Development and Assessment of a Computerized Prescription Alert System

• Main Authors: Shu-Hua Tai, 戴淑華
• Other Authors: Hui-Jen Chang
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/47235907245735949537

碩士 === 國立成功大學 === 臨床藥學研究所 === 92 === 　　Medication errors may result in adverse drug events (ADEs), increase the workload of health care professionals, and deplete medical resources. Twenty-eight percent to 56% of ADEs are judged to be preventable and most commonly to occur during medication prescribing. The common factors associated with prescribing errors are inadequate provision of drug knowledge and patient information. A computerized physician order entry system（CPOE）is a great tool to provide drug and patient information at the time orders are prescribed. Many studies have demonstrated that CPOE with medication alerts may reduce medication errors, provide standardization of care and improve efficiency of care delivery and costs saving. 　　This study developed a real time medication alert system in original computerized order entry system at the outpatient department. The impacts of medication alert system on physician’s prescribing practices were evaluated. A prospective before-after comparison was carried out to assess the effects of the alert system in reducing the number of prescribing and transcribing errors. After two months of intervening medication alert system in practice, we conducted questionnaire survey to evaluate the user’s satisfaction. 　　During the study, 0.27% of prescriptions triggered the alert. Among the alerted prescriptions, 58.9% were revised and administering frequency was the most frequent revisions. On the other hand, major reason to override the drug alert was “Justification of patient’s condition”. In comparison with pre-intervention period, the prescribing and transcribing error rate dropped from 0.67 per 1000 medications to 0.43 per 1000 medications（P<0.001）after intervention. The results of questionnaire survey revealed that over 60% of physicians, pharmacists and clerks agreed with the criteria and quality of the medication alert system. More than 75% of users considered that it shluld be compulsary to remark the reason for overriding drug alerts, and over 90% had confidence on the alert system to reduce medication errors. Fifty-seven % of the clerks commented that medication alerts slow down the computer processing of orders. However, some users （27.3~35%） felt annoyed while alerts appeared. 　　In conclusion, computerized order entry with medication alert is an effective tool for improving physician prescribing practices and substantially decreases the rate of prescribing and transcribing errors. Overall, users are satisfied with the medication alert system.