1
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Liu KW, Shih YF, Chiang YJ, Chen LJ, Lee CH, Chen HN, Chen JY, Hsiao CC. Reducing Medication Errors in Children's Hospitals. J Patient Saf 2023; 19:151-157. [PMID: 36728168 DOI: 10.1097/pts.0000000000001087] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Knowledge of the prevalence and characteristics of medication errors in pediatric and neonatal patients is limited. This study aimed to evaluate the incidence and medication error characteristics in a pediatric hospital over 5 years and to determine whether serial error prevention programs to optimize a computerized physician order entry (CPOE) system reduce error incidence. METHODS We retrospectively reviewed medication errors documented between January 2015 and December 2019. RESULTS A total of 2,591,596 prescriptions were checked, and 255 errors were identified. Wrong dose prescriptions constituted the most common errors (56.9%). Medications with the highest rate of errors were antibiotics/antiviral drugs (36.9%). Oral route medications comprised the highest portion (60.8%), followed by intravenous ones (28.6%). The most common stage for medication errors was physician ordering (93.3%). Junior residents were responsible for most errors (45.9%). Most errors occurred in the pediatric ward (53.7%). In total, 221 (86.7%) errors were near misses. Only 4 errors (1.6%) were considered significant and required active monitoring or intervention. Type of error, stage of error, staff composition, and severity level of errors were significantly related to the number of errors in different years. There was a statistically significant decrease in errors per 100,000 prescriptions across different years after optimizing the CPOE system. CONCLUSIONS The incidence of medication errors decreased with extensive use of the CPOE system. Continuous application of the CPOE optimization program can effectively reduce medication errors. Further incorporation of pediatric-specific decision-making and support tools and error prevention measures into CPOE systems is needed.
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Affiliation(s)
- Kai-Wen Liu
- From the Department of Neonatology, Changhua Christian Children's Hospital
| | - Ya-Fen Shih
- Department of Pharmacy, Changhua Christian Hospital, Changhua
| | - Yi-Jung Chiang
- Department of Pharmacy, Changhua Christian Hospital, Changhua
| | - Lih-Ju Chen
- From the Department of Neonatology, Changhua Christian Children's Hospital
| | - Cheng-Han Lee
- From the Department of Neonatology, Changhua Christian Children's Hospital
| | - Hsiao-Neng Chen
- From the Department of Neonatology, Changhua Christian Children's Hospital
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2
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Rappaport LD, Markowitz G, Hulac S, Roosevelt G. Medication Errors in Pediatric Patients after Implementation of a Field Guide with Volume-Based Dosing. PREHOSP EMERG CARE 2023; 27:213-220. [PMID: 35020551 DOI: 10.1080/10903127.2022.2025962] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Several studies have demonstrated the high frequency of medication errors in pediatric patients by prehospital providers during both patient care and simulation. In 2015, our hospital-based urban EMS system introduced the HandtevyTM Field Guide that provides precalculated pediatric doses in milliliters (mL) by patient age. We hypothesized that implementation of the Field Guide would increase the percentage of correct pediatric medication doses to greater than 85%. METHODS We performed a single center retrospective cohort study of medications administered to patients < 13 years of age from August 2017 to July 2019 compared to 2014 baseline data through electronic medical record review. We excluded nebulized medications and online medication direction cases. Our primary outcome was the percentage of correct doses defined as a dose within 80-120% of the Field Guide dose recommendation. Each dosing error was reviewed by two investigators. RESULTS We analyzed 483 drug administrations in 375 patients for the Field Guide study period. Doses were correct in 89.4% of medication administrations with 68.5% reportedly administered exactly as dictated by the Field Guide compared to 51.1% in the baseline period (p < 0.001). During the Field Guide study period, the following medications had 100% appropriate dosing: adenosine, dextrose 10%, diphenhydramine, epinephrine 1:10,000, glucagon, naloxone and oral ondansetron. Overdoses accounted for 4.4% of medication errors and underdoses accounted for 6.2% of medications errors. The most overdosed medications were intranasal (IN) midazolam (11.8%) and intravenous fentanyl (9.4%). The most underdosed medications were IN midazolam (23.5%) and intramuscular epinephrine 1:1000 (12.5%). The highest percentage of errors (20%) were seen in the zero to one-year-old age group. CONCLUSION After implementation of a precalculated mL dose system by patient age for EMS providers, most pediatric medications were reportedly administered within the appropriate dose range. A field guide with precalculated doses (in mL) may be an effective tool for reducing pediatric medication dosing errors by EMS providers.
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Affiliation(s)
- Lara D Rappaport
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Genie Roosevelt
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
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3
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Bosch J, Ludwig C, Fluch-Niebuhr J, Stoevesandt D. Empowerment for the Digital Transformation: Results of a Structured Blended-Learning On-the-Job Training for Practicing Physicians in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12991. [PMID: 36293572 PMCID: PMC9603236 DOI: 10.3390/ijerph192012991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Practicing physicians have not been in the focus of structured qualifications in basic digital competences so far. However, they are the current gatekeepers to implement digital technologies and need empowerment to proactively take part in the ongoing digital transformation process. The present study investigates if a structured blended-learning training for practicing physicians in Germany enhances both physicians' knowledge about central aspects of the digital transformation (including awareness of personal possibilities to act) and their attitudes towards a more digitally empowered mindset. (2) Methods: Participants (n = 32) self-assessed their knowledge (19 items, 10-point Likert-scale) and attitudes (6 items, 5-point Likert-scale) towards the digital transformation at the beginning and at the end of the training. MANCOVAs were conducted. (3) Results: Participants reported an increase in every knowledge domain, representing large effects (Hedges' g 1.06 to 2.82). Attitudes were partly shifted towards a more empowered mindset with decreased insecurity towards technological, legal, and ethical aspects of the digital transformation (Hedges' g -0.82 to -1.40). However, preparedness for the digital transformation remained low. (4) Conclusions: Generally, the hypotheses were confirmed. The presented on-the-job training had the desired effects on practicing physicians' knowledge and attitudes. Nevertheless, additional empowerment and support are essential.
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Affiliation(s)
- Josefin Bosch
- Dorothea Erxleben Learning Center, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Christiane Ludwig
- Dorothea Erxleben Learning Center, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
- Department for Internal Medicine, University Medicine Halle, 06120 Halle (Saale), Germany
| | | | - Dietrich Stoevesandt
- Dorothea Erxleben Learning Center, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
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4
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Kandaswamy S, Grimes J, Hoffman D, Marquard J, Ratwani RM, Hettinger AZ. Free-Text Computerized Provider Order Entry Orders Used as Workaround for Communicating Medication Information. J Patient Saf 2022; 18:430-434. [PMID: 35948292 PMCID: PMC9366105 DOI: 10.1097/pts.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Medication information is frequently communicated via free-text computerized provider order entry (CPOE) orders in electronic health records. When such information is transmitted separately from a structured CPOE medication order, there is a significant risk of medication error. Although prior studies have described the frequency of using free-text CPOE orders for communicating medication information, there is a gap in understanding the nature of the medication information contained in the free-text CPOE orders. The aims of this study are to (1) identify the most common medication names communicated in free-text CPOE orders and their risk levels and (2) identify what actions physicians expect that nurses will complete when they place free-text CPOE orders, and (3) describe differences in these patterns across hospitals. METHODS This study was a retrospective analysis of a sample of 26,524 free-text CPOE orders from 6 hospitals in the mid-Atlantic U.S. region. RESULTS Free-text CPOE orders contained in the sample mentioned 193 medication names. Free-text CPOE orders were used frequently to communicate information about naloxone, heparin, flumazenil, and dextrose. Twenty-two percent of the free-text CPOE orders related to discontinuing medication(s), whereas 7% of the free-text CPOE orders relate to giving medication(s). There was high variation across hospitals both in the percentage of free-text CPOE orders mentioning medication information and in the proportion of those that referred to high-risk medications. CONCLUSIONS The prevalence of medication information in free-text CPOE orders may suggest specific communication challenges in respect to urgency, uncertainty, planning, and other aspects of communication and clinical needs. Understanding and addressing communication challenges around commonly mentioned medication names and actions, especially those that are high risk, can help reduce the risk of medication errors.
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Affiliation(s)
| | - Joanna Grimes
- MedStar Health National Center for Human Factors in
Healthcare
- Georgetown University School of Medicine
| | - Daniel Hoffman
- Robert H. Smith School of Business, University of
Maryland
| | | | - Raj M Ratwani
- MedStar Health National Center for Human Factors in
Healthcare
- Georgetown University School of Medicine
| | - Aaron Z Hettinger
- MedStar Health National Center for Human Factors in
Healthcare
- Georgetown University School of Medicine
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5
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Jungreithmayr V, Meid AD, Haefeli WE, Seidling HM. The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation-a before-and-after study. BMC Med Inform Decis Mak 2021; 21:279. [PMID: 34635100 PMCID: PMC8504043 DOI: 10.1186/s12911-021-01607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background The medication process is complex and error-prone. To avoid medication errors, a medication order should fulfil certain criteria, such as good readability and comprehensiveness. In this context, a computerized physician order entry (CPOE) system can be helpful. This study aims to investigate the distinct effects on the quality of prescription documentation of a CPOE system implemented on general wards in a large tertiary care hospital. Methods In a retrospective analysis, the prescriptions of two groups of 160 patients each were evaluated, with data collected before and after the introduction of a CPOE system. According to nationally available recommendations on prescription documentation, it was assessed whether each prescription fulfilled the established 20 criteria for a safe, complete, and actionable prescription. The resulting fulfilment scores (prescription-Fscores) were compared between the pre-implementation and the post-implementation group and a multivariable analysis was performed to identify the effects of further covariates, i.e., the prescription category, the ward, and the number of concurrently prescribed drugs. Additionally, the fulfilment of the 20 criteria was assessed at an individual criterion-level (denoted criteria-Fscores). Results The overall mean prescription-Fscore increased from 57.4% ± 12.0% (n = 1850 prescriptions) before to 89.8% ± 7.2% (n = 1592 prescriptions) after the implementation (p < 0.001). At the level of individual criteria, criteria-Fscores significantly improved in most criteria (n = 14), with 6 criteria reaching a total score of 100% after CPOE implementation. Four criteria showed no statistically significant difference and in two criteria, criteria-Fscores deteriorated significantly. A multivariable analysis confirmed the large impact of the CPOE implementation on prescription-Fscores which was consistent when adjusting for the confounding potential of further covariates. Conclusions While the quality of prescription documentation generally increases with implementation of a CPOE system, certain criteria are difficult to fulfil even with the help of a CPOE system. This highlights the need to accompany a CPOE implementation with a thorough evaluation that can provide important information on possible improvements of the software, training needs of prescribers, or the necessity of modifying the underlying clinical processes. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01607-6.
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Affiliation(s)
- Viktoria Jungreithmayr
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | | | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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6
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Peltoniemi T, Suomi R, Peura S, Lähteenoja MNY. Electronic prescription as a driver for digitalization in Finnish pharmacies. BMC Health Serv Res 2021; 21:1017. [PMID: 34565354 PMCID: PMC8474735 DOI: 10.1186/s12913-021-07003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Finnish community pharmacies have undergone digitalization during the past decade. The introduction of the electronic prescription has had a significant impact on pharmacy workflows, such as the dispensing process. This inevitably has significant sociotechnical implications. We examine the impact of digitalization on the dispensing process and the sociotechnical orientation of a pharmacy. Methods We utilize data collected in customer service situations in Finnish community pharmacies at two points in time: in the traditional workflow, when electronic prescriptions were not in use, and in the new direct dispensing workflow, which is the usual delivery model in the case of electronic prescriptions. We analyze this data in terms of changes in workflow efficiency. We also draw on existing literature to build a conceptual model for digitalization in the pharmacy sector from a sociotechnical standpoint. Results In the Finnish environment, the results, based on our study sample, show that with electronic prescriptions and the direct dispensing model, the delivery time for a single medication over the counter was reduced by 13%. The results also indicate that the process has become more predictable, as the variation in terms of the workflow lead time has decreased. Conclusions The results indicate that the dispensing process has become more efficient in terms of time and throughput as well as more technically oriented and predictable. From a sociotechnical perspective, the results indicate that the technical subsystem has strengthened, and pharmacies have adapted to the new technology in the dispensing process.
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Affiliation(s)
| | - Reima Suomi
- University of Turku, 20014 Turun Yliopisto, Turku, Finland
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7
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Romanelli RJ, Schwartz NRM, Dixon WG, Rodriguez-Watson C, Sauer BC, Albright D, Marcum ZA. The use of narrative electronic prescribing instructions in pharmacoepidemiology: A scoping review for the International Society for Pharmacoepidemiology. Pharmacoepidemiol Drug Saf 2021; 30:1281-1292. [PMID: 34278660 PMCID: PMC8419095 DOI: 10.1002/pds.5331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022]
Abstract
Narrative electronic prescribing instructions (NEPIs) are text that convey information on the administration or co‐administration of a drug as directed by a prescriber. For researchers, NEPIs have the potential to advance our understanding of the risks and benefits of medications in populations; however, due to their unstructured nature, they are not often utilized. The goal of this scoping review was to evaluate how NEPIs are currently employed in research, identify opportunities and challenges for their broader application, and provide recommendations on their future use. The scoping review comprised a comprehensive literature review and a survey of key stakeholders. From the literature review, we identified 33 primary articles that described the use of NEPIs. The majority of articles (n = 19) identified issues with the quality of information in NEPIs compared with structured prescribing information; nine articles described the development of novel algorithms that performed well in extracting information from NEPIs, and five described the used of manual or simpler algorithms to extract prescribing information from NEPIs. A survey of 19 stakeholders indicated concerns for the quality of information in NEPIs and called for standardization of NEPIs to reduce data variability/errors. Nevertheless, stakeholders believed NEPIs present an opportunity to identify prescriber's intent for the prescription and to study temporal treatment patterns. In summary, NEPIs hold much promise for advancing the field of pharmacoepidemiology. Researchers should take advantage of addressing important questions that can be uniquely answered with NEPIs, but exercise caution when using this information and carefully consider the quality of the data.
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Affiliation(s)
- Robert J Romanelli
- Center for Health Systems Research, Sutter Health, Walnut Creek, California, USA
| | - Naomi R M Schwartz
- The Comparative Health Outcomes Policy and Economics Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - William G Dixon
- Center for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Carla Rodriguez-Watson
- Innovation in Medical Evidence Development and Surveillance (IMEDS), Reagan-Udall Foundation for the Food and Drug Administration, Washington, DC, USA
| | - Brian C Sauer
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | | | - Zachary A Marcum
- The Comparative Health Outcomes Policy and Economics Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
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8
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Vaghasiya MR, Penm J, Kuan KKY, Gunja N, Liu Y, Kim ED, Petrina N, Poon S. Implementation of an Electronic Medication Management System in a large tertiary hospital: a case of qualitative inquiry. BMC Med Inform Decis Mak 2021; 21:226. [PMID: 34315447 PMCID: PMC8314474 DOI: 10.1186/s12911-021-01584-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitals across Australia are implementing Clinical Information Systems, e.g. Electronic Medication Management Systems (EMMS) at a rapid pace to moderate health services. The benefits of the EMMS depend on the acceptance of the system by the clinicians. The study hospital used a unique patient-centric implementation strategy that was based on the guiding principle of "one patient, one chart" to avoid a patient being on a hybrid medication chart. This paper aims to study the factors facilitating or hindering the adoption of the EMMS as viewed by clinicians and the implementation team. METHODS Four focus groups (FG), one each for (1) doctors, (2) nurses, (3) pharmacists, and (4) implementation team, were conducted. A guide for the FG was based on the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS A total of 23 unique subthemes were identified and were grouped into five main themes (1) implementation strategy, (2) organisational outcome of EMMS, (3) individual impact of EMMS, (4) IT product, and (5) organisational culture. Clinicians reported improvement in their workflow efficiency post-EMMS implementation. They also reported some challenges in using the EMMS that centered around the area of infrastructure, technical and design issues. Additionally, the implementation team highlighted two crucial factors influencing the success of EMMS implementation, namely: (1) the patient-centric implementation strategy, and (2) the organisation readiness. CONCLUSION Overall, this study outlines the implementation process of the EMMS in a large healthcare facility from the clinicians' and the implementation team's perspectives using UTAUT model. The result suggests that clinicians' acceptance of the EMMS was highly influenced by the unique implementation strategy (namely, patient-centric approach and clinical leadership in the implementation team). Whereas the level of adoption of EMMS by clinicians was determined by their level of perceived and realised benefits. On the other hand, a number of barriers to the adoption of EMMS were discovered, namely, general training instead of customised training based on local needs, technical and design issues and lack of availability of computer systems. It is suggested that promptly resolving these issues can improve the adoption of the EMMS.
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Affiliation(s)
- Milan Rasikbhai Vaghasiya
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia. .,Western Sydney Local Health District, Westmead, NSW, 2145, Australia.
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, 2006, Australia.,Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Kevin K Y Kuan
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Naren Gunja
- Western Sydney Local Health District, Westmead, NSW, 2145, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Yiren Liu
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Eui Dong Kim
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Neysa Petrina
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Simon Poon
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia.,Western Sydney Local Health District, Westmead, NSW, 2145, Australia
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Corny J, Rajkumar A, Martin O, Dode X, Lajonchère JP, Billuart O, Bézie Y, Buronfosse A. A machine learning-based clinical decision support system to identify prescriptions with a high risk of medication error. J Am Med Inform Assoc 2021; 27:1688-1694. [PMID: 32984901 PMCID: PMC7671619 DOI: 10.1093/jamia/ocaa154] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/10/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To improve patient safety and clinical outcomes by reducing the risk of prescribing errors, we tested the accuracy of a hybrid clinical decision support system in prioritizing prescription checks. Materials and Methods Data from electronic health records were collated over a period of 18 months. Inferred scores at a patient level (probability of a patient’s set of active orders to require a pharmacist review) were calculated using a hybrid approach (machine learning and a rule-based expert system). A clinical pharmacist analyzed randomly selected prescription orders over a 2-week period to corroborate our findings. Predicted scores were compared with the pharmacist’s review using the area under the receiving-operating characteristic curve and area under the precision-recall curve. These metrics were compared with existing tools: computerized alerts generated by a clinical decision support (CDS) system and a literature-based multicriteria query prioritization technique. Data from 10 716 individual patients (133 179 prescription orders) were used to train the algorithm on the basis of 25 features in a development dataset. Results While the pharmacist analyzed 412 individual patients (3364 prescription orders) in an independent validation dataset, the areas under the receiving-operating characteristic and precision-recall curves of our digital system were 0.81 and 0.75, respectively, thus demonstrating greater accuracy than the CDS system (0.65 and 0.56, respectively) and multicriteria query techniques (0.68 and 0.56, respectively). Discussion Our innovative digital tool was notably more accurate than existing techniques (CDS system and multicriteria query) at intercepting potential prescription errors. Conclusions By primarily targeting high-risk patients, this novel hybrid decision support system improved the accuracy and reliability of prescription checks in a hospital setting.
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Affiliation(s)
- Jennifer Corny
- Pharmacy Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Asok Rajkumar
- Pharmacy Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Xavier Dode
- Centre National Hospitalier d'Information sur le Médicament, Paris, France.,Pharmacy Department, Hospices Civils de Lyon University Hospital, Lyon, France
| | | | - Olivier Billuart
- Medical Information Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Yvonnick Bézie
- Pharmacy Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Anne Buronfosse
- Medical Information Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
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10
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Kinlay M, Zheng WY, Burke R, Juraskova I, Moles R, Baysari M. Medication errors related to computerized provider order entry systems in hospitals and how they change over time: A narrative review. Res Social Adm Pharm 2020; 17:1546-1552. [PMID: 33353834 DOI: 10.1016/j.sapharm.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evaluations of computerized provider order entry (CPOE) systems have revealed that reductions in certain types of medication errors occur simultaneously with the emergence of system-related errors - errors that are unlikely or not possible to occur with the use of paper-based medication charts. System-related errors appear to persist many years post-implementation of CPOE, although little is known about whether the types and rates of system-related errors that occur immediately following CPOE implementation are similar to those that endure or emerge after years of system use. OBJECTIVE To analyze and synthesize the literature on system-related errors, specifically in relation to the length of time that CPOE systems have been in use, to determine what is currently known about how system-related errors change over time. METHODS A literature search was undertaken using the PubMed database to identify English language articles published between January 2005 and March 2020 that provided original data on system-related errors resulting from CPOE system use. Studies were included if they provided results on system-related errors and information relating to the length of time that CPOE had been in use. RESULTS Thirty-one studies met the inclusion criteria for this narrative review. System-related errors were identified and described during short, medium and long-term use of CPOE systems, but no single study examined how errors changed over time. In comparing findings across studies, results suggest that system-related errors persist with long-term use of CPOE systems, although likely to occur at a reduced rate. CONCLUSIONS This review has highlighted a significant gap in knowledge on how system-related errors change over time. Determining what and when system-related errors occur and the system factors that contribute to their occurrence at different time points after CPOE implementation is necessary for the future prevention and mitigation of these errors.
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Affiliation(s)
- Madaline Kinlay
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Wu Yi Zheng
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Rosemary Burke
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melissa Baysari
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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11
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Elshayib M, Pawola L. Computerized provider order entry-related medication errors among hospitalized patients: An integrative review. Health Informatics J 2020; 26:2834-2859. [PMID: 32744148 DOI: 10.1177/1460458220941750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Institute of Medicine estimates that 7,000 lives are lost yearly as a result of medication errors. Computerized physician and/or provider order entry was one of the proposed solutions to overcome this tragic issue. Despite some promising data about its effectiveness, it has been found that computerized provider order entry may facilitate medication errors.The purpose of this review is to summarize current evidence of computerized provider order entry -related medication errors and address the sociotechnical factors impacting the safe use of computerized provider order entry. By using PubMed and Google Scholar databases, a systematic search was conducted for articles published in English between 2007 and 2019 regarding the unintended consequences of computerized provider order entry and its related medication errors. A total of 288 articles were screened and categorized based on their use within the review. One hundred six articles met our pre-defined inclusion criteria and were read in full, in addition to another 27 articles obtained from references. All included articles were classified into the following categories: rates and statistics on computerized provider order entry -related medication errors, types of computerized provider order entry -related unintended consequences, factors contributing to computerized provider order entry failure, and recommendations based on addressing sociotechnical factors. Identifying major types of computerized provider order entry -related unintended consequences and addressing their causes can help in developing appropriate strategies for safe and effective computerized provider order entry. The interplay between social and technical factors can largely affect its safe implementation and use. This review discusses several factors associated with the unintended consequences of this technology in healthcare settings and presents recommendations for enhancing its effectiveness and safety within the context of sociotechnical factors.
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Abraham J, Kitsiou S, Meng A, Burton S, Vatani H, Kannampallil T. Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews. BMJ Qual Saf 2020; 29:1-2. [PMID: 32371457 DOI: 10.1136/bmjqs-2019-010436] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/22/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Computerised provider order entry (CPOE) systems are widely used in clinical settings for the electronic ordering of medications, laboratory tests and radiological therapies. However, evidence regarding effects of CPOE-based medication ordering on clinical and safety outcomes is mixed. We conducted an overview of systematic reviews (SRs) to characterise the cumulative effects of CPOE use for medication ordering in clinical settings. METHODS MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched to identify published SRs from inception to 12 February 2018. SRs investigating the effects of the use of CPOE for medication ordering were included. Two reviewers independently extracted data and assessed the methodological quality of included SRs. RESULTS Seven SRs covering 118 primary studies were included for review. Pooled studies from the SRs in inpatient settings showed that CPOE use resulted in statistically significant decreases in medication errors and adverse drug events (ADEs); however, there was considerable variation in the magnitude of their relative risk reduction (54%-92% for errors, 35%-53% for ADEs). There was no significant relative risk reduction on hospital mortality or length of stay. Bibliographic analysis showed limited overlap (24%) among studies included across all SRs. CONCLUSION SRs on CPOEs included predominantly non-randomised controlled trials and observational studies with varying foci. SRs predominantly focused on inpatient settings and often lacked comparison groups; SRs used inconsistent definitions of outcomes, lacked descriptions regarding the effects on patient harm and did not differentiate among the levels of available decision support. With five of the seven SRs having low to moderate quality, findings from the SRs must be interpreted with caution. We discuss potential directions for future primary studies and SRs of CPOE.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alicia Meng
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Shirley Burton
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Haleh Vatani
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
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Vélez-Díaz-Pallarés M, Pérez-Menéndez-Conde C, Bermejo-Vicedo T. Systematic review of computerized prescriber order entry and clinical decision support. Am J Health Syst Pharm 2019; 75:1909-1921. [PMID: 30463867 DOI: 10.2146/ajhp170870] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of a systematic review of published data on the effect of computerized prescriber order entry (CPOE) with clinical decision support on medication error (ME) and adverse drug event (ADE) rates are presented. METHODS Literature searches of MEDLINE, Embase, and other databases were conducted to identify English- and Spanish-language articles on selected CPOE outcomes published from 1995 through 2016; in addition, 5 specific journals were searched for pertinent articles published during the period 2010-16. Publications on controlled prospective studies and before-and-after studies that assessed MEs and/or ADEs as main outcomes were selected for inclusion in the review. RESULTS Nineteen studies met the inclusion criteria. Data on MEs and ADEs could not be pooled, mainly due to heterogeneity in outcome definitions and study methodologies. The reviewed evidence indicated that CPOE implementation led to an overall reduction in errors at the prescription stage of the medication-use process (relative risk reduction, 0.29 [95% confidence interval, 0.10-0.85]; I 2 = 99%) and reductions in most types of prescription errors, but CPOE also resulted in the emergence of other types of errors. CONCLUSION CPOE reduces the overall ME rate in the prescription process, as well as specific types of errors, such as wrong dose or strength, wrong drug, frequency, administration route, and drug-drug interaction errors. The implementation of CPOE can lead to new errors, such as wrong drug selection from drop-down menus.
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Carrera-Hueso FJ, Merino-Plaza MJ, Ramón-Barrios MA, Lopez-Merino EI, Vazquez-Ferreiro P, Poquet-Jornet J. Proposed model to determine satisfaction with computerised provider order entry systems in a long-stay hospital. Eur J Hosp Pharm 2019; 26:73-78. [PMID: 31157103 DOI: 10.1136/ejhpharm-2017-001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives Computerised provider order entry (CPOE) systems reduce medication errors, but are not without dangers. Knowing satisfaction with the CPOE helps to improve its implementation. Our objective was to determine the satisfaction of healthcare professionals with the CPOE in a long-stay hospital and to propose a single model. Methods A cross-sectional study in a long-stay hospital. Two questionnaires were distributed to determine satisfaction with CPOE, one for medical personnel (MP) and another for nursing personnel (NP). Data collected were: sex, age and work aspects. A strategy for item refinement and creation of a single scale was designed. Results The overall participation rate was 63.6%, with 68 responses from the target population of 107. Overall, 72.2% (13 of 18) of MP and 40% (20 of 50) of NP were satisfied with CPOE. Regarding the specific questions on satisfaction in the questionnaires, 88.9% (n=16) of MP were very satisfied but only 56.0% (n=28) of NP. The median of each question was 4, with the exception of those for NP referring to a faster process and improved coordination, which were 3 and 3.5, respectively. The items weighing more in the second component were eliminated and the questions merged. After refining the items, a final six-item model was obtained with a single component of high reliability (Cronbach's α=0.896), which accounts for 67% of total variance. Conclusion The degree of satisfaction with CPOE in a long-stay hospital was high, though lower in NP than MP. Obtaining a single questionnaire can facilitate this process.
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Affiliation(s)
| | - Maria Jose Merino-Plaza
- Department of Laboratory, Hospital Dr Moliner, Serra, Valencia, Spain.,Social Pharmacy, University of Granada, Granada, Spain
| | | | | | | | - Jaime Poquet-Jornet
- Department of Pharmacy, Hospital de Denia (Marina Salud), Denia, Alicante, Spain
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15
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Prevalence of computerized physician order entry systems-related medication prescription errors: A systematic review. Int J Med Inform 2017; 111:112-122. [PMID: 29425622 DOI: 10.1016/j.ijmedinf.2017.12.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The positive impact of computerized physician order entry (CPOE) systems on prescription safety must be considered in light of the persistence of certain types of medication-prescription errors. We performed a systematic review, based on the PRISMA statement, to analyze the prevalence of prescription errors related to the use of CPOE systems. MATERIALS AND METHODS We searched MEDLINE, EMBASE, CENTRAL, DBLP, the International Clinical Trials Registry, the ISI Web of Science, and reference lists of relevant articles from March 1982 to August 2017. We included original peer-reviewed studies which quantitatively reported medication-prescription errors related to CPOE. We analyzed the prevalence of medication-prescription errors according to an adapted version of the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) taxonomy and assessed the mechanisms responsible for each type of prescription error due to CPOE. RESULTS Fourteen studies were included. The prevalence of CPOE systems-related medication errors relative to all prescription medication errors ranged from 6.1 to 77.7% (median = 26.1% [IQR:17.6-42,1]) and was less than 6.3% relative to the number of prescriptions reviewed. All studies reported "wrong dose" and "wrong drug" errors. The "wrong dose" error was the most frequently reported (from 7 to 67.4%, median = 31.5% [IQR:20.5-44.5]). We report the associated mechanism for each type of medication described (those due to CPOE or those occurring despite CPOE). DISCUSSION We observed very heterogeneous results, probably due to the definition of error, the type of health information system used for the study, and the data collection method used. Each data collection method provides valuable and useful information concerning the prevalence and specific types of errors related to CPOE systems. CONCLUSIONS The reporting of prescription errors should be continued because the weaknesses of CPOE systems are potential sources of error. Analysis of the mechanisms behind CPOE errors can reveal areas for improvement.
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Kadmon G, Pinchover M, Weissbach A, Kogan Hazan S, Nahum E. Case Not Closed: Prescription Errors 12 Years after Computerized Physician Order Entry Implementation. J Pediatr 2017; 190:236-240.e2. [PMID: 29144250 DOI: 10.1016/j.jpeds.2017.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/18/2017] [Accepted: 08/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the prolonged impact of computerized physician order entry (CPOE) on medication prescription errors in pediatric intensive care patients. STUDY DESIGN This observational study was conducted at a pediatric intensive care unit in which a CPOE (Metavision, iMDsoft, Israel) with a limited clinical decision support system was implemented between 2004 and 2007. Since then, no changes were made to the systems. We analyzed 2500 electronic prescriptions (1250 prescriptions from 2015 and 1250 prescriptions from 2016). Prescription errors were identified by a pediatric intensive care physician and classified as potential adverse drug events, medication prescription errors, or rule violations. Their prevalence was compared with the rate in 2007, reported in a previous study from the same unit. A randomly selected 10% of the prescriptions were also analyzed by the pediatric intensive care unit pharmacist, and the level of agreement was determined. RESULTS The rate of prescription errors increased from 1.4% in 2007 to 3.2% in 2015 (P = .03). Following revision of the clinical decision support system tools, prescription errors decreased to 1% in 2016 (P < .0001). The potential adverse drug event rate dropped from 2% in 2015 to 0.7% in 2016 (P = .006), and the medication prescription error rate, from 1% to 0.2% (P = .01). The agreement between the 2 reviewers was excellent (k = 0.96). CONCLUSIONS The rate of prescription errors may increase with time from implementation of a CPOE. Repeated surveillance of prescription errors is highly advised to plan strategies to reduce them. This approach should be considered in quality improvement of computerized information systems in general.
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Affiliation(s)
- Gili Kadmon
- Pediatric Intensive Care Unit, Schneider Children's Medical Center in Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michal Pinchover
- Pharmacy Department, Schneider Children's Medical Center in Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avichai Weissbach
- Pediatric Intensive Care Unit, Schneider Children's Medical Center in Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shirley Kogan Hazan
- Pediatric Intensive Care Unit, Schneider Children's Medical Center in Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elhanan Nahum
- Pediatric Intensive Care Unit, Schneider Children's Medical Center in Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Technology-induced errors associated with computerized provider order entry software for older patients. Int J Clin Pharm 2017; 39:729-742. [DOI: 10.1007/s11096-017-0474-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
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Quist AJL, Hickman TTT, Amato MG, Volk LA, Salazar A, Robertson A, Wright A, Bates DW, Phansalkar S, Lambert BL, Schiff GD. Analysis of variations in the display of drug names in computerized prescriber-order-entry systems. Am J Health Syst Pharm 2017; 74:499-509. [DOI: 10.2146/ajhp151051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Arbor J. L. Quist
- Epidemiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Mary G. Amato
- Department of Pharmacy Practice, MCPHS University, Boston, MA
| | | | | | | | | | | | - Shobha Phansalkar
- Brigham and Women’s Hospital, Boston, MA
- Clinical Drug Information Division, Wolters Kluwer Health, Indianapolis, IN
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Brockow K, Aberer W, Atanaskovic-Markovic M, Bavbek S, Bircher A, Bilo B, Blanca M, Bonadonna P, Burbach G, Calogiuri G, Caruso C, Celik G, Cernadas J, Chiriac A, Demoly P, Oude Elberink JNG, Fernandez J, Gomes E, Garvey LH, Gooi J, Gotua M, Grosber M, Kauppi P, Kvedariene V, Laguna JJ, Makowska J, Mosbech H, Nakonechna A, Papadopolous NG, Ring J, Romano A, Rockmann H, Sargur R, Sedlackova L, Sigurdardottir S, Schnyder B, Storaas T, Torres M, Zidarn M, Terreehorst I. Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper. Allergy 2016; 71:1533-1539. [PMID: 27145347 DOI: 10.1111/all.12929] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 12/27/2022]
Abstract
The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross-reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation.
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Moro Agud M, Menéndez Colino R, Mauleón Ladrero MDC, Ruano Encinar M, Díez Sebastián J, Villamañán Bueno E, Herrero Ambrosio A, González Montalvo JI. Analysis of an electronic medication reconciliation and information at discharge programme for frail elderly patients. Int J Clin Pharm 2016; 38:996-1001. [DOI: 10.1007/s11096-016-0331-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 06/04/2016] [Indexed: 10/21/2022]
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New technologies as a strategy to decrease medication errors: how do they affect adults and children differently? World J Pediatr 2016; 12:28-34. [PMID: 26684316 DOI: 10.1007/s12519-015-0067-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/12/2014] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medication error can occur throughout the drug treatment process, with special relevance in children given the risk of adverse effects resulting from a medication error is more prevalent than in adults. The significance of medication error in children is also greater because small error that would be tolerated in adults can cause significant damage in children. Moreover, the likelihood of injury is higher than in adults. DATA SOURCES Based on the data published, most medication errors take place in prescribing and administration stages in both populations. Taking in account that child's risk factors are different from those of adults, with some specific causes to pediatrics, we have reviewed available data about new technologies as a strategy to reduce pediatric medication errors. RESULTS Even though there is a lack of standardized definitions and terminology that makes studies difficult to compare, we checked that new technologies have proven to be effectives in reducing medication errors, mainly computerized physician order entry (CPOE) and platforms to aid decision-making. However, we also observed that the use of these informatic tools can also generate new errors. CONCLUSIONS Implementation of CPOE programs for pediatrics, communication improvement between healthcare professionals taking care of admitted children and the knowledge of these programs should be the mayor priorities for the safety of hospitalized children.
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Wu X, Wu C, Zhang K, Wei D. Residents' numeric inputting error in computerized physician order entry prescription. Int J Med Inform 2016; 88:25-33. [PMID: 26878759 DOI: 10.1016/j.ijmedinf.2016.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/22/2015] [Accepted: 01/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Computerized physician order entry (CPOE) system with embedded clinical decision support (CDS) can significantly reduce certain types of prescription error. However, prescription errors still occur. Various factors such as the numeric inputting methods in human computer interaction (HCI) produce different error rates and types, but has received relatively little attention. OBJECTIVE This study aimed to examine the effects of numeric inputting methods and urgency levels on numeric inputting errors of prescription, as well as categorize the types of errors. METHODS Thirty residents participated in four prescribing tasks in which two factors were manipulated: numeric inputting methods (numeric row in the main keyboard vs. numeric keypad) and urgency levels (urgent situation vs. non-urgent situation). Multiple aspects of participants' prescribing behavior were measured in sober prescribing situations. RESULTS The results revealed that in urgent situations, participants were prone to make mistakes when using the numeric row in the main keyboard. With control of performance in the sober prescribing situation, the effects of the input methods disappeared, and urgency was found to play a significant role in the generalized linear model. Most errors were either omission or substitution types, but the proportion of transposition and intrusion error types were significantly higher than that of the previous research. Among numbers 3, 8, and 9, which were the less common digits used in prescription, the error rate was higher, which was a great risk to patient safety. CONCLUSIONS Urgency played a more important role in CPOE numeric typing error-making than typing skills and typing habits. It was recommended that inputting with the numeric keypad had lower error rates in urgent situation. An alternative design could consider increasing the sensitivity of the keys with lower frequency of occurrence and decimals. To improve the usability of CPOE, numeric keyboard design and error detection could benefit from spatial incidence of errors found in this study.
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Affiliation(s)
- Xue Wu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Peking University School of Nursing, Beijing, China
| | - Changxu Wu
- Department of Industrial and Systems Engineering, State University of New York (SUNY)-Buffalo, NY, USA.
| | - Kan Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Dong Wei
- General Surgery Department, Beijing Hospital, Beijing, China
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Idemoto LM, Williams BL, Ching JM, Blackmore CC. Implementation of a custom alert to prevent medication-timing errors associated with computerized prescriber order entry. Am J Health Syst Pharm 2015; 72:1481-8. [DOI: 10.2146/ajhp140790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Joan M. Ching
- Center for Health Services Research, Virginia Mason Medical Center, Seattle, WA
| | - C. Craig Blackmore
- Center for Health Services Research, Virginia Mason Medical Center, Seattle, WA
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Hellot-Guersing M, Jarre C, Molina C, Leromain AS, Derharoutunian C, Gadot A, Roubille R. [Medication errors related to computerized physician order entry at the hospital: Record and analysis over a period of 4 years]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 74:61-70. [PMID: 26283161 DOI: 10.1016/j.pharma.2015.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Computerized physician order entry (CPOE) can generate medication errors. It is necessary to identify them and analyse their causes in order to secure the medication use system. METHODS Errors were recorded during the pharmaceutical analysis of prescriptions over a period of 4 years on 425 beds. A code frame was provided. Errors were classified according to type, causes and time of detection. The most often drug implicated and the error correction rate were studied. Deep causes were determined and contributing factors were listed. RESULTS Among 99,536 prescriptions analyzed, 2636 errors were detected (2.65 errors per 100 orders analyzed). The most common error was omission (31.49%). The most represented cause was redundancy requirement (11.34%). Antibacterials were most commonly involved (224 errors). Exactly 65.9% of the prescriptions were modified by physicians. Three root causes were identified: (1) configuration issues; (2) misuse; (3) design problem. Three types of contributing factors have also been detailed: economic, human and technical factors. CONCLUSIONS Identifying root causes has targeted three types of improvement actions: (1) software settings; (2) training of users; (3) requests for improvements. Contributing factors have to be identified to control the generated risk. Some errors related to CPOE may lead to serious side effects for the patient. That is why it is necessary to identify these errors and analyze them in order to implement improvement actions and prevention to secure the prescription.
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Affiliation(s)
- M Hellot-Guersing
- Service de pharmacie, centre hospitalier Lucien-Hussel, montée du Docteur-Chapuis, 38200 Vienne, France.
| | - C Jarre
- Service de pharmacie, centre hospitalier Lucien-Hussel, montée du Docteur-Chapuis, 38200 Vienne, France
| | - C Molina
- Service de pharmacie, centre hospitalier Lucien-Hussel, montée du Docteur-Chapuis, 38200 Vienne, France
| | - A-S Leromain
- Service de pharmacie, centre hospitalier Lucien-Hussel, montée du Docteur-Chapuis, 38200 Vienne, France
| | - C Derharoutunian
- Service de pharmacie, centre hospitalier Lucien-Hussel, montée du Docteur-Chapuis, 38200 Vienne, France
| | - A Gadot
- Service de pharmacie, centre hospitalier Lucien-Hussel, montée du Docteur-Chapuis, 38200 Vienne, France
| | - R Roubille
- Service de pharmacie, centre hospitalier Lucien-Hussel, montée du Docteur-Chapuis, 38200 Vienne, France
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Sanchez Cuervo M, Rojo Sanchis A, Pueyo Lopez C, Gomez de Salazar Lopez de Silanes E, Gramage Caro T, Bermejo Vicedo T. The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation. J Clin Pharm Ther 2015; 40:550-554. [PMID: 26177870 DOI: 10.1111/jcpt.12305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Computerized physician order entry (CPOE) systems reduce medical errors (MEs). Nevertheless, a CPOE system may also lead to new types of errors, especially when it is first implemented. The objectives of this study were to determine the impact of a CPOE on the number of MEs and to identify the types of MEs in prescriptions issued by the Haematology Department 5 years after the implementation of the CPOE system. METHODS We conducted a prospective analytical study on the implementation of a CPOE system at the Pharmacy Department of the Hospital Ramon y Cajal (Madrid, Spain). The study comprised three phases: a pre-implementation phase, an implementation phase conducted in the Haematology Department and a post-implementation phase, which was conducted 5 years after the implementation of the CPOE system. One hundred and fifty prescriptions per pre- and post-implementation phase were consecutively included in the study. A previously described classification scheme was used to detect and classify MEs. RESULTS AND DISCUSSION The implementation of a CPOE system was associated with a large reduction in MEs. One hundred and fourteen patients (pre-implementation phase) were compared to 82 patients (post-implementation phase). The total number of MEs per 100 patients decreased from 236·8 (95% CI: 212·1-261·3) to 10·9 (95% CI: 5·8-19·6), with an absolute risk reduction of 36·2 (95% CI: 32·6-39·9). The percentage of prescriptions with an ME decreased from 37·5% to 1·2% (P < 0.001). In the pre-implementation phase, the drugs most frequently associated with MEs were rituximab (35·9%), cyclophosphamide (13%) and methotrexate (7%). In the post-implementation phase, 44·4% of prescription errors involved methotrexate. Five years after the implementation of the CPOE system, the majority of MEs were eliminated, the number of remaining errors (quantity, concentration and ambiguous prescription errors) decreased, and no new types of ME were detected. WHAT IS NEW AND CONCLUSION The CPOE system almost completely eliminated MEs with antineoplastic drugs in the Haematology Department. No new types of MEs were observed once physicians had become accustomed to using the system. However, some MEs were not eliminated. Constant diligence is needed to analyse and evaluate MEs associated with the CPOE system and their causes, such that the limitations of CPOE can be identified and overcome and the medication-use process associated with antineoplastic agents improved.
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Affiliation(s)
| | - A Rojo Sanchis
- Department of Pharmacy, Ramon y Cajal Hospital, Madrid, Spain
| | - C Pueyo Lopez
- Department of Pharmacy, Ramon y Cajal Hospital, Madrid, Spain
| | | | - T Gramage Caro
- Department of Pharmacy, Ramon y Cajal Hospital, Madrid, Spain
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Green RA, Hripcsak G, Salmasian H, Lazar EJ, Bostwick SB, Bakken SR, Vawdrey DK. Intercepting wrong-patient orders in a computerized provider order entry system. Ann Emerg Med 2014; 65:679-686.e1. [PMID: 25534652 DOI: 10.1016/j.annemergmed.2014.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 10/08/2014] [Accepted: 11/21/2014] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE We evaluate the short- and long-term effect of a computerized provider order entry-based patient verification intervention to reduce wrong-patient orders in 5 emergency departments. METHODS A patient verification dialog appeared at the beginning of each ordering session, requiring providers to confirm the patient's identity after a mandatory 2.5-second delay. Using the retract-and-reorder technique, we estimated the rate of wrong-patient orders before and after the implementation of the intervention to intercept these errors. We conducted a short- and long-term quasi-experimental study with both historical and parallel controls. We also measured the amount of time providers spent addressing the verification system, and reasons for discontinuing ordering sessions as a result of the intervention. RESULTS Wrong-patient orders were reduced by 30% immediately after implementation of the intervention. This reduction persisted when inpatients were used as a parallel control. After 2 years, the rate of wrong-patient orders remained 24.8% less than before intervention. The mean viewing time of the patient verification dialog was 4.2 seconds (SD=4.0 seconds) and was longer when providers indicated they placed the order for the wrong patient (4.9 versus 4.1 seconds). Although the display of each dialog took only seconds, the large number of display episodes triggered meant that the physician time to prevent each retract-and-reorder event was 1.5 hours. CONCLUSION A computerized provider order entry-based patient verification system led to a moderate reduction in wrong-patient orders that was sustained over time. Interception of wrong-patient orders at data entry is an important step in reducing these errors.
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Affiliation(s)
- Robert A Green
- Department of Emergency Medicine, Columbia University Medical Center and NewYork-Presbyterian Hospital, New York, NY; Division of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, NY.
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY; Medical Informatics Services, NewYork-Presbyterian Hospital, New York, NY
| | - Hojjat Salmasian
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Eliot J Lazar
- Division of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, NY
| | - Susan B Bostwick
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Suzanne R Bakken
- Department of Biomedical Informatics, Columbia University, New York, NY; School of Nursing, Columbia University, New York, NY
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY; Medical Informatics Services, NewYork-Presbyterian Hospital, New York, NY
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Answer to the comment on 'potential medication errors associated with computer prescriber order entry'. Int J Clin Pharm 2014; 36:1099-100. [PMID: 25348680 DOI: 10.1007/s11096-014-0028-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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28
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The impact of computerized physician order entry on medication error prevention. Int J Clin Pharm 2014; 36:1097-8. [DOI: 10.1007/s11096-014-0027-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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29
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Improving radiopharmaceutical supply chain safety by implementing bar code technology. Nucl Med Commun 2014; 35:1179-87. [PMID: 25144560 DOI: 10.1097/mnm.0000000000000177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to describe and evaluate an approach for improving radiopharmaceutical supply chain safety by implementing bar code technology. We first evaluated the current situation of our radiopharmaceutical supply chain and, by means of the ALARM protocol, analysed two dispensing errors that occurred in our department. Thereafter, we implemented a bar code system to secure selected key stages of the radiopharmaceutical supply chain. Finally, we evaluated the cost of this implementation, from overtime, to overheads, to additional radiation exposure to workers. An analysis of the events that occurred revealed a lack of identification of prepared or dispensed drugs. Moreover, the evaluation of the current radiopharmaceutical supply chain showed that the dispensation and injection steps needed to be further secured. The bar code system was used to reinforce product identification at three selected key stages: at usable stock entry; at preparation-dispensation; and during administration, allowing to check conformity between the labelling of the delivered product (identity and activity) and the prescription. The extra time needed for all these steps had no impact on the number and successful conduct of examinations. The investment cost was reduced (2600 euros for new material and 30 euros a year for additional supplies) because of pre-existing computing equipment. With regard to the radiation exposure to workers there was an insignificant overexposure for hands with this new organization because of the labelling and scanning processes of radiolabelled preparation vials. Implementation of bar code technology is now an essential part of a global securing approach towards optimum patient management.
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30
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Farmer B. Prevention of adverse drug events. Clin Toxicol (Phila) 2014; 52:573-8. [DOI: 10.3109/15563650.2014.909602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lövborg H, Holmlund M, Hägg S. Medication errors related to transdermal opioid patches: lessons from a regional incident reporting system. BMC Pharmacol Toxicol 2014; 15:31. [PMID: 24912424 PMCID: PMC4062292 DOI: 10.1186/2050-6511-15-31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/20/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE A few cases of adverse reactions linked to erroneous use of transdermal opioid patches have been reported in the literature. The aim of this study was to describe and characterize medication errors (MEs) associated with use of transdermal fentanyl and buprenorphine. METHODS All events concerning transdermal opioid patches reported between 2004 and 2011 to a regional incident reporting system and assessed as MEs were scrutinized and characterized. MEs were defined as "a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient". RESULTS In the study 151 MEs were identified. The three most common error types were wrong administration time 67 (44%), wrong dose 34 (23%), and omission of dose 20 (13%). Of all MEs, 118 (78%) occurred in the administration stage of the medication process. Harm was reported in 26 (17%) of the included cases, of which 2 (1%) were regarded as serious harm (nausea/vomiting and respiratory depression). Pain was the most common adverse reaction reported. CONCLUSIONS Of the reported MEs related to transdermal fentanyl and buprenorphine, most occurred during administration. Improved routines to ascertain correct and timely administration and educational interventions to reduce MEs for these drugs are warranted.
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Affiliation(s)
- Henrik Lövborg
- Department of Clinical Pharmacology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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