處方。

　　兒科醫令警示系統設置於醫師開立處方時，能立即提示醫師修改劑量錯誤。結果顯示系統能顯著偵測劑量錯誤，也可有效減低藥物疏失的發生及嚴重度，增加兒科用藥安全。

關鍵字

兒科 ； 醫令 ； 劑量 ； 藥物疏失 ； 警示系統

並列摘要

Children are more susceptible to medication errors and related injuries due to the significant differences in both pharmacokinetics and pharmacodynamic compared with adults. Potentially harmful medication errors that occurred 3 times more in children than in adult are major concerns in many medical institutions. The weight-base dosing, significant weight changes in short period of time and deficiency of communication with pediatric patients are main factors making children vulnerable to medication errors.

The purpose of this study is to build a standard pediatric dosing recommendations into CPOE (Computerized Physician Order Entry) in order to assist the physician while ordering the pediatric doses. This is a cross-sectional study analysis of outpatient from January to March 2010 and 2011. Patients were eligible for inclusion in the study if they were < 18 years of age. The primary outcome is the incidence of dose prescribing errors and severity.

Before the implementation of CPOE with alert system, dose prescribing errors which were retrospectively detected by alert system, occurred in 4051of 72431(5.6%)prescriptions with the pharmacist-detected 16 (0.022%) errors in all prescriptions. After the implementation of CPOE with alert system, dosing prescribing errors occurred in 3131 of 80532(3.9%, p <0.001), and the alert system detected dose prescribing errors rate of 3.9% which was significantly increased comparing to pharmacist-detected error rate (0.022%;p<0.001) before the implementation of CPOE.
On top of that, adjustment of doses by physician based on the alert system reduced dose-related prescribing error to 2698 errors. The implementation of the system resulted in a significant decline in dose-related medication errors from 5.6% to 3.4% (p<0.001). A significant increasing in rate of decreased dose-related errors was also observed (p<0.001).About the severity of the errors, before the implementation, there were 2 potential lethal errors occurred when the pharmacists were dispensing. With the help of CPOE with alert system, there were 14 potential lethal errors occurred but corrected with the recommendation immediately. Therefore, there were no potential lethal errors detected when the pharmacists were dispensing.

The CPOE with alert system showed the warnings once the errors were detected so that the doctors might change the prescription immediately, which may prevent the dose prescribing errors effectively。The CPOE with alert system can improve patient safety and significantly decreased risk of medication dosing errors.

並列關鍵字

Pediatric ； Computerized Physician Order Entry ； dosage ； Medication Errors ； Alert System

參考文獻

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