临床决策支持作为手术室用药错误的预防工具:回顾性横断面研究。

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Anesthesia and analgesia Pub Date : 2024-10-01 Epub Date: 2024-09-04 DOI:10.1213/ANE.0000000000007058
Lynda D Amici, Maria van Pelt, Laura Mylott, Marin Langlieb, Karen C Nanji
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引用次数: 0

摘要

背景:手术室用药错误极有可能对患者造成伤害。虽然电子临床决策支持(CDS)软件已在许多非手术室患者护理领域有效预防了用药错误,但在手术室尚未得到广泛应用。本研究的目的是确定可通过 CDS 算法预防的自我报告的术中用药错误的百分比:在这项回顾性横断面研究中,我们获得了一家拥有 1046 张病床的三级医疗学术医疗中心的麻醉临床医生在 2020 年 8 月至 2022 年 8 月期间记录的涉及用药错误的安全报告。审查人员根据用药过程的阶段、错误类型、是否存在不良用药事件以及相关严重性和 CDS 的可预防性对每个用药错误进行了分类。信息缺失通过回顾性病历审查得到证实,审查人员之间的分歧通过协商一致的方式解决。主要结果是可通过 CDS 预防的错误百分比。次要结果是按用药错误类型和严重程度分层的 CDS 可预防性:我们收到了 127 份安全报告,涉及 80 个用药错误,其中 76/80 个错误(95%)被归类为可通过 CDS 预防。与其他错误类型相比,某些错误类型更有可能通过 CDS 预防(P < .001)。最有可能通过 CDS 预防的错误类型是错误用药(36 例,100% 可预防)、错误剂量(30 例,100% 可预防)和文档错误(3 例,100% 可预防)。最不可能通过 CDS 预防的错误类型是用药不慎(3 例,无一例被评为可预防):结论:在自我报告的手术室用药错误中,有 95% 被归类为 CDS 可预防的错误。未来的研究应包括随机对照试验,以评估使用和不使用 CDS 的用药错误率和类型。
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Clinical Decision Support as a Prevention Tool for Medication Errors in the Operating Room: A Retrospective Cross-Sectional Study.

Background: Medication errors in the operating room have high potential for patient harm. While electronic clinical decision support (CDS) software has been effective in preventing medication errors in many nonoperating room patient care areas, it is not yet widely used in operating rooms. The purpose of this study was to determine the percentage of self-reported intraoperative medication errors that could be prevented by CDS algorithms.

Methods: In this retrospective cross-sectional study, we obtained safety reports involving medication errors documented by anesthesia clinicians between August 2020 and August 2022 at a 1046-bed tertiary care academic medical center. Reviewers classified each medication error by its stage in the medication use process, error type, presence of an adverse medication event, and its associated severity and preventability by CDS. Informational gaps were corroborated by retrospective chart review and disagreements between reviewers were resolved by consensus. The primary outcome was the percentage of errors that were preventable by CDS. Secondary outcomes were preventability by CDS stratified by medication error type and severity.

Results: We received 127 safety reports involving 80 medication errors, and 76/80 (95%) of the errors were classified as preventable by CDS. Certain error types were more likely to be preventable by CDS than others ( P < .001). The most likely error types to be preventable by CDS were wrong medication (N = 36, 100% rated as preventable), wrong dose (N = 30, 100% rated as preventable), and documentation errors (N = 3, 100% rated as preventable). The least likely error type to be preventable by CDS was inadvertent bolus (N = 3, none rated as preventable).

Conclusions: Ninety-five percent of self-reported medication errors in the operating room were classified as preventable by CDS. Future research should include a randomized controlled trial to assess medication error rates and types with and without the use of CDS.

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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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