%0期刊文章%@ 1438- 8871% I JMIR出版物%V 20卡塔尔世界杯8强波胆分析% N 9% P e258% T药物过敏检查临床决策支持系统:系统综述%A Légat,Laura %A Van Laere,Sven %A Nyssen,Marc %A Steurbaut,Stephane %A Dupont,Alain G %A Cornu,Pieter %+研究组临床药理学和临床药学，布鲁塞尔自由大学，Laarbeeklaan 103，布鲁塞尔，1090，比利时，32 24766432，pieter.cornu@vub.ac.be %K警报%K临床决策支持系统%K计算机化医生订单录入%K药物过敏%K患者安全%D 2018年%7 07.09.9 %9回顾%J J医学互联网Res %G英文%X背景:在世界范围内，过敏的负担，特别是药物过敏，正在增长。在开处方、配药或给药过程中，可能发生用药错误，并可能产生不良后果;例如，可以给对特定药物有过敏记录的患者服用某种药物。内置临床决策支持系统(CDSS)的计算机化医生指令输入(CPOE)系统有可能防止此类用药错误和不良事件。目的:本文综述的目的是全面概述药物过敏CDSS的各个方面，包括记录、编码、规则库、警报和警报疲劳以及结果评估。方法:尽可能遵循PRISMA (Preferred Reporting Items for Systematic Reviews and meta - analysis)指南，以CPOE、CDSS、alert、allergy或allergy为关键词，在5个数据库中进行检索。由于综述中纳入的研究类型的异质性，无法根据PRISMA指南评估偏倚。结果:在3160篇文章中，有60篇符合纳入标准。 A further 9 articles were added based on expert opinion, resulting in a total of 69 articles. An interrater agreement of 90.9% with a reliability Κ=.787 (95% CI 0.686-0.888) was reached. Large heterogeneity across study objectives, study designs, study populations, and reported results was found. Several key findings were identified. Evidence of the usefulness of clinical decision support for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of information on drug allergies in electronic health records (EHRs) is difficult, as it is often not clear to healthcare providers how and where to document drug allergies. Besides the underreporting of drug allergies, outdated or inaccurate drug allergy information in EHRs poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is no generally accepted standard terminology for structured documentation of allergy information. The final key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90%, leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We found only one study specifically reporting outcomes related to CDSS for drug allergies. It showed that adverse drug events resulting from overridden drug allergy alerts do not occur frequently. Conclusions: Accurate and comprehensive recording of drug allergies is required for good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergy are recorded in EHRs. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Also, the effect on patient outcomes and cost-effectiveness should be evaluated. %M 30194058 %R 10.2196/jmir.8206 %U //www.mybigtv.com/2018/9/e258/ %U https://doi.org/10.2196/jmir.8206 %U http://www.ncbi.nlm.nih.gov/pubmed/30194058