[Computerized physician order entry, a tool for added safety in the hospital].
DRUG-RELATED IATROGENIC NOSOCOMIAL ILLNESS: Remains a matter of concern in the public health area. Responsibility of hospitals is challenged by the ever increasing number of patients' claims. Dysfunction in the drug-prescribing and delivery system account, to a large extent, for medication errors, some of them resulting in adverse drug events. Most generally, medication ordering by the physician is handwritten, without nominative recapitulating prescriptions, and followed by nurse transcriptions and a global medication order is transmitted to the pharmacy. This system does not integrate the pharmaceutical analysis of the prescription, before distribution of the drugs. THE COMPUTERIZED DRUG ORDER ENTRY PROCESS: The prescription is entered directly and is displayed on the computer screen, together with the previous prescriptions for the same patient. Transcription is hence eliminated. Depending on the sophistication of the software, the prescription undergoes a series of tests; warnings and reminders can be displayed online before the physician validates the prescription. Moreover, various guidelines in some aspects of drug therapy may be presented online before the prescription is completed. POSSIBILITIES: The pharmacist's access to the complete prescriptions permits analysis of the quality and safety of the prescriptions and the adequation with eventual current applicable recommendations. Prospective drug utilization review, with immediate feedback to the prescribing physician in case of concern, may be undertaken, further improving the quality of drug therapy. Moreover, a work sheet is printed out for the nurses, further enhancing the safety of drug administration and validation. The computerized drug network also permits the development of other functions. A TOOL FOR SAFETY: Currently available reports in the literature suggest that computerized drug prescription reduces the incidence of prescribing errors, improves the appropriateness of drug choices, optimises therapeutic follow-up, and reduces the incidence adverse drug events and leads to substantial reduction in drug expenditures.
Westphal
Jean-Frédéric
JF
Unité de médecine gériatrique Comité du médicament Etablissement public de santé Alsace Nord, BP 83, 67170 Brumath.
Farinotti
Robert
R
D003201:Computers; D003257:Consumer Product Safety; D011307:Drug Prescriptions; D001330:Electronic Data Processing; D006761:Hospitals; D006801:Humans