Background

For patients requiring admission to the Intensive Care Unit (ICU), transfers of care (TOC) during admission to and discharge from the ICU are particularly high-risk periods for medication errors. In the Australian setting, commonly general wards and the ICU do not share an integrated Electronic Medical ecord (EMR) and specifically an Electronic Medication Management System (EMMS) as part of the EMR.

Purpose

To evaluate the effect of a hospital wide integrated EMMS on medication error rates during ICU admission and at TOC.

Method

A 6-month historical control study was performed before and after implementation of the EMMS in the ICU of a tertiary hospital. Prescribing errors detected by pharmacists in the study period were divided into phase 1, (pre-EMMS, 6months), phase 2 (3 months post implementation after shakedown stage) and phase 3 (next 3 months of post implementation). They were categorized as prescribing error types under system or clinical intervention. Chi square statistics and interrupted time series analysis were used to determine if there was significant change in the proportion of patients who had an error at TOC during each phase. Logistics regression was used to determine the relationship between the dependent (error type) and the independent variable (study phase) for errors that occurred during TOC.

Results

Errors occurred during TOC in 42 %, 64 % and 19 % of patients in phase 1, 2 and 3 respectively. There was a significant decline in the proportion of patients with an error between phase 1 and 3 (p < 0.01). During a patient’s ICU admission, at least one medication error occurred in 28.3 %, 62.6 % and 25.1 % in phase 1, 2 and 3 respectively. Besides procedural errors, the likelihood of an error occurring was greatest in phase 1, compared to phase 2 and 3 across system-related error categories.

Conclusion

Medication errors during TOC reduced following implementation of the integrated ICU EMMS. EMMS safety features facilitated reduced system related prescribing errors as well as the severity of errors made.

中文翻译：

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实施电子药物管理系统后，澳大利亚重症监护病房在护理过渡期间改善了药物安全性

背景

对于需要入住重症监护病房（ICU）的患者，入院和出院期间的护理转移（TOC）是药物错误的特别高风险期。在澳大利亚，普通病房和ICU不共享集成的电子医学证书（EMR），特别是电子药物管理系统（EMMS）作为EMR的一部分。

目的

为了评估在ICU入院期间和TOC期间医院范围内集成的EMMS对药物错误率的影响。

方法

在一家三级医院的ICU中实施EMMS前后，进行了为期6个月的历史对照研究。在研究期间，药剂师发现的处方错误分为第一阶段（EMMS实施前为6个月），第二阶段（实施阶段后3个月的调整后）和第三阶段（实施后接下来的3个月）。它们被归类为在系统或临床干预下规定的错误类型。卡方统计和间断时间序列分析用于确定在每个阶段中TOC有误的患者比例是否有显着变化。后勤回归用于确定在TOC期间发生的错误的因变量（错误类型）和自变量（研究阶段）之间的关系。

结果

在阶段1、2和3的TOC期间，分别有42％，64％和19％的患者发生了错误。在第1阶段和第3阶段之间有错误的患者比例显着下降（p <0.01）。在患者的ICU入院期间，阶段1、2和3分别发生至少28.3％，62.6％和25.1％的用药错误。除了程序错误外，与系统相关的错误类别的第2阶段和第3阶段相比，第1阶段发生错误的可能性最大。

结论

实施集成ICU EMMS后，TOC期间的用药错误减少了。EMMS安全功能有助于减少与系统相关的处方错误以及错误的严重性。