临床决策支持对计算机辅助医嘱录入系统提高肠外营养安全性的影响
现有计算机辅助医嘱录入系统（CPOE）可以提高医生工作效率及医疗服务质量。将临床决策支持（CDS）联合CPOE系统后，可大幅降低肠外营养（PN）医嘱的出错率，改善PN应用的安全性。其中，包含医生、药剂师、营养师等多学科医务人员参与到CDS的设计及软件开发中。
为此，美国范德堡大学医学中心回顾分析了使用CPOE系统患者3243例，及CDS改进后的CPOE系统患者2745例。系统改进后，PN医嘱出错率由7.8%降至0.5%（P＜0.001）。
因此，将现有CPOE系统联合全国安全标准和先进的CDS可显著降低PN医嘱的出错率，提高安全性。
JPEN J Parenter Enteral Nutr. 2017;41(2):288.
Evaluation of standards-driven clinical decision support effects on improving safety of parenteral nutrition orders in a computerized provider order entry system.
Diana W. Mulherin; David P. Mulherin; Vanessa Kumpf; Jennifer Hale; Jill N. Murphree; Mhd Wael Alrifai.
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Purpose: To evaluate the safety of parenteral nutrition (PN) ordering through a computerized provider order entry (CPOE) system before and after implementation of clinical decision support (CDS) enhancements to meet safe practice standards.
Methods: This was a prospective quality improvement analysis of a CPOE system for PN ordering at a large academic medical center. A complete revision of an existing CPOE ordering system for PN was developed with new CDS enhancements and implemented in September 2015 to comply with safe practice standards for PN ordering and to reduce PN ordering errors. A multidisciplinary task force made up of pediatric and adult physicians, pharmacists, and dietitians collaborated with pharmacy informatics members on the CDS design and software development process. Using an online survey, interventions required by pharmacists to correct PN order errors were recorded daily from June 4 to August 2, 2015 (period 1: before CDS updates) and June 1 to July 31, 2016 (period 2: after CDS updates). An error was defined as any order detail that required a modification to the original provider order during the pharmacist verification process. The frequency of each error type was compared between the 2 periods using χ² tests. A P value of <.05 was considered to be statistically significant.
Results: A total of 3243 PN orders were submitted during period 1 (2157 pediatric, 1086 adult) and 2745 PN orders during period 2 (1815 pediatric, 930 adult). Errors decreased from 7.8% in period 1 to 0.5% in period 2 (P < .0001). During period 1, the most common error type was volume/dilutional error (n = 87), followed by errors involving substitution of a trace element product on shortage (n = 51) and peripheral PN formulas exceeding osmolarity limits (n = 49). During period 2, the most common error type was exceeding calcium-phosphate product limits (n = 5).
Conclusions: Incorporating national safety standards and advanced clinical decision support to an existing CPOE system for PN ordering significantly reduced PN order errors. Additional studies are required to evaluate the benefits of CDS in preventing actual patient harm.
DOI: 10.1177/0148607116686023