Difference between revisions of "Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)"

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(Background and Method)
(Background and Method)
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== Background and Method ==
 
== Background and Method ==
CPOE systems are known for their cost savings, decrease of medication errors and ability to identify adverse drug reactions for the healthcare systems as part of federal regulations. However, CPOE systems can also increase the risk of opportunities for providers to accidentally enter orders on wrong patient charts if they do not have visual cues . Wrong-patient selection occurs if a system has features that allows providers to search for patients charts rapidly, through "recent" patient list selections or through the ability to have multiple charts open during one session. The article describes how the UI-Health participated in a study, in which they created a group of [[CDS|CDS]] alerts to "prompt prescribers (providers) to add problems to the problem list when they were prescribing certain medications in the absence of certain documented problems."  The alerts were aimed to improve the provider's situation awareness and patient safety. In the study, not only did the medication trigger an alert if the problem list was missing an active problem, it also offered a list of problems were linked to the medication and gave the provider the ability to add them at their discretion.
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CPOE systems are known for their cost savings, decrease of medication errors and ability to identify adverse drug reactions for the healthcare systems as part of federal regulations. However, CPOE systems can also increase the risk of opportunities for providers to accidentally enter orders on wrong patient charts if they do not have visual cues . Wrong-patient selection occurs if a system has features that allows providers to search for patients charts rapidly, through "recent" patient list selections or through the ability to have multiple charts open during one session. The article describes how the UI-Health participated in a study, in which they created a group of [[CDS|CDS]] alerts to "prompt prescribers (providers) to add problems to the problem list when they were prescribing certain medications in the absence of certain documented problems."  The alerts were aimed to improve the provider's situation awareness and patient safety. In the study, not only did the medication trigger an alert if the problem list was missing an active problem, it also offered a list of problems that were linked to the medication and gave the provider the ability to add them at their discretion.
  
 
== Results ==
 
== Results ==

Revision as of 03:25, 11 February 2015

Computerized provider order entry (CPOE) systems allow providers to electronically enter patient services and medication orders. With the introduction of the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, implemented CPOE systems in hospitals are capable of reducing medical errors and adverse drug reactions, especially when linked to clinical decision support systems (CDSS). The article, "Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)”, from the Journal of the American Medical Informatics Association, demonstrates whether indication-based computer order entry alerts can intercept wrong-patient medication errors. [1]


Background and Method

CPOE systems are known for their cost savings, decrease of medication errors and ability to identify adverse drug reactions for the healthcare systems as part of federal regulations. However, CPOE systems can also increase the risk of opportunities for providers to accidentally enter orders on wrong patient charts if they do not have visual cues . Wrong-patient selection occurs if a system has features that allows providers to search for patients charts rapidly, through "recent" patient list selections or through the ability to have multiple charts open during one session. The article describes how the UI-Health participated in a study, in which they created a group of CDS alerts to "prompt prescribers (providers) to add problems to the problem list when they were prescribing certain medications in the absence of certain documented problems." The alerts were aimed to improve the provider's situation awareness and patient safety. In the study, not only did the medication trigger an alert if the problem list was missing an active problem, it also offered a list of problems that were linked to the medication and gave the provider the ability to add them at their discretion.

Results

Over the 6 year period of the study, the system fired 127,320 alerts for 79,304 encounters from 54,608 unique patients.[1] After further review only 32 intercepted wrong chart errors were identified within the 127, 320 alerts.[1] Overall the study illustrated the concept of medication-problem list mismatches which aims to improve problem list documentation within the electronic medical record (EMR). The article also indicates that although the alerts prevent providers in entering wrong-patient errors, one of the better solutions is to restrict the providers the ability to have more than one patient chart open at a time. In addition, including a photo file of the patient on their chart may be beneficial as well to helping them identify and preventing an error.


Comments

Although, the authors did a good representation of demonstrating the functionality of CDS rules when linked to CPOE systems and the effect of preventing wrong-patient errors, the study was limited to only one single medical center facility and used only a group of certain medications (without variation) over a 6 year period. If there had been a rotation of medications within the years, the interception rate could have differed than what was reported in the article. Although it is evident that CPOE systems can increase the risk of wrong-patient errors within EMRs, these type of errors are more evident when entered directly by the user rather than when prompted by the system. In conclusion, the indication-based alerts not only assisted in preventing wrong-patient errors but also in the improvement in the documentation of the problem list more so than expected.

References

  1. 1.0 1.1 1.2 Galanter W,Falck S, Burns M, et al. Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry. Journal of the American Medical Informatics Association 2013; 20: 477-481