PDF(Pubmed)
Abstract：
UNASSIGNED: In 2021, a computerized physician order entry (CPOE) system with an integrated clinical decision support system (CDSS) was implemented at a tertiary care center for the treatment of mental health conditions in Lübeck, Germany. To date, no study has been reported on the types and prevalence of drug-related problems (DRPs) before and after CPOE implementation in a psychiatric inpatient setting. The aim of this retrospective before-and-after cohort study was to investigate whether the implementation of a CPOE system with CDSS accompanied by the introduction of regular medication plausibility checks by a pharmacist led to a decrease of DRPs during hospitalization and unsolved DRPs at discharge in psychiatric inpatients.
UNASSIGNED: Medication charts and electronic patient records of 54 patients before (cohort I) and 65 patients after (cohort II) CPOE implementation were reviewed retrospectively by a clinical pharmacist. All identified DRPs were collected and classified based on \'The PCNE Classification V9.1\', the German database DokuPIK, and the \'NCC MERP Taxonomy of Medication Errors\'.
UNASSIGNED: 325 DRPs were identified in 54 patients with a mean of 6 DRPs per patient and 151.9 DRPs per 1000 patient days in cohort I. In cohort II, 214 DRPs were identified in 65 patients with a mean of 3.3 DRPs per patient and 81.3 DRPs per 1000 patient days. The odds of having a DRP were significantly lower in cohort II (OR=0.545, 95% CI 0.412-0.721, p<0.001). The most frequent DRP in cohort I was an erroneous prescription (n=113, 34.8%), which was significantly reduced in cohort II (n=12, 5.6%, p<0.001). During the retrospective in-depth review, more DRPs were identified than during the daily plausibility analyses. At hospital discharge, patients had significantly less unsolved DRPs in cohort II than in cohort I.
UNASSIGNED: The implementation of a CPOE system with an integrated CDSS reduced the overall prevalence of DRPs, especially of prescription errors, and led to a smaller rate of unsolved DRPs in psychiatric inpatients at hospital discharge. Not all DRPs were found by plausibility analyses based on the medication charts. A more interactive and interdisciplinary patient-oriented approach might result in the resolution of more DRPs.
UNASSIGNED: Medication charts and electronic patient records of 54 patients before (cohort I) and 65 patients after (cohort II) CPOE implementation were reviewed retrospectively by a clinical pharmacist. All identified DRPs were collected and classified based on \'The PCNE Classification V9.1\', the German database DokuPIK, and the \'NCC MERP Taxonomy of Medication Errors\'.
UNASSIGNED: 325 DRPs were identified in 54 patients with a mean of 6 DRPs per patient and 151.9 DRPs per 1000 patient days in cohort I. In cohort II, 214 DRPs were identified in 65 patients with a mean of 3.3 DRPs per patient and 81.3 DRPs per 1000 patient days. The odds of having a DRP were significantly lower in cohort II (OR=0.545, 95% CI 0.412-0.721, p<0.001). The most frequent DRP in cohort I was an erroneous prescription (n=113, 34.8%), which was significantly reduced in cohort II (n=12, 5.6%, p<0.001). During the retrospective in-depth review, more DRPs were identified than during the daily plausibility analyses. At hospital discharge, patients had significantly less unsolved DRPs in cohort II than in cohort I.
UNASSIGNED: The implementation of a CPOE system with an integrated CDSS reduced the overall prevalence of DRPs, especially of prescription errors, and led to a smaller rate of unsolved DRPs in psychiatric inpatients at hospital discharge. Not all DRPs were found by plausibility analyses based on the medication charts. A more interactive and interdisciplinary patient-oriented approach might result in the resolution of more DRPs.
摘要：
■2021年，在吕贝克的三级护理中心实施了带有集成临床决策支持系统（CDSS）的计算机化医嘱录入（CPOE）系统，用于治疗精神健康状况，德国。迄今为止,没有关于精神病住院患者实施CPOE前后药物相关问题(DRPs)的类型和患病率的研究报告.这项回顾性前后队列研究的目的是调查使用CDSS的CPOE系统的实施是否伴随着药剂师的定期药物合理性检查导致住院期间DRPs的减少和出院时未解决的DRPs的减少。
■临床药师回顾性审查了CPOE实施前（队列I）54例患者和实施后（队列II）65例患者的用药图表和电子病历。所有确定的DRP都是根据“PCNE分类V9.1”收集和分类的，德国数据库DokuPIK,和“NCCMERP药物错误分类法”。
■在54例患者中确定了325个DRPs，平均每个患者6个DRPs，在队列I中每1000个患者天151.9个DRPs，在65名患者中鉴定出214名DRP，平均每名患者3.3名DRP，每1000名患者天平均81.3名DRP。在队列II中，发生DRP的几率显着降低（OR=0.545，95％CI0.412-0.721，p<0.001）。队列I中最常见的DRP是错误的处方（n=113，34.8％），在队列II中显著降低(n=12，5.6%，p<0.001)。在回顾性深入审查期间，与每日合理性分析相比,发现的DRP更多.出院时，队列II患者的未解决DRPs明显少于队列I。
■实施具有集成CDSS的CPOE系统降低了DRPs的总体患病率，尤其是处方错误，并导致精神病住院患者出院时未解决的DRPs发生率较低。并非所有DRP都是通过基于药物图表的合理性分析找到的。一种更具互动性和跨学科的面向患者的方法可能会导致更多DRP的解决。
■临床药师回顾性审查了CPOE实施前（队列I）54例患者和实施后（队列II）65例患者的用药图表和电子病历。所有确定的DRP都是根据“PCNE分类V9.1”收集和分类的，德国数据库DokuPIK,和“NCCMERP药物错误分类法”。
■在54例患者中确定了325个DRPs，平均每个患者6个DRPs，在队列I中每1000个患者天151.9个DRPs，在65名患者中鉴定出214名DRP，平均每名患者3.3名DRP，每1000名患者天平均81.3名DRP。在队列II中，发生DRP的几率显着降低（OR=0.545，95％CI0.412-0.721，p<0.001）。队列I中最常见的DRP是错误的处方（n=113，34.8％），在队列II中显著降低(n=12，5.6%，p<0.001)。在回顾性深入审查期间，与每日合理性分析相比,发现的DRP更多.出院时，队列II患者的未解决DRPs明显少于队列I。
■实施具有集成CDSS的CPOE系统降低了DRPs的总体患病率，尤其是处方错误，并导致精神病住院患者出院时未解决的DRPs发生率较低。并非所有DRP都是通过基于药物图表的合理性分析找到的。一种更具互动性和跨学科的面向患者的方法可能会导致更多DRP的解决。
