処方オーダリングシステムによる塩酸チクロピジンの適正使用の推進

抄録

Ticlopidine has been reported to cause critical adverse reactions, among them thrombotic thrombocytopenic purpura, granulocytopenia and liver failure. In view of this, emergency safety information has been issued on two occasions and after it was issued for the second time in July 2002, a warning function was incorporated into the computerized order entry system. Under this function, a warning message is displayed on the screen when this drug is to be prescribed for a patient for the first time and physicians can only enter a prescription order for ticlopidine when they have acknowledged the message.
We compared the frequencies of prescribing ticlopidine and of conducting blood tests, and the rate of adverse reactions before and after the issue of the emergency safety information and introduction of the warning function. Patients treated with ticlopidine were selected from the prescription database file created from the prescription order entry system, which contains details of all the prescriptions filled for outpatients between January 1998 and December 2002.
Following the issue of emergency safety information for the second time, the prescription frequency of ticlopidine started to decrease and there was a significant increase in the frequency of blood tests, though there had been no difference in the amount of blood testing between before and after the issue of emergency safety information for the first time. This showed that the timely provision of safety information to physicians through the computerized order entry system has been effective in promoting the proper use of ticlopidine.