The Leapfrog Group is an alliance of over 170 large public and private organizations including many Fortune 500 companies that together spend “nearly $67 billion each year on health care for 36 million Americans in all 50 states.” The alliance was formed to utilize the combined purchasing power of the members to make giant “leaps” forward in improving the safety, quality and affordability of health care.
Because of the demonstrated potential benefits to improve patient safety, the Leapfrog Group adopted Computerized Physician Order Entry (CPOE) as one of its safety standards.
What is the Leapfrog CPOE standard?
To meet the Leapfrog CPOE standard, a hospital must:
- Assure that at least 75% of medication orders are entered by physicians into a system that includes clinical decision support to prevent errors.
- Demonstrate that the system can alert physicians of at least 50% of common serious prescribing errors.
- Require that physicians electronically document a reason for overriding an alert.
A hospital certifies that it meets the second requirement by completing an independent test which consists of over 130 adult and over 50 pediatric order sets. The test addresses nine types of decision support for medication errors and three types of decision support that evaluate system efficiency. The twelve decision support categories are listed in the table below:
|Decision Support Category
|Medication with therapeutic overlap with another new or active order; may be same drug, within drug class, or involve components of combination products
|Codeine AND Tylenol #3
|Single and cumulative dose limits
|Medication with a specified dose that exceeds recommended dose ranges or that will result in a cumulative dose that exceeds recommended ranges
|Ten-fold excess dose of Methotrexate
|Allergies and cross-allergies
|Medication for which patient allergy has been documented or allergy to other drug in same category has been documented
|Penicillin prescribed for patient with documented Penicillin allergy
|Contraindicated route of administration
|Order specifying a route of administration (e.g., oral, intramuscular, intravenous) not appropriate for the identified medication
|Tylenol to be administered intravenously
|Drug-drug and drug-food interactions
|Medication that results in known, dangerous interaction when administered in combination with a different medication in a new or existing order for the patient or results in an interaction in combination with a food or food group
|Digoxin AND Quinidine
|Contraindication/dose limits based on patient diagnosis
|Medication either contraindicated based on patient diagnosis or diagnosis affects appropriate dosing
|Nonspecific beta blocker in patient with asthma
|Contraindication dose limits based on patient age and weight
|Medication either contraindicated for this patient based on age and weight or for which age and weight must be considered in appropriate dosing
|Adult dose of antibiotic in a newborn
|Contraindication/dose limits based on laboratory studies
|Medication either contraindicated for this patient based on laboratory studies or for which relevant laboratory results must be considered in appropriate dosing
|Normal adult dose regimen of renally eliminated medication in patient with elevated creatinine
|Contraindication/dose limits based on radiology studies
|Medication contraindicated for this patient based on interaction with contrast medium in recent or ordered radiology study
|Medication prescribed known to interact with iodine to be used as contrast medium in ordered head CT exam
|Intervention that requires an associated or secondary order to meet the standard of care
|Prompt to order drug levels when ordering aminoglycoside
|Cost of care
|Test that duplicates a service within a timeframe in which there is typically minimal benefits from repeating the test
|Repeat test for Digoxin level within twp hours
|Order with such a mild or typically inconsequential interaction that clinicians typically ignore the advice provided
|Lasix AND Digoxin in patient with normal potassium
The Leapfrog Group Fact Sheet. http://www.leapfroggroup.org/media/file/LF_FactSheet_01_26_06.pdf
The Leapfrog Group Mission Statement. http://www.leapfroggroup.org/about_us/our_mission
The Leapfrog Group CPOE Fact Sheet http://www.leapfroggroup.org/media/file/Leapfrog-Computer_Physician_Order_Entry_Fact_Sheet.pdf
Peter Kilbridge, Emily Welebob, David Classen. Overview of the Leapfrog Group Evaluation Tool for Computerized Physician Order Entry. December 2001 http://www.leapfroggroup.org/media/file/Leapfrog-CPOE_Evaluation.pdf
Peter Kilbridge, Emily Welebob, David Classen. Development of the Leapfrog methodology for evaluating hospital implemented inpatient computerized physician order entry systems. Quality and Safety in Health Care 2006(15): 81-84