TY - JOUR AU - Kazemi, Alireza AU - Fors, Uno GH AU - Tofighi, Shahram AU - Tessma, Mesfin AU - Ellenius, Johan PY - 2010 DA - 2010/2/26 TI -医生订单输入或护士订单输入?旨在减少给药错误的计算机化医嘱输入系统的两种实施策略的比较[J] Med Internet Res SP - e5 VL - 12 IS - 1 KW -医疗医嘱输入系统KW -决策支持系统，临床KW -用药错误KW -伊朗KW -婴儿，新生儿KW -患者安全AB -尽管计算机化医嘱输入(CPOE)在减少新生儿住院患者的非截获性用药错误方面效果显著，但只有少数医院成功实施了这种系统。医生的抵制和用户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输入过程，以减少医生的数据输入工作量和阻力。然而，这种协同订单输入方法在减少用药错误方面的效果应该与严格的医生订单输入方法进行比较。目的:探讨伊朗某教学医院新生儿病房采用由护士医嘱录入(NOE)、医师验证和会签组成的协作医嘱录入方法是否与严格医嘱录入(POE)方法在减少非阻断剂量和用药频率错误方面同样有效。方法:设计为期4个月的前瞻性研究，分为两期。在第一个阶段使用POE，在第二个阶段使用NOE。在这两种方法中，当处方药物的剂量或频率不正确时，就会出现警告，向医生建议适当的剂量。 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. SN - 1438-8871 UR - //www.mybigtv.com/2010/1/e5/ UR - https://doi.org/10.2196/jmir.1284 UR - http://www.ncbi.nlm.nih.gov/pubmed/20185400 DO - 10.2196/jmir.1284 ID - info:doi/10.2196/jmir.1284 ER -