2005年NPR美国国家公共电台三月-Computerized Prescription Systems Introdu（在线收听） |
| This is All Things Considered from NPR news. I am Elizabeth Broad .And I am Rabbit Seagol. Hospitals across the country have instituted computer programs in an effort to reduce mistakes in prescribing medication. Many large employers say they'll contract only with hospitals that have these programs. But a study in this week's Journal of the American Medical Association finds the programs are actually causing new kinds of medical mistakes.NPR's Patricia Neighmond reports. Thousands of prescriptions are written in hospitals every day. Most of them by young doctors in training. Sociologist Robert Copell and colleagues at the University of Pennsylvania School of Medicine wanna to know more about what could be done to cut down on errors. The young doctors kept telling them that the CPOE system, the Computerized Physician Order Entry System itself was a cause of error and stress. Copell:"And we kept on saying that's not possible.All the literature says that CPOE reduces error and stress. And they said you're out of your mind." So Copell decided to examine the work habits of the residents, nurses, doctors and pharmacists at his hospital.After intense scrutiny ,he found many aspects of the new system counter-productive. For example, surgeons had to go to a different display screen and attach information to order a CT scan. In some cases, doctors had to order certain medications twice ,then all of a patient's medications could not be displayed on one screen. In some cases, it took a confusing 20 screens. These problems are a waste of time, says Copell, but others can be dangerous. The canceling of one medication and the ordering of another are separate. For instance, let's say a patient is doing better and you want to reduce his dosage from 8 times a day to 4 times a day. While you put in the order for 4 times a day and then you are interrupted before you get a chance to cancel the 8 times a day, so the patient is now getting that medication 12 times a day. In other cases, the medication was put in an area of the screen that people couldn't see and patients never got it. Often allergy information was displayed after physicians had ordered it. In all, Copell found 22 new types of medication error risks. This computer software is widely used by hospitals. Doctor Rubber Wheels is a patient safety expert. He says this study's findings don't surprise him. Highly automated computer-controlled aircraft, when they were first introduced, one of the classic things that happened there is they reduced the pilots' workload during times that were already easy, and they increased it during times that were already hard, like takeoff and landing. Wheels says it took a decade to refine the automated aircraft and it may take that long in health care too. In the mean time, he suggests smaller community hospitals hold off implementing computer systems until larger institutions with more resources do the footwork. The Veterans Administration, for example, has already made big strides in reducing medical mistakes. Patricia Neighmond, NPR news. |
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