Vermeidung von Medikationsfehlern durch elektronische Verordnungsunterstützung

Zusammenfassung

Trotz ärztlicher Kompetenz und Sorgfalt treten inadäquate Verordnungen auf. Erfahrungen in anderen Ländern zeigen, dass diese Medikationsfehler großteils vermeidbar sind, wenn ihre Ursachen nicht in persönlichem Verschulden, sondern in der Organisation des Medikationsprozesses gesucht werden. Die Einführung der elektronischen Gesundheitskarte in Deutschland 2006 soll elektronische Verordnungsunterstützung ermöglichen, um Medikationsfehler zu verhindern. Dass elektronische Verordnungsunterstützung bis zu 80 % der Medikationsfehler verhindern kann, zeigen internationale Studien. Was darunter zu verstehen ist, welche Funktionalität wichtig und welche Voraussetzungen gegeben sein müssen, wird dargestellt.

Abstract

Drug therapy has led to major advances in medicine. The beneficial effects of drug therapy are coupled with the inevitable risk of adverse drug reactions. Many adverse drug reactions are preventable. They result from the failure to disseminate knowledge about drugs to prescribers, insufficient knowledge of individual patient characteristics, e. g. on renal function and from noncompliance of the patient. The electronic health card that will be introduced in Germany starting 2006 is designed to support electronic decision support to prevent medication errors. Studies have demonstrated that CPOES can reduce medication errors by 80 %. Preconditions for and functions of electronic decision support in drug therapy are outlined.

Schlüsselwörter

Medikationsfehler - unerwünschte Arzneimittelwirkungen - elektronische Verordnungsunterstützung - Gesundheitskarte

Key words

medication errors - iatrogenic disease - drug therapy - computer-assisted - decision-support systems

Publikationsverlauf

Publikationsdatum:
11. August 2005 (online)

• Literatur

• 1 Dean B, Schachter M, Vincent C. et al Prescribing errors in hospital inpatients: their incidence and clinical significance.. Qual Saf Health Care 2002; 11: 340-344
• 2 Morris CJ, Savelyich BS, Avery AJ. et al Patient safety features of clinical computer systems: questionnaire survey of GP views.. Qual Saf Health Care 2005; 14: 164-168
• 3 Leal HM, Abellan AJ, Casa Pina MT. et al [Patients on multiple medication: do they know the right doses? Do they take their medications correctly?]. Aten Primaria 2004; 33: 451-456
• 4 Barat I, Andreasen F, Damsgaard EM. Drug therapy in the elderly: what doctors believe and patients actually do.. Br J Clin Pharmacol 2001; 51: 615-622
• 5 Glassman PA, Simon B, Belperio P. et al Improving recognition of drug interactions: benefits and barriers to using automated drug alerts.. Med Care 2002; 40: 1161-1171
• 6 Pirmohamed M, James S, Meakin S. et al Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients.. BMJ 2004; 329: 15-19
• 7 Gandhi TK, Weingart SN, Borus J. et al Adverse drug events in ambulatory care.. N Engl J Med 2003; 348: 1556-1564
• 8 Hart D. Arzneimittelinformation zwischen Sicherheits- und Arzthaftungsrecht.. MedR 2003; 11: 603-609
• 9 Reng CM, Friedrich HJ, Timmer A. et al [German physicians' access to professional knowledge. Acceptance, quality and availability of professional information with special reference to electronic information media].. Med Klin (Munich) 2003; 98: 648-655
• 10 Bates DW, Gawande AA. Improving safety with information technology.. N Engl J Med 2003; 348: 2526-2534
• 11 Bjeldbak-Oelsen I. Elektronische Medikation: Rolle und Verantwortung des Krankenhausapothekers.. Eur J Hosp Pharm 2004; 10: 64-64
• 12 Kuperman GJ, Teich JM, Gandhi TK. et al Patient safety and computerized medication ordering at Brigham and Women's Hospital.. Jt Comm J Qual Improv 2001; 27: 509-521
• 13 Evans RS, Pestotnik SL, Classen DC. et al A computer-assisted management program for antibiotics and other antiinfective agents.. N Engl J Med 1998; 338: 232-238
• 14 Potts AL, Barr FE, Gregory DF. et al Computerized physician order entry and medication errors in a pediatric critical care unit.. Pediatrics 2004; 113: 59-63
• 15 Payne TH, Nichol WP, Hoey P. et al Characteristics and override rates of order checks in a practitioner order entry system.. Proc AMIA Symp 2002; 602-606
• 16 Falconnier AD, Haefeli WE, Schoenenberger RA. et al Drug dosage in patients with renal failure optimized by immediate concurrent feedback.. J Gen Intern Med 2001; 16: 369-375
• 17 Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine.. Nephron 1976; 16: 31-41
• 18 Dormann H, Neubert A, Criegee-Rieck M. et al Readmissions and adverse drug reactions in internal medicine: the economic impact.. J Intern Med 2004; 255: 653-663
• 19 Grandt D, Müller-Oerlinghausen B. Elektronische Gesundheitskarte: Anforderungen an die medizinischen Daten.. Dt Ärztebl 2004; 101: A 2102-A 2105
• 20 Bero LA, Lipton HL, Bird JA. Characterization of geriatric drug-related hospital readmissions.. Med Care 1991; 29: 989-1003
• 21 Chan M, Nicklason F, Vial JH. Adverse drug events as a cause of hospital admission in the elderly.. Intern Med J 2001; 31: 199-205
• 22 Aziz AM, Ibrahim MI. Medication noncompliance - a thriving problem.. Med J Malaysia 1999; 54: 192-199
• 23 Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly.. Arch Intern Med 1990; 150: 841-845