临床决策辅助系统减少药物差错的系统评价再评价

目的对临床决策辅助系统应用于药物差错、药物安全领域的系统评价(SR)进行再评价。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data、VIP和CNKI数据库,搜集临床决策辅助系统应用于药物差错、药物安全领域的SR,检索时限均从1996年1月至2018年11月。由2名研究者独立筛选文献、提取资料后,采用AMSTAR标准评价纳入SR的方法学质量。结果共纳入20个SR,包括256 980名医务工作者和1 683 675名患者。纳入的SR中,高质量4个、中等质量16个。19个SR报告了多个过程结局指标:9个有充分证据证明临床决策辅助系统对过程结局有积极影响,6个证据有限,7个尚无充分证据。13个SR报告了患者结局:仅1个有充分证据证明临床决策辅助系统对患者结局有积极影响,3个证据有限,9个尚无充分证据。结论现有临床决策辅助系统减少药物差错的SR方法学质量为中到高等。临床决策辅助系统可显著改善与药物相关的过程结局;但对患者结局的影响目前仅有1个SR充分证据支持,结论尚不能确定,仍需大样本,长期随访的研究来证实。

Clinical decision support system for medication safety: an overview of systematic reviews

Objectives To provide an overview of whether the clinical decision support system(CDSS) was effective in reducing medication error and improving medication safety and to assess the quality of available scientific evidence.Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were electronically searched to collect systematic reviews(SRs) on application of clinical decision support system in the medication error and safety from January, 1996 to November, 2018. Two reviewers independently screened literature, extracted data and then evaluated methodological quality of included SRs by using AMSTAR tool.g AMSTAR tool. Results A total of 20 SRs including 256 980 healthcare practitioners and 1 683 675 patients were included. Specifically, 16 studies demonstrated moderate quality and 4 demonstrated high quality. 19 SRs evaluated multiple process of care outcome: 9 were sufficient evidence, 6 were limited evidence, and 7 were insufficient evidence which proved that CDSS had a positive effect on process outcome.13 SRs evaluated reported patient outcomes: 1 with sufficient evidence, 3 with limited evidence, and 9 without sufficient evidence. Conclusions CDSS reduces medication error by inconsistently improving process of care measures and seldom improving patient outcomes. Larger samples and longer-term studies are required to ensure a larger and more reliable evidence base on the effects of CDSS intervention on patient outcomes.