移动护理信息系统在临床用药安全实践中的效果评价

摘要

Objective To evaluate the effectiveness of the mobile care information system (MCIS) in the management of clinical drug safety.Methods The incidence and causes of clinical medication errors before and after the comprehensive implementation of MCIS were analyzed retrospectively.Results Before the implementation of MCIS,67 cases of clinical medication errors occurred,including 19 (28.35％) cases of administration to wrong patients 8 (11.95％) drug dosage errors,21 (31.34％) cases of failure administrate drugs,9 (13.43％) cases of administration at the wrong time,and 10 (14.93) cases of wrong routes of administration.When the scan rate was 50％,27 cases of errors occurred:10 (37.03％),3 (11.11％),10 (37.03％),2(7.41％),2(7.41％),respectively,but when the scan rate was 95％,only 9 cases of errors occurred:1 (11.11％),1 (11.11％),4 (44.44 ％0),2 (22.22 ％),1 (11.11％0),respectively.Conclusion Overall implementation of MCIS can help to prevent and reduce clinical medication errors.Raising the scan rate of physicians' instructions is the key to ensuring the safety of clinical drugs.%目的 对移动护理信息系统在控制临床用药安全的效果进行评价.方法 回顾性分析全面实施移动护理信息化前后临床用药错误发生率及原因.结果 未实行移动护理信息系统时年发生临床用药错误67例,包括患者错误19例(28.35％),用药剂量错误8例(11.95％),漏给药21例(31.34％),给药时间错误9例(13.43％),给药途径错误10例(14.93);扫码率50％时发生临床用药错误27例,分别是10(37.03％),3(11.11％),10(37.03％),2(7.41％),2(7.41％);扫码率95％时临床用药错误率9例,分别是1(11.11％),1(11.11％),4(44.44％),2(22.22％),1(11.11％).结论 全面实施移动护理信息系统可预防和降低临床用药错误,使用移动终端扫码执行医嘱,提高扫码率是确保临床用药安全的关键.