@Article{信息:doi 10.2196 / / jmir。1284，作者=“Kazemi, Alireza和Fors, Uno GH和Tofighi, Shahram和Tessma, Mesfin和Ellenius, Johan”，标题=“医生命令入口还是护士命令入口?”减少配药差错的计算机配单系统两种实施策略的比较”，期刊=“J Medical Internet Res”，年=“2010”，月=“2”，日=“26”，卷=“12”，数=“1”，页=“e5”，关键词=“医疗配单系统;临床决策支持系统;药物erors;伊朗;婴儿,新生;背景:尽管计算机医嘱输入(CPOE)在减少新生儿住院患者非拦截性用药错误方面有显著作用，但只有少数医院成功地实施了该系统。医生的抗拒和使用者的沮丧似乎是两个最重要的障碍。一种解决方案可能是让护士参与订单录入过程，以减少医生的数据录入工作量和阻力。 However, the effect of this collaborative order entry method in reducing medication errors should be compared with a strictly physician order entry method. Objective: To investigate whether a collaborative order entry method consisting of nurse order entry (NOE) followed by physician verification and countersignature is as effective as a strictly physician order entry (POE) method in reducing nonintercepted dose and frequency medication errors in the neonatal ward of an Iranian teaching hospital. Methods: A four-month prospective study was designed with two equal periods. During the first period POE was used and during the second period NOE was used. In both methods, a warning appeared when the dose or frequency of the prescribed medication was incorrect that suggested the appropriate dosage to the physicians. Physicians' responses to the warnings were recorded in a database and subsequently analyzed. Relevant paper-based and electronic medical records were reviewed to increase credibility. Results: Medication prescribing for 158 neonates was studied. The rate of nonintercepted medication errors during the NOE period was 40{\%} lower than during the POE period (rate ratio 0.60; 95{\%} confidence interval [CI] .50, .71;P < .001). During the POE period, 80{\%} of nonintercepted errors occurred at the prescription stage, while during the NOE period, 60{\%} of nonintercepted errors occurred in that stage. Prescription errors decreased from 10.3{\%} during the POE period to 4.6{\%} during the NOE period (P < .001), and the number of warnings with which physicians complied increased from 44{\%} to 68{\%} respectively (P < .001). Meanwhile, transcription errors showed a nonsignificant increase from the POE period to the NOE period. The median error per patient was reduced from 2 during the POE period to 0 during the NOE period (P = .005). Underdose and curtailed and prolonged interval errors were significantly reduced from the POE period to the NOE period. The rate of nonintercepted overdose errors remained constant between the two periods. However, the severity of overdose errors was lower in the NOE period (P = .02). Conclusions: NOE can increase physicians' compliance with warnings and recommended dose and frequency and reduce nonintercepted medication dosing errors in the neonatal ward as effectively as POE or even better. In settings where there is major physician resistance to implementation of CPOE, and nurses are willing to participate in the order entry and are capable of doing so, NOE may be considered a beneficial alternative order entry method. ", issn="1438-8871", doi="10.2196/jmir.1284", url="//www.mybigtv.com/2010/1/e5/", url="https://doi.org/10.2196/jmir.1284", url="http://www.ncbi.nlm.nih.gov/pubmed/20185400" }