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Ruan EL, Rossetti SC, Hsu H, Kim EY, Trepp RC. A Practical Approach to Optimize Computerized Provider Order Entry Systems and Reduce Clinician Burden: Pre-Post Evaluation of Vendor-Derived "Order Friction" Data. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1246-1256. [PMID: 38222358 PMCID: PMC10785931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Computerized provider order entry (CPOE) systems have been cited as a significant contributor to clinician burden. Vendor-derived measures and data sets have been developed to help with optimization of CPOE systems. We describe how we analyzed vendor-derived Order Friction (OF) EHR log data at our health system and propose a practical approach for optimizing CPOE systems by reducing OF. We also conducted a pre-post intervention study using OF data to evaluate the impact of defaulting the frequency of urine, stool and nasal swab tests and found that all modified orders had significantly fewer changes required per order (p<0.01). Our proposed approach is a six-step process: 1) understand the ordering process, 2) understand OF data elements contextually, 3) explore ordering user-level factors, 4) evaluate order volume and friction from different order sources, 5) optimize order-level design, 6) identify high volume alerts to evaluate for appropriateness.
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Affiliation(s)
- Elise L Ruan
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Sarah C Rossetti
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- School of Nursing, Columbia University, New York, New York, USA
| | - Hanson Hsu
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Eugene Y Kim
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Richard C Trepp
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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Climent-Ballester S, García-Salom P, Sanz-Valero J. Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature. Front Public Health 2023; 11:1233264. [PMID: 37711235 PMCID: PMC10498460 DOI: 10.3389/fpubh.2023.1233264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs). Methods The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital." Results A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations. Conclusion Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.
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Affiliation(s)
- Seira Climent-Ballester
- Pharmacy Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pedro García-Salom
- Pharmacy Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Javier Sanz-Valero
- National School of Occupational Medicine, Carlos III Health Institute, Madrid, Spain
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Impact of Computerized Provider Order Entry on Chemotherapy Medication Errors: A Systematic Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-120300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Chemotherapy errors are considered the second most common cause of fatal medication errors (ME). Currently, computerized provider order entry (CPOE) is increasingly used to prevent or decrease ME and improve the safety of the medication process. Objectives: This study was conducted to systematically review the impacts of CPOE on the incidence of chemotherapy ME, the severity of errors, and adverse drug events (ADEs) in cancer care units. Data Sources: The literature search was conducted, using 5 databases of PubMed, EMBASE, Scopus, Web of Science, and ScienceDirect between 2000 and 2020. Search terms included keywords and MESH terms related to CPOE, ME, chemotherapy, and cancer care unit. Study Selection: Articles were included in this research if they investigated the CPOE system, reported ME, and were carried out in the oncology department. Non-English papers, duplications, review studies, and conference papers were excluded. Data Extraction: The selected papers were read repeatedly and related papers were extracted. All eligible articles were qualitatively evaluated with a tool provided by Downs. The extracted information included the author’s name, year of publication, study location, type of study, study objectives, and main findings. Results: A total of 829 studies were retrieved. Fourteen articles met the inclusion criteria. Ten studies (71%) reported the impact of CPOE on chemotherapy ME in comparison with the paper-based ordering method. In 4 studies (29%), researchers developed a CPOE for the oncology department, and the system was, then, assessed concerning user experience, safety challenges as well as the effects of CPOE on ME. Nine articles (64%) reported the impact of the CPOE system on ME only in the prescribing phase, and 5 studies (36%) examined ME in all phases of the chemotherapy process. Five studies (36%) reported the impact of the CPOE system on ADEs and the severity of errors. Conclusions: Implementing CPOE is associated with a significant reduction in ME in all phases of the chemotherapy process. However, the CPOE does not prevent all MEs and may cause new errors. The rigorous analysis of the chemotherapy process and considering the designing principles could help develop the CPOE systems and minimize ME.
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Shah SN, Amato MG, Garlo KG, Seger DL, Bates DW. Renal medication-related clinical decision support (CDS) alerts and overrides in the inpatient setting following implementation of a commercial electronic health record: implications for designing more effective alerts. J Am Med Inform Assoc 2021; 28:1081-1087. [PMID: 33517413 PMCID: PMC8661393 DOI: 10.1093/jamia/ocaa222] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 09/04/2020] [Indexed: 11/12/2022] Open
Abstract
Objective To assess the appropriateness of medication-related clinical decision support (CDS) alerts associated with renal insufficiency and the potential/actual harm from overriding the alerts. Materials and Methods Override rate frequency was recorded for all inpatients who had a renal CDS alert trigger between 05/2017 and 04/2018. Two random samples of 300 for each of 2 types of medication-related CDS alerts associated with renal insufficiency—“dose change” and “avoid medication”—were evaluated by 2 independent reviewers using predetermined criteria for appropriateness of alert trigger, appropriateness of override, and patient harm. Results We identified 37 100 “dose change” and 5095 “avoid medication” alerts in the population evaluated, and 100% of each were overridden. Dose change triggers were classified as 12.5% appropriate and overrides of these alerts classified as 90.5% appropriate. Avoid medication triggers were classified as 29.6% appropriate and overrides 76.5% appropriate. We identified 5 adverse drug events, and, of these, 4 of the 5 were due to inappropriately overridden alerts. Conclusion Alerts were nearly always presented inappropriately and were all overridden during the 1-year period studied. Alert fatigue resulting from receiving too many poor-quality alerts may result in failure to recognize errors that could lead to patient harm. Although medication-related CDS alerts associated with renal insufficiency had previously been found to be the most clinically beneficial alerts in a legacy system, in this system they were ineffective. These findings underscore the need for improvements in alert design, implementation, and monitoring of alert performance to make alerts more patient-specific and clinically appropriate.
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Affiliation(s)
- Sonam N Shah
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,MCPHS University, Boston, Massachusetts, USA
| | - Mary G Amato
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,MCPHS University, Boston, Massachusetts, USA
| | - Katherine G Garlo
- Division of Nephrology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Diane L Seger
- Clinical and Quality Analysis, Partners HealthCare, Somerville, Massachusetts, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Clinical and Quality Analysis, Partners HealthCare, Somerville, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Gates PJ, Hardie RA, Raban MZ, Li L, Westbrook JI. How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis. J Am Med Inform Assoc 2021; 28:167-176. [PMID: 33164058 PMCID: PMC7810459 DOI: 10.1093/jamia/ocaa230] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. MATERIALS AND METHODS We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. RESULTS There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18-8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72-0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. DISCUSSION AND CONCLUSION Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Rae-Anne Hardie
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Shah SN, Seger DL, Fiskio JM, Horn JR, Bates DW. Comparison of Medication Alerts from Two Commercial Applications in the USA. Drug Saf 2021; 44:661-668. [PMID: 33616888 PMCID: PMC8184526 DOI: 10.1007/s40264-021-01048-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
Introduction Medication organizations across the USA have adopted electronic health records, and one of the most anticipated benefits of these was improved medication safety, but alert fatigue has been a major issue. Objective We compared the appropriateness of medication-related clinical decision support alerts triggered by two commercial applications: EPIC and Seegnal’s platform. Methods This was a retrospective comparison of two commercial applications. We provided Seegnal with deidentified inpatient, outpatient, and inpatient genetic electronic medical record (EMR)-extracted datasets for 657, 2731, and 413 patients, respectively. Seegnal then provided the alerts that would have triggered, which we compared with those triggered by EPIC in clinical care. A random sample of the alerts triggered were reviewed for appropriateness, and the positive predictive value (PPV) and negative predictive value (NPV) were calculated. We also reviewed all the inpatient and outpatient charts for patients within our cohort who were receiving ten or more concomitant medications with alerts we found to be appropriate to assess whether any adverse events had occurred and whether Seegnal’s platform could have prevented them. Results Results from EPIC and the Seegnal platform were compared based on alert load, PPV, NPV, and potential adverse events. Overall, compared with EPIC, the Seegnal platform triggered fewer alerts in the inpatient (1697 vs. 27,540), outpatient (2341 vs. 35,134), and inpatient genetic (1493 vs. 20,975) cohorts. The Seegnal platform had higher specificity in the inpatient (99 vs. 0.3%; p < 0.0001), outpatient (99 vs. 0.3%; p < 0.0001), and inpatient genetic (97.9 vs. 1.2%; p < 0.0001) groups and higher sensitivity in the inpatient (100 vs. 68.8%; p < 0.0001) and outpatient (88.6 vs.78.3%; p < 0.0001) groups but not in the inpatient genetic cohort (81 vs. 78.5%; p = 0.11). We identified 16 adverse events that occurred in the inpatient setting, 11 (69%) of which potentially could have been prevented with the Seegnal platform. Conclusions Overall, the Seegnal platform triggered 94% fewer alerts than EPIC in the inpatient setting and 93% fewer in the outpatient setting, with much higher sensitivity and specificity. This application could substantially reduce alert fatigue and improve medication safety at the same time. Supplementary Information The online version of this article (10.1007/s40264-021-01048-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sonam N Shah
- Department of General Internal Medicine, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, Office 103, Boston, MA, 02115, USA. .,Department of Pharmacy Practice, MCPHS University, Boston, MA, USA.
| | - Diane L Seger
- Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, USA
| | - Julie M Fiskio
- Department of General Internal Medicine, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, Office 103, Boston, MA, 02115, USA
| | - John R Horn
- University of Washington Medicine Pharmacy Services, Seattle, WA, USA
| | - David W Bates
- Department of General Internal Medicine, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, Office 103, Boston, MA, 02115, USA.,Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, USA.,Harvard Medical School, Boston, MA, USA
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7
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Abstract
BACKGROUND Medication errors are one of the leading avoidable sources of harm to hospital patients. In hospitals, a range of interventions have been used to reduce the risk of errors at each of the points they may occur, such as prescription, dispensing and/or administration. Systematic reviews have been conducted on many of these interventions; however, it is difficult to compare the clinical utility of any of the separate interventions without the use of a rigorous umbrella review methodology. OBJECTIVES The aim of this umbrella review was to synthesize the evidence from all systematic reviews investigating the effectiveness of medication safety interventions, in comparison to any or no comparator, for preventing medication errors, medication-related harms and death in acute care patients. METHOD The review considered quantitative systematic reviews with participants who were healthcare workers involved in prescribing, dispensing or administering medications. These healthcare workers were registered nurses, enrolled or licensed vocational nurses, midwives, pharmacists or medical doctors. Interventions of interest were those designed to prevent medication error in acute care settings. Eligible systematic reviews reported medication errors, medication-related harms and medication-related death as measured by error rates, numbers of adverse events and numbers of medication-related deaths. To qualify for inclusion, systematic reviews needed to provide a clearly articulated and comprehensive search strategy, and evidence of critical appraisal of the included studies using a standardized tool. Systematic reviews published in English since 2007 were included until present (March 2020). We searched a range of databases such MEDLINE, CINAHL, Web of Science, EMBASE, and The Cochrane Library for potentially eligible reviews. Identified citations were screened by two reviewers working independently. Potentially eligible articles were retrieved and assessed against the inclusion criteria and those meeting the criteria were then critically appraised using the JBI SUMARI instrument for assessing the methodological quality of systematic reviews and research syntheses. A predetermined quality threshold was used to exclude studies based on their reported methods. Following critical appraisal, data were extracted from the included studies by two independent reviewers using the relevant instrument in JBI SUMARI. Extracted findings were synthesized narratively and presented in tables to illustrate the reported outcomes for each intervention. The strength of the evidence for each intervention was indicated using 'traffic light' colors: green for effective interventions, amber for interventions with no evidence of an effect and red for interventions less effective than the comparison. RESULTS A total of 23 systematic reviews were included in this umbrella review. Most reviews did not report the number of participants in their included studies. Interventions targeted pharmacists, medical doctors, medical students and nurses, or were nonspecific about the participants. The majority of included reviews examined single interventions. All reviews were published and in English. Four interventions, medication administration education, medication reconciliation or review, specialist pharmacists' roles and physical or design modifications, reported effectiveness in reducing errors; however, heterogeneity between the included studies in these reviews was high. CONCLUSION For some interventions, there are strong indications of effectiveness in reducing medication errors in the inpatient setting. Government initiatives, policy makers and practitioners interested in improving medication safety are encouraged to adopt those interventions.
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McCarthy S, Fitzgerald C, Sahm L, Bradley C, Walsh EK. Patient-held health IT adoption across the primary-secondary care interface: a Normalisation Process Theory perspective. Health Syst (Basingstoke) 2020; 11:17-29. [DOI: 10.1080/20476965.2020.1822146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Stephen McCarthy
- Business Information Systems, University College Cork, Cork, Ireland
| | - Ciara Fitzgerald
- Business Information Systems, University College Cork, Cork, Ireland
| | - Laura Sahm
- Business Information Systems, University College Cork, Cork, Ireland
| | - Colin Bradley
- Business Information Systems, University College Cork, Cork, Ireland
| | - Elaine K Walsh
- Business Information Systems, University College Cork, Cork, Ireland
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9
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Bird J. Using change management to implement barcode medicines administration technology. Nurs Manag (Harrow) 2020; 27:30-34. [PMID: 32779450 DOI: 10.7748/nm.2020.e1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/09/2022]
Abstract
Confirming the patient's identity is one of the most important elements in medicines administration, with research showing that medication errors are one of the most common sources of harm caused to patients. This article discusses the implementation of a barcode medicines administration system using two change management models. A complex project such as the implementation of barcode medicines administration technology, requires staff engagement at all levels. The adoption rates of the new workflow patterns in this project showed the benefits of using various change management models during different phases of a project. The project also demonstrated how nurse leaders must use a range of resources to effectively implement a new project.
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Affiliation(s)
- James Bird
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, England
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Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Publication and related bias in quantitative health services and delivery research: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research.
Objectives
To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias.
Methods
The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8).
Results
We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates sometimes differed significantly between published and unpublished literature. Work package 2 showed low prevalence of considering/assessing publication (43%) and outcome reporting (17%) bias in health services and delivery research systematic reviews. The prevalence was lower among reviews of associations than among reviews of interventions. The case studies in work package 3 highlighted limitations in current methods for detecting these biases due to heterogeneity and potential confounders. Follow-up of health services and delivery research cohorts in work package 4 showed positive association between publication status and having statistically significant or positive findings. Diverse views concerning publication and related bias and insights into how features of health services and delivery research might influence its occurrence were uncovered through the interviews with health services and delivery research stakeholders and focus group discussion conducted in work package 5.
Conclusions
This study provided prima facie evidence on publication and related bias in quantitative health services and delivery research. This bias does appear to exist, but its prevalence and impact may vary depending on study characteristics, such as study design, and motivation for conducting the evaluation. Emphasis on methodological novelty and focus beyond summative assessments may mitigate/lessen the risk of such bias in health services and delivery research. Methodological and epistemological diversity in health services and delivery research and changing landscape in research publication need to be considered when interpreting the evidence. Collection of further empirical evidence and exploration of optimal health services and delivery research practice are required.
Study registration
This study is registered as PROSPERO CRD42016052333 and CRD42016052366.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Abimbola A Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iestyn Williams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Mousavi B, Maftoon F, Soroush M, Mohammad K, Majdzadeh R. Health Care Utilization and Expenditure in War Survivors. ARCHIVES OF IRANIAN MEDICINE 2020; 23:S9-S15. [DOI: 10.34172/aim.2020.s3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/12/2019] [Indexed: 11/09/2022]
Abstract
Background: To describe the utilization and out-of-pocket (OOP) payments of war survivors receiving health care services and its determinants. Methods: A cross-sectional study was carried out by systematic random sampling at national level (n = 3079) on healthcare utilization in war survivors on their last received services. A validated questionnaire was used to gather the information of inpatient and outpatient healthcare services and OOP payment. The data were analyzed to indicate the determinants of health utilization and expenses. Results: Health care utilization was reported in 91.6% (n = 2822). The majority (82.5%) received one or two services in their last visits, mostly related to physician visits and medications (65.97%). Health care utilization was higher than general population annually, especially in physician visit (6.6 versus 4.89), medication (5.1 versus 3.6), and hospitalization (0.78 versus 0.15). About 20.2% (n = 599) of the study population paid out of their pocket for their last medical care services. The frequency of OOP payment was greater for physician visit and medication. Payment for hospitalization, imaging, and lab tests were more significantly associated with proceeding to reimburse the expenses (P<0.001). The median OOP payment was US$10.8 (interquartile range US$20.6). Gender (P=0.003), area of residence (P=0.01) and being war victims (P=0.005) were the significant determinants for both OOP payments and reclaiming the expenditure. Higher amount of payments (P<0.001) and more received health services (P=0.002) were also important factors in reclaiming the expenditure. Conclusion: Both outpatient services and hospital admission are more frequent among war survivors compared to the general Iranian population. Future studies should attempt to explore the reasons.
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Affiliation(s)
- Batool Mousavi
- Prevention Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, IR Iran
| | - Farzaneh Maftoon
- Population Health Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, IR Iran
| | | | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Community Based Participatory Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Unexpected Increase in Benzodiazepine Prescriptions Related to the Introduction of an Electronic Prescribing Tool: Evidence from Multicenter Hospital Data. Diagnostics (Basel) 2019; 9:diagnostics9040190. [PMID: 31731589 PMCID: PMC6963612 DOI: 10.3390/diagnostics9040190] [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: 10/10/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022] Open
Abstract
Electronic Prescribing tools (e-prescribing) have shown several benefits in terms of prescribing process adequacy and health care quality in hospital settings. We hypothesize however, that an undesired effect of digitalisation, due to the easier and faster prescribing process allowing patients to skip face-to-face conversations with patients and nurses, is that it could facilitate the prescription of medications at high risk of overuse or abuse, such as benzodiazepines (BZDs). We conducted a panel data study to investigate, the impact of the introduction of an e-prescribing system on new BZD prescriptions in hospitalised patients in a network of five teaching hospitals. During the observation period 1 July 2014-30 April 2019, 43,320 admissions were analysed. A fixed-effects model was adopted to estimate the effect of e-prescribing on new BZD prescriptions. E-prescribing implementation was associated with a significant increase of new BZD prescriptions: absolute +1.5%, and relative +43% (p < 0.001). The effect was similar in males and females (respectively, absolute +2.3%, relative +65% (p < 0.001); absolute +1.8%, relative +58% (p = 0.01)) and in patients ≥70 years old (absolute +1.6%, relative +59% (p < 0.001)). After controlling for time-varying explanatory variables, the implementation of the e-prescribing tool showed similar significant effects. E-prescribing implementation was associated with a significant increase of new in-hospital BZD prescriptions. For classes of drugs at risk of overuse or abuse, e-prescribing should be used cautiously, to minimize the risk of over-prescriptions. Further research in other settings and countries is needed to analyse causal interactions between e-prescribing and BZD prescriptions in the hospital setting, and to promote the ultimate goal of high-value care.
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Papandreou P, Ntountaniotis D, Skouroliakou M, Massara P, Siahanidou T. Does a parenteral nutrition decision support system for total nutrients improve prescription procedure and neonatal growth? J Matern Fetal Neonatal Med 2019; 34:747-754. [PMID: 31122088 DOI: 10.1080/14767058.2019.1615432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background and objectives: Parenteral nutrition (PN) is an integral part of the nutritional support of critically ill neonates in the intensive care units (ICU). The evaluation of a decision support system for total nutrients (DSSFTN) is of great importance for clinical practice. This study's aim was to evaluate the impact caused by implementation of a DSSFTN on PN support and neonatal growth. This pilot work was supported by the hospital PN team (PNT) in order to assess possible benefits stemming from the use of DSSFTN.Materials and methods: DSSFTN development is based on the incorporation of pharmaceutical and therapeutic protocols. Thirty-eight neonates were recruited. Inclusion criteria included: patients should (a) be hospitalized in ICU, (b) receive PN support at least for 15 days, (c) have birth weight 550-1600 g. One exclusion criterion was applied: patients should have no inborn error of metabolism. 15 doctors prescribed PN for two groups of neonates. PN was calculated by doctors for Group 1 (19 neonates) and respectively was calculated by the DSSFTN (and checked by doctors) for Group 2 (19 neonates). A questionnaire was completed later by doctors to evaluate DSSFTN.Results: The implementation of DSSFTN led to appropriate composition and administration of PN. Growth was not significantly different between the study groups. Compliance with guidelines was observed. DSSFTN ameliorated intercommunication among doctors.Conclusions: The implementation of DSSFTN enables health professionals to facilitate the complex task of prescribing. It ensures the consistency of PN prescriptions, as it leads to appropriate dosing in all nutrients. DSSFTN provides real-time PN interventions (clinical conditions and enteral amounts are included additionally) and minimizes exposure to human errors.
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Affiliation(s)
- Panos Papandreou
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Skouroliakou
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Paraskevi Massara
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Tania Siahanidou
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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14
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Daupin J, Perrin G, Lhermitte-Pastor C, Loustalot MC, Pernot S, Savoldelli V, Thibault C, Landi B, Sabatier B, Caudron E. Pharmaceutical interventions to improve safety of chemotherapy-treated cancer patients: A cross-sectional study. J Oncol Pharm Pract 2019; 25:1195-1203. [DOI: 10.1177/1078155219826344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Johanne Daupin
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Germain Perrin
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- INSERM UMR 1138, Equipe 22, Centre de recherche des Cordeliers, Paris, France
| | | | | | - Simon Pernot
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | - Virginie Savoldelli
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- Clinical Pharmacy Department, Faculty of Pharmacy, U-Psud University Paris-Saclay, Châtenay-Malabry, France
| | - Constance Thibault
- Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France
| | - Bruno Landi
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | - Brigitte Sabatier
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- INSERM UMR 1138, Equipe 22, Centre de recherche des Cordeliers, Paris, France
| | - Eric Caudron
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- Lip(Sys)2 Laboratory of analytical chemistry, EA7357, U-Psud University Paris-Saclay, Châtenay-Malabry, France
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15
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Pouliot JD, Neal EB, Lobo BL, Hargrove F, Gupta RK. The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy. Hosp Pharm 2018; 53:170-176. [PMID: 30147137 DOI: 10.1177/0018578717741392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The use of epidural anesthesia has been shown to improve outcomes in the postoperative setting. To minimize risk of complications, avoiding certain medications with epidural anesthesia is advised. Objective: This study sought to determine the role of a computerized clinical decision support module implemented into the computerized physician order entry (CPOE) system on the incidence of administration of medications known to increase complications with epidural anesthesia. Methods: This study was a retrospective cohort chart review in adult patients receiving epidural anesthesia for at least 1 day. Patients were identified retrospectively and divided into 2 cohorts, those receiving an epidural 3 months prior to initiation of the module and those receiving an epidural 3 months following implementation. The primary end point was incidence of inappropriate medication administration before and after implementation. Complications of therapy were collected as secondary end points. Results: There was a reduction in the incidence of inappropriate medication administration in the postimplementation group versus the preimplementation group (6.3% vs 12.8%) although statistical significance was not achieved. In addition, the incidence of enoxaparin administration was significantly lower postimplementation than the preimplementation (0% vs 3.9%). There were no significant differences in other complications of therapy. Conclusions: This study demonstrated that application of decision support for this high-risk procedural population was able to eliminate the incidence of the most common inappropriate medication for epidural analgesia, enoxaparin. A reduction in incidence of other inappropriate medications was also observed; however, statistical significance was not reached. The use of computerized clinical decision support can be a powerful tool in reducing or ameliorating medication errors, and further study will be required to determine the most appropriate and effective implementation strategies.
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Affiliation(s)
- Jonathon D Pouliot
- Lipscomb University College of Pharmacy and Health Sciences, Nashville, TN, USA
| | - Erin B Neal
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bob L Lobo
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fred Hargrove
- Vanderbilt University Medical Center, Nashville, TN, USA
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16
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Cheng CM, Salazar A, Amato MG, Lambert BL, Volk LA, Schiff GD. Using drug knowledgebase information to distinguish between look-alike-sound-alike drugs. J Am Med Inform Assoc 2018; 25:872-884. [PMID: 29800453 DOI: 10.1093/jamia/ocy043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/05/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To extract drug indications from a commercial drug knowledgebase and determine to what extent drug indications can discriminate between look-alike-sound-alike (LASA) drugs. Methods We extracted drug indications disease concepts from the MedKnowledge Indications module from First Databank Inc. (South San Francisco, CA) and associated them with drugs on the Institute for Safe Medication Practices (ISMP) list of commonly confused drug names. We used high-level concepts (rather than granular concepts) to represent the general indications for each drug. Two pharmacists reviewed each drug's association with its high-level indications concepts for accuracy and clinical relevance. We compared the high-level indications for each commonly confused drug pair and categorized each pair as having a complete overlap, partial overlap or no overlap in high-level indications. Results Of 278 LASA drug pairs, 165 (59%) had no overlap and 58 (21%) had partial overlap in high-level indications. Fifty-five pairs (20%) had complete overlap in high-level indications; nearly half of these were comprised of drugs with the same active ingredient and route of administration (e.g., Adderall, Adderall XR). Conclusions Drug indications data from a drug knowledgebase can discriminate between many LASA drugs.
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Affiliation(s)
- Christine M Cheng
- First Databank, Inc., Disease Decision Support Group, South San Francisco, CA, USA
| | - Alejandra Salazar
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary G Amato
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.,Department of Pharmacy Practice, MCPHS University, Boston, MA, USA
| | - Bruce L Lambert
- Department of Communication Studies, Northwestern University, Chicago, IL, USA.,Center for Communication and Health, Northwestern University, Chicago, IL, USA
| | - Lynn A Volk
- Clinical and Quality Analysis, Partners HealthCare, Somerville, MA, USA
| | - Gordon D Schiff
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
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17
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Pontefract SK, Hodson J, Slee A, Shah S, Girling AJ, Williams R, Sheikh A, Coleman JJ. Impact of a commercial order entry system on prescribing errors amenable to computerised decision support in the hospital setting: a prospective pre-post study. BMJ Qual Saf 2018; 27:725-736. [PMID: 29572298 PMCID: PMC6109251 DOI: 10.1136/bmjqs-2017-007135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/20/2023]
Abstract
Background In this UK study, we investigated the impact of computerised physician order entry (CPOE) and clinical decision support (CDS) implementation on the rate of 78 high-risk prescribing errors amenable to CDS. Methods We conducted a preintervention/postintervention study in three acute hospitals in England. A predefined list of prescribing errors was incorporated into an audit tool. At each site, approximately 4000 prescriptions were reviewed both pre-CPOE and 6 months post-CPOE implementation. The number of opportunities for error and the number of errors that occurred were collated. Error rates were then calculated and compared between periods, as well as by the level of CDS. Results The prescriptions of 1244 patients were audited pre-CPOE and 1178 post-CPOE implementation. A total of 28 526 prescriptions were reviewed, with 21 138 opportunities for error identified based on 78 defined errors. Across the three sites, for those prescriptions where opportunities for error were identified, the error rate was found to reduce significantly post-CPOE implementation, from 5.0% to 4.0% (P<0.001). CDS implementation by error type was found to differ significantly between sites, ranging from 0% to 88% across clinical contraindication, dose/frequency, drug interactions and other error types (P<0.001). Overall, 43/78 (55%) of the errors had some degree of CDS implemented in at least one of the hospitals. Conclusions Implementation of CPOE with CDS was associated with clinically important reductions in the rate of high-risk prescribing errors. Given the pre-post design, these findings however need to be interpreted with caution. The occurrence of errors was found to be highly dependent on the level of restriction of CDS presented to the prescriber, with the effect that different configurations of the same CPOE system can produce very different results.
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Affiliation(s)
- Sarah K Pontefract
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ann Slee
- Digital Technology, NHS England, London, UK.,School of Health and Population Sciences, University of Edinburgh, Edinburgh, UK
| | - Sonal Shah
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alan J Girling
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Robin Williams
- Institute for the Study of Science, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Jamie J Coleman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham Medical School, Birmingham, UK
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18
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Drug-drug interactions and their harmful effects in hospitalised patients: a systematic review and meta-analysis. Eur J Clin Pharmacol 2017; 74:15-27. [PMID: 29058038 DOI: 10.1007/s00228-017-2357-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/16/2017] [Indexed: 02/01/2023]
Abstract
PURPOSE Drug-drug interactions (DDIs) are often avoidable and, if undetected, can lead to patient harm. This review aimed to determine the prevalence of potential DDIs (pDDIs), clinically relevant DDIs (DDIs that could lead to measurable patient harm, taking into account the patient's individual clinical profile) and DDIs that resulted in actual patient harm during hospitalisation. METHOD Four databases were scanned for English papers published from 2000 to 2016. Papers that reported prevalence of DDIs in the outpatient setting, at admission or discharge, involving only specific drugs, or in specific disease populations or age groups were excluded. RESULTS Twenty-seven papers met the inclusion criteria and were graded for quality using the Critical Appraisal Skills Programme (CASP) cohort study checklist. Ten papers were rated as 'poor', 14 as 'fair' and only three papers as 'good'. Overall, the meta-analysis revealed that 33% of general patients and 67% of intensive care patients experienced a pDDI during their hospital stay. It was not possible to determine the prevalence of clinically relevant DDIs or DDIs that resulted in actual patient harm as data on these categories were limited. Of the very few studies that reported on harm, only a small proportion of DDIs were found to have resulted in actual patient harm. CONCLUSIONS Standardisation of DDI definitions and research methods are required to allow meaningful prevalence rates to be obtained and compared. Studies that go further than measuring pDDIs are critically needed to determine the impact of DDIs on patient safety.
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19
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Jheeta S, Franklin BD. The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study. BMC Health Serv Res 2017; 17:547. [PMID: 28793906 PMCID: PMC5549345 DOI: 10.1186/s12913-017-2462-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 07/19/2017] [Indexed: 11/18/2022] Open
Abstract
Background The aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Additionally, we wanted to describe any observed changes to medication administration practices. Methods The study was based on an elderly medicine ward in an English hospital. From December 2014 to June 2015, nurses’ medication administration rounds were observed every 5 days before and after ePA implementation using an interrupted time-series approach. Medication administration error and documentation discrepancy rates pre- versus post-ePA were analysed descriptively and chi-squared tests used to test for any difference; segmented regression analysis was used to determine changes in longitudinal trend. Results Observations were made at 15 pre- and 15 post-ePA implementation time-points. Pre-ePA on paper, there were 18 medication administration errors in 428 opportunities for error (4.2%; 95% confidence interval 2.3–6.1%), and with ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9–5.0%; p = 0.64). Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1–2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8–4.7%; p = 0.04). The most common electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing and administering medications. Conclusions Findings suggest no change in medication error rate, although ePA encourages certain types of errors and mitigates others. There was a statistically significant increase in documentation discrepancies which is likely to be due to adoption of new working practices with ePA. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2462-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seetal Jheeta
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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20
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Abstract
BACKGROUND Adverse drug events (ADEs) represent a significant cause of injury in the ambulatory care setting. Computerized physician order entry reduces rates of serious medication errors that can lead to ADEs in the inpatient setting, but few studies have evaluated whether computerized prescribing in the ambulatory setting reduces preventable ADE rates in ambulatory care. OBJECTIVE To determine the rates of preventable ADEs before and after the implementation of computerized prescribing with basic clinical decision support for ordering medications. DESIGN Before-after study of ADE rates in practices implementing computer order entry. PARTICIPANTS Adult patients seeking care in primary care practices at academic medical centers in Boston, Massachusetts (n = 41,819), and Indianapolis, Indiana (n = 9128). MAIN MEASURES We attempted to standardize the medication-related decision support knowledge base provided at the 2 sites, although the electronic records and presentation layers used at the 2 sites differed. The primary outcome was preventable ADEs identified based on structured results or symptoms defined by extracting symptom concepts from provider notes; potential ADEs were a secondary outcome. RESULTS Computerized prescribing did not significantly change the rate of preventable ADEs at either site. Compared with Boston practices, the rate of potential ADEs was more than seven-fold greater at Indianapolis (6.4/10,000 patient-months vs. 49.5/10,000 patient-months, P < 0.001). Computerized prescribing was associated with a 56% decrease in the potential ADE rate at Indianapolis (49.5 to 21.9/10,000 patient-months, P < 0.001) but a 104% increase at Boston (6.4 to 13.0/10,000 patient-months, P < 0.001). Preventable ADEs that occurred after computerized prescribing was implemented were due to patient education issues, physicians ignoring feedback from CDSS, and incomplete computerized knowledge base was incomplete (34%, 33%, and 33% in Indianapolis and 44%, 28%, and 28% in Boston). CONCLUSIONS The implementation of computerized prescribing in the ambulatory setting was not associated with any change in preventable ADEs but was associated with a decrease in potential ADEs at Indianapolis but an increase at Boston, although the absolute rate of ADEs was much lower in Boston.
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21
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Jia P, Zhang L, Chen J, Zhao P, Zhang M. The Effects of Clinical Decision Support Systems on Medication Safety: An Overview. PLoS One 2016; 11:e0167683. [PMID: 27977697 PMCID: PMC5157990 DOI: 10.1371/journal.pone.0167683] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 11/18/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The clinical decision support system(CDSS) has potential to improving medication safety. However, the effects of the intervention were conflicting and uncertain. Meanwhile, the reporting and methodological quality of this field were unknown. OBJECTIVE The aim of this overview is to evaluate the effects of CDSS on medication safety and to examine the methodological and reporting quality. METHODS PubMed, Embase and Cochrane Library were searched to August 2015. Systematic reviews (SRs) investigating the effects of CDSS on medication safety were included. Outcomes were determined in advance and assessed separately for process of care and patient outcomes. The methodological quality was assessed by Assessment of Multiple Systematic Reviews (AMSTAR) and the reporting quality was examined by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Twenty systematic reviews, consisting of 237 unique randomized controlled trials(RCTs) and 176 non-RCTs were included. Evidence that CDSS significantly impacted process of care was found in 108 out of 143 unique studies of the 16 SRs examining this effect (75%). Only 18 out of 90 unique studies of the 13 SRs reported significantly evidence that CDSS positively impacted patient outcomes (20%). Ratings for the overall scores of AMSTAR resulted in a mean score of 8.3 with a range of scores from 7.5 to 10.5. The reporting quality was varied. Some contents were particularly strong. However, some contents were poor. CONCLUSIONS CDSS reduces medication error by obviously improving process of care and inconsistently improving patient outcomes. Larger samples and longer-term studies are required to ensure more reliable evidence base on the effects of CDSS on patient outcomes. The methodological and reporting quality were varied and some realms need to be improved.
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Affiliation(s)
- Pengli Jia
- Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, PR, China
| | - Longhao Zhang
- Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, PR, China
| | - Jingjing Chen
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR, China
| | - Pujing Zhao
- Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, PR, China
| | - Mingming Zhang
- Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, PR, China
- * E-mail:
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22
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Zalin A, Papoutsi C, Shotliff K, Majeed A, Marston C, Reed J. The use of information for diabetes research and care: patient views in West London. PRACTICAL DIABETES 2016. [DOI: 10.1002/pdi.2008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Zalin
- NIHR CLAHRC Northwest London, Imperial College London; Chelsea & Westminster Hospital NHS Foundation Trust; London UK
| | - C Papoutsi
- NIHR CLAHRC Northwest London, Imperial College London; Chelsea & Westminster Hospital NHS Foundation Trust; London UK
| | - K Shotliff
- Beta Cell Centre for Diabetes, Chelsea and Westminster Hospital NHS Foundation Trust; London UK
| | - A Majeed
- Department of Primary Care & Public Health; Imperial College London; London UK
| | - C Marston
- Department of Social and Environmental Health Research; London School of Hygiene and Tropical Medicine; London UK
| | - J Reed
- NIHR CLAHRC Northwest London, Imperial College London; Chelsea & Westminster Hospital NHS Foundation Trust; London UK
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23
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Basco WT, Garner SS, Ebeling M, Freeland KD, Hulsey TC, Simpson K. Evaluating the Potential Severity of Look-Alike, Sound-Alike Drug Substitution Errors in Children. Acad Pediatr 2016; 16:183-91. [PMID: 26946271 PMCID: PMC4852303 DOI: 10.1016/j.acap.2015.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Look-alike, sound-alike (LASA) drug name substitution errors in children may pose potentially severe consequences. Our objective was to determine the degree of potential harm pediatricians ascribe to specific ambulatory LASA drug substitution errors. METHODS We developed a unified list of LASA pairs from published sources, removing selected drugs on the basis of preparation type (eg, injectable drugs). Using a modified Delphi method over 3 rounds, 38 practicing pediatricians estimated degree of potential harm that might occur should a patient receive the delivered drug in error and the degree of potential harm that might occur from not receiving the intended drug. RESULTS We identified 3550 published LASA drug pairs. A total of 1834 pairs were retained for the Delphi surveys, and 608 drug pairs were retained for round 3. Final scoring demonstrated that participants were able to identify pairs where the substitutions represented high risk of harm for receiving the delivered drug in error (eg, did not receive methylphenidate/received methadone), high risk of harm for not receiving the intended drug (eg, did not receive furosemide/received fosinopril), and pairs where the potential harm was high from not receiving the intended drug and from erroneously receiving the delivered drug (eg, did not receive albuterol/received labetalol). CONCLUSIONS Pediatricians have identified LASA drug substitutions that pose a high potential risk of harm to children. These results will allow future efforts to prioritize pediatric LASA errors that can be screened prospectively in outpatient pharmacies.
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Affiliation(s)
- William T Basco
- Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, SC.
| | - Sandra S Garner
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, SC
| | - Myla Ebeling
- Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, SC
| | - Katherine D Freeland
- Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, SC
| | - Thomas C Hulsey
- Department of Epidemiology, West Virginia University, Morgantown, WV
| | - Kit Simpson
- Department of Health Administration and Policy, College of Health Professions, The Medical University of South Carolina, Charleston, SC
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Grissinger M. Small Effort, Big Payoff: Automated Maximum Dose Alerts With Hard Stops. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2016; 41:82-128. [PMID: 26908995 PMCID: PMC4745632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Automated dose alerts with hard stops aid patient safety.
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25
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Guérin A, Hall K, Bussières JF. Pharmacy Practices and Technologies: Evidence for Effectiveness and Adoption into Canadian Hospital Pharmacy Practice. Can J Hosp Pharm 2015; 68:474-7. [PMID: 26715785 PMCID: PMC4690674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Aurélie Guérin
- is a Research Assistant with the Pharmacy Practice Research Unit and the Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec. She is also a DPharm candidate in the Faculté de pharmacie de Paris, Université Paris Descartes, Paris, France
| | - Kevin Hall
- PharmD, was, at the time this study was conducted, a Clinical Associate Professor in Social and Administrative Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta. He is now retired
| | - Jean-François Bussières
- BPharm, MSc, MBA, FCSHP, is Director of the Pharmacy Practice Research Unit and the Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, and Clinical Professor, Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
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26
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Enriquez JR, de Lemos JA, Parikh SV, Simon DN, Thomas LE, Wang TY, Chan PS, Spertus JA, Das SR. Modest Associations Between Electronic Health Record Use and Acute Myocardial Infarction Quality of Care and Outcomes: Results From the National Cardiovascular Data Registry. Circ Cardiovasc Qual Outcomes 2015; 8:576-85. [PMID: 26487739 DOI: 10.1161/circoutcomes.115.001837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2009, national legislation promoted wide-spread adoption of electronic health records (EHRs) across US hospitals; however, the association of EHR use with quality of care and outcomes after acute myocardial infarction (AMI) remains unclear. METHODS AND RESULTS Data on EHR use were collected from the American Hospital Association Annual Surveys (2007-2010) and data on AMI care and outcomes from the National Cardiovascular Data Registry Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines. Comparisons were made between patients treated at hospitals with fully implemented EHR (n=43 527), partially implemented EHR (n=72 029), and no EHR (n=9270). Overall EHR use increased from 82.1% (183/223) hospitals in 2007 to 99.3% (275/277) hospitals in 2010. Patients treated at hospitals with fully implemented EHRs had fewer heparin overdosing errors (45.7% versus 72.8%; P<0.01) and a higher likelihood of guideline-recommended care (adjusted odds ratio, 1.40 [confidence interval, 1.07-1.84]) compared with patients treated at hospitals with no EHR. In non-ST-segment-elevation AMI, fully implemented EHR use was associated with lower risk of major bleeding (adjusted odds ratio, 0.78 [confidence interval, 0.67-0.91]) and mortality (adjusted odds ratio, 0.82 [confidence interval, 0.69-0.97]) compared with no EHR. In ST-segment-elevation MI, outcomes did not significantly differ by EHR status. CONCLUSIONS EHR use has risen to high levels among hospitals in the National Cardiovascular Data Registry. EHR use was associated with less frequent heparin overdosing and modestly greater adherence to acute MI guideline-recommended therapies. In non-ST-segment-elevation MI, slightly lower adjusted risk of major bleeding and mortality were seen in hospitals implemented with full EHRs; however, in ST-segment-elevation MI, differences in outcomes were not seen.
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Affiliation(s)
- Jonathan R Enriquez
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
| | - James A de Lemos
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Shailja V Parikh
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - DaJuanicia N Simon
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Laine E Thomas
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Tracy Y Wang
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Paul S Chan
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - John A Spertus
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Sandeep R Das
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
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An Evaluation of the Effects of Human Factors and Ergonomics on Health Care and Patient Safety Practices: A Systematic Review. PLoS One 2015; 10:e0129948. [PMID: 26067774 PMCID: PMC4466322 DOI: 10.1371/journal.pone.0129948] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/15/2015] [Indexed: 02/05/2023] Open
Abstract
Background From the viewpoint of human factors and ergonomics (HFE), errors often occur because of the mismatch between the system, technique and characteristics of the human body. HFE is a scientific discipline concerned with understanding interactions between human behavior, system design and safety. Objective To evaluate the effectiveness of HFE interventions in improving health care workers’ outcomes and patient safety and to assess the quality of the available evidence. Methods We searched databases, including MEDLINE, EMBASE, BIOSIS Previews and the CBM (Chinese BioMedical Literature Database), for articles published from 1996 to Mar.2015. The quality assessment tool was based on the risk of bias criteria developed by the Cochrane Effective Practice and Organization of Care (EPOC) Group. The interventions of the included studies were categorized into four relevant domains, as defined by the International Ergonomics Association. Results For this descriptive study, we identified 8, 949 studies based on our initial search. Finally, 28 studies with 3,227 participants were included. Among the 28 included studies, 20 studies were controlled studies, two of which were randomized controlled trials. The other eight studies were before/after surveys, without controls. Most of the studies were of moderate or low quality. Five broad categories of outcomes were identified in this study: 1) medical errors or patient safety, 2) health care workers’ quality of working life (e.g. reduced fatigue, discomfort, workload, pain and injury), 3) user performance (e.g., efficiency or accuracy), 4) health care workers’ attitudes towards the interventions(e.g., satisfaction and preference), and 5) economic evaluations. Conclusion The results showed that the interventions positively affected the outcomes of health care workers. Few studies considered the financial merits of these interventions. Most of the included studies were of moderate quality. This review highlights the need for scientific and standardized guidelines regarding how HFE should be implemented in health care.
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Patterson ME, Marken P, Zhong Y, Simon SD, Ketcherside W. Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure. Appl Clin Inform 2014; 5:670-84. [PMID: 25298808 DOI: 10.4338/aci-2014-01-ra-0008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/16/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Regulatory standards for 30-day readmissions incentivize hospitals to improve quality of care. Implementing comprehensive electronic health record systems potentially decreases readmission rates by improving medication reconciliation at discharge, demonstrating the additional benefits of inpatient EHRs beyond improved safety and decreased errors. OBJECTIVE To compare 30-day all-cause readmission incidence rates within Medicare fee-for-service with heart failure discharged from hospitals with full implementation levels of comprehensive EHR systems versus those without. METHODS This retrospective cohort study uses data from the American Hospital Association Health IT survey and Medicare Part A claims to measure associations between hospital EHR implementation levels and beneficiary readmissions. Multivariable Cox regressions estimate the hazard ratio of 30-day all-cause readmissions within beneficiaries discharged from hospitals implementing comprehensive EHRs versus those without, controlling for beneficiary health status and hospital organizational factors. Propensity scores are used to account for selection bias. RESULTS The proportion of heart failure patients with 30-day all-cause readmissions was 30%, 29%, and 32% for those discharged from hospitals with full, some, and no comprehensive EHR systems. Heart failure patients discharged from hospitals with fully implemented comprehensive EHRs compared to those with no comprehensive EHR systems had equivalent 30-day readmission incidence rates (HR = 0.97, 95% CI 0.73 - 1.3). CONCLUSIONS Implementation of comprehensive electronic health record systems does not necessarily improve a hospital's ability to decrease 30-day readmission rates. Improving the efficiency of post-acute care will require more coordination of information systems between inpatient and ambulatory providers.
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Affiliation(s)
- M E Patterson
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy , Kansas City, Missouri
| | - P Marken
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy , Kansas City, Missouri
| | - Y Zhong
- Department of Biostatistics, University of Kansas Medical Center , Kansas City, Kansas
| | - S D Simon
- Department of Informatics Medicine and Personalized Health, University of Missouri-Kansas City , Kansas City, Missouri
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Kukreti V, Cosby R, Cheung A, Lankshear S. Computerized prescriber order entry in the outpatient oncology setting: from evidence to meaningful use. ACTA ACUST UNITED AC 2014; 21:e604-12. [PMID: 25089110 DOI: 10.3747/co.21.1990] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chemotherapy is an effective treatment in the fight against many cancers. Medication errors in oncology can be particularly serious given the narrow therapeutic window of antineoplastic drugs and their high toxicities. Computerized prescriber order entry (cpoe) has consistently been shown to reduce medication errors and adverse drug events in various settings, but its use in the oncology setting has not been well established. To gain a better understanding of the meaningful use of cpoe systems in the outpatient chemotherapy setting, we undertook a systematic review of systemic therapy cpoe. METHODS A province-wide expert panel consisting of clinical experts, health information professionals, and specialists in human factors design provided guidance in the development of the research questions, search terms, databases, and inclusion criteria. The systematic review was undertaken by a core team consisting of a medical oncologist, nurse, pharmacist, and methodologist. The medline, embase, cinahl, and compendex databases were searched for relevant evidence. RESULTS The database searches resulted in 5642 hits, of which 9 met the inclusion criteria and were retained. In the oncology setting, cpoe systems generally reduce chemotherapy medication errors; however, specific types of errors increase with the use of cpoe. These systems affect practice both positively and negatively with respect to time, workload, and productivity. CONCLUSIONS Despite the paucity of oncology-specific research, cpoe should be used in outpatient chemotherapy delivery to reduce chemotherapy-related medication errors. Adoption by clinicians will be enhanced by cpoe processes that complement current practice and workflow processes.
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Affiliation(s)
| | - R Cosby
- Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON
| | - A Cheung
- Cancer Care Ontario, Toronto, ON
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Coleman JJ, Hodson J, Thomas SK, Brooks HL, Ferner RE. Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system. J Am Med Inform Assoc 2014; 22:206-12. [PMID: 25074989 DOI: 10.1136/amiajnl-2014-002822] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND A computerized physician order entry (CPOE) system with embedded clinical decision support can reduce medication errors in hospitals, but might increase the time taken to generate orders. AIMS We aimed to quantify the effects of temporal (month, day of week, hour of shift) and other factors (grade of doctor, prior experience with the system, alert characteristics, and shift type) on the time taken to generate a prescription order. SETTING A large university teaching hospital using a locally developed CPOE system with an extensive audit database. DESIGN We retrospectively analyzed prescription orders from the audit database between August 2011 and July 2012. RESULTS The geometric mean time taken to generate a prescription order within the CPOE system was 11.75 s (95% CI 11.72 to 11.78). Time to prescribe was most affected by the display of high-level (24.59 s (24.43 to 24.76); p<0.001) or previously unseen (18.87 s (18.78 to 18.96); p<0.001) alerts. Prescribers took significantly less time at weekends (11.29 s (11.23 to 11.35)) than on weekdays (11.88 s (11.84 to 11.91); p<0.001), in the first (11.25 s (11.16 to 11.34); p<0.001) and final (11.56 s (11.47 to 11.66); p<0.001) hour of their shifts, and after the first month of using the system. CONCLUSIONS The display of alerts, prescribing experience, system familiarity, and environment all affect the time taken to generate a prescription order. Our study reinforces the need for appropriate alerts to be presented to individuals at an appropriate place in the workflow, in order to improve prescribing efficiency.
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Affiliation(s)
- Jamie J Coleman
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah K Thomas
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hannah L Brooks
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robin E Ferner
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Fauvelle F, Kabirian F, Bernard A, Bonnet-Zamponi D, Esposito-Farèse M, Tubach F, Gault N. [Medical treatment of the elderly in residential care: a multicenter cross-sectional study]. Therapie 2014; 69:419-26. [PMID: 25047673 DOI: 10.2515/therapie/2014037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/24/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To retrospectively assess the quality of prescriptions in elderly patients prior the distribution of guidelines for geriatric drug prescriptions. METHODS A cross-sectional study was conducted for one day in 2012 to investigate the quality of the prescriptions in 495 residents of 8 nursing homes. A 6 items-quality score was calculated, ranging from 0 (lowest quality) to 6 (highest quality). RESULTS The median number of prescribed drugs was 8,5 per resident. Over a total of 4311 prescribed drugs, the average quality score was 4,96 ± 0,45; 4,54 ± 0,70 in computerized orders and 3,4 ± 1,02 in handwritten orders. Among 939 drugs considered as at high risk of inducing serious adverse reactions, monitoring was prescribed 154 times only (16,4%). CONCLUSIONS A lack of drug monitoring was highlighted, especially for high risk drugs. The quality of prescription may be improved by the use of computerized orders.
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Affiliation(s)
- Francis Fauvelle
- Service Pharmacie, Groupe hospitalier Le Raincy-Montfermeil, Montfermeil, France
| | - Fariba Kabirian
- Service de Gériatrie, Groupe hospitalier Le Raincy-Montfermeil, Montfermeil, France
| | - Aurélie Bernard
- Omedit Ile-de-France, Agence régionale de Santé, Paris, France
| | - Dominique Bonnet-Zamponi
- Omedit Ile-de-France, Agence régionale de Santé, Paris, France - AP-HP, Hôpital Bichat, Département épidémiologique et Recherche clinique, Paris, France
| | - Marina Esposito-Farèse
- AP-HP, Hôpital Bichat, Département épidémiologique et Recherche clinique, Paris, France - INSERM CIE 801, Paris, France
| | - Florence Tubach
- AP-HP, Hôpital Bichat, Département épidémiologique et Recherche clinique, Paris, France - INSERM CIE 801, Paris, France - Université Paris Diderot, Sorbonne Paris-Cité, Paris, France
| | - Nathalie Gault
- AP-HP, Hôpital Bichat, Département épidémiologique et Recherche clinique, Paris, France - INSERM CIE 801, Paris, France - Université Paris Diderot, Sorbonne Paris-Cité, Paris, France
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Pritzlaff M, Yorczyk A, Robinson LS, Pirzadeh-Miller S, Lin T, Euhus D, Ross TS. An internal performance assessment of CancerGene Connect: an electronic tool to streamline, measure and improve the genetic counseling process. J Genet Couns 2014; 23:1034-44. [PMID: 24916850 DOI: 10.1007/s10897-014-9732-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/14/2014] [Indexed: 11/24/2022]
Abstract
CancerGene Connect (CGC) is a web-based program that combines the collection of family and medical history, cancer risk assessment, psychosocial assessment, report templates, a result tracking system, and a patient follow up system. The performance of CGC was assessed in several ways: pre-appointment completion data analyzed for demographic and health variables; a time study to assess overall time per case and to compare the data entry by the genetic counselor compared to the patient, and a measured quality assessment of the program via observation and interview of patients. Prior to their appointment, 52.3% of 2,414 patients completed the online patient questionnaire section of CGC. There were significant differences in completion rates among racial and ethnic groups. County hospital patients were less likely to complete the questionnaire than insured patients (p < 0.0001); and likewise uninsured patients and patients with Medicare/Medicaid were less likely to complete the questionnaire than private patients (p < 0.0001). The average genetic counseling time per case was 82 min, with no significant differences whether the counselor or the patient completed CGC. CGC reduces genetic counselor time by approximately 14-46% compared to average time per case using traditional risk assessment and documentation methods previously reported. All surveyed users felt the questionnaire was easy to understand. CGC is an effective tool that streamlines workflow, and provides a standardized data collection tool that can be used to evaluate and improve the genetic counseling process.
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Affiliation(s)
- Mary Pritzlaff
- Department of Cancer Genetics, University of Texas Southwestern Medical Center's Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Dallas, TX, USA
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Nuckols TK, Smith-Spangler C, Morton SC, Asch SM, Patel VM, Anderson LJ, Deichsel EL, Shekelle PG. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Syst Rev 2014; 3:56. [PMID: 24894078 PMCID: PMC4096499 DOI: 10.1186/2046-4053-3-56] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/29/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Health Information Technology for Economic and Clinical Health (HITECH) Act subsidizes implementation by hospitals of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries caused by medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, and effects on medication errors have been variable. The objectives of this analysis were to assess the effectiveness of CPOE at reducing pADEs in hospital-related settings, and examine reasons for heterogeneous effects on medication errors. METHODS Articles were identified using MEDLINE, Cochrane Library, Econlit, web-based databases, and bibliographies of previous systematic reviews (September 2013). Eligible studies compared CPOE with paper-order entry in acute care hospitals, and examined diverse pADEs or medication errors. Studies on children or with limited event-detection methods were excluded. Two investigators extracted data on events and factors potentially associated with effectiveness. We used random effects models to pool data. RESULTS Sixteen studies addressing medication errors met pooling criteria; six also addressed pADEs. Thirteen studies used pre-post designs. Compared with paper-order entry, CPOE was associated with half as many pADEs (pooled risk ratio (RR) = 0.47, 95% CI 0.31 to 0.71) and medication errors (RR = 0.46, 95% CI 0.35 to 0.60). Regarding reasons for heterogeneous effects on medication errors, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta-regression. Differences between commercial versus homegrown systems, presence and sophistication of clinical decision support, hospital-wide versus limited implementation, and US versus non-US studies were not significant, nor was timing of publication. Higher baseline rates of medication errors predicted greater reductions (P < 0.001). Other context and implementation variables were seldom reported. CONCLUSIONS In hospital-related settings, implementing CPOE is associated with a greater than 50% decline in pADEs, although the studies used weak designs. Decreases in medication errors are similar and robust to variations in important aspects of intervention design and context. This suggests that CPOE implementation, as subsidized under the HITECH Act, may benefit public health. More detailed reporting of the context and process of implementation could shed light on factors associated with greater effectiveness.
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Affiliation(s)
- Teryl K Nuckols
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, 911 Broxton Ave, Los Angeles, CA 90024, USA
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
| | - Crystal Smith-Spangler
- VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
- Stanford University, Palo Alto, CA 94305, USA
| | - Sally C Morton
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA
| | - Steven M Asch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
- VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
- Stanford University, Palo Alto, CA 94305, USA
| | - Vaspaan M Patel
- NCQA, 1100 13th street NW, Washington, DC 20005, USA
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90024, USA
| | - Laura J Anderson
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90024, USA
| | - Emily L Deichsel
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90024, USA
| | - Paul G Shekelle
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, 911 Broxton Ave, Los Angeles, CA 90024, USA
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Forrester SH, Hepp Z, Roth JA, Wirtz HS, Devine EB. Cost-effectiveness of a computerized provider order entry system in improving medication safety ambulatory care. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:340-349. [PMID: 24968993 PMCID: PMC4079669 DOI: 10.1016/j.jval.2014.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/18/2014] [Accepted: 01/27/2014] [Indexed: 05/30/2023]
Abstract
BACKGROUND Computerized provider order entry (CPOE) is the process of entering physician orders directly into an electronic health record. Although CPOE has been shown to improve medication safety and reduce health care costs, these improvements have been demonstrated largely in the inpatient setting; the cost-effectiveness in the ambulatory setting remains uncertain. OBJECTIVE The objective was to estimate the cost-effectiveness of CPOE in reducing medication errors and adverse drug events (ADEs) in the ambulatory setting. METHODS We created a decision-analytic model to estimate the cost-effectiveness of CPOE in a midsized (400 providers) multidisciplinary medical group over a 5-year time horizon- 2010 to 2014-the time frame during which health systems are implementing CPOE to meet Meaningful Use criteria. We adopted the medical group's perspective and utilized their costs, changes in efficiency, and actual number of medication errors and ADEs. One-way and probabilistic sensitivity analyses were conducted. Scenario analyses were explored. RESULTS In the base case, CPOE dominated paper prescribing, that is, CPOE cost $18 million less than paper prescribing, and was associated with 1.5 million and 14,500 fewer medication errors and ADEs, respectively, over 5 years. In the scenario that reflected a practice group of five providers, CPOE cost $265,000 less than paper prescribing, was associated with 3875 and 39 fewer medication errors and ADEs, respectively, over 5 years, and was dominant in 80% of the simulations. CONCLUSIONS Our model suggests that the adoption of CPOE in the ambulatory setting provides excellent value for the investment, and is a cost-effective strategy to improve medication safety over a wide range of practice sizes.
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Affiliation(s)
- Sara H Forrester
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Zsolt Hepp
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Joshua A Roth
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA; Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Heidi S Wirtz
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Emily Beth Devine
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA; Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA.
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Vermeulen KM, van Doormaal JE, Zaal RJ, Mol PGM, Lenderink AW, Haaijer-Ruskamp FM, Kosterink JGW, van den Bemt PMLA. Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. Int J Med Inform 2014; 83:572-80. [PMID: 24929633 DOI: 10.1016/j.ijmedinf.2014.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Prescribing medication is an important aspect of almost all in-hospital treatment regimes. Besides their obviously beneficial effects, medicines can also cause adverse drug events (ADE), which increase morbidity, mortality and health care costs. Partially, these ADEs arise from medication errors, e.g. at the prescribing stage. ADEs caused by medication errors are preventable ADEs. Until now, medication ordering was primarily a paper-based process and consequently, it was error prone. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) is considered to enhance patient safety. Limited information is available on the balance between the health gains and the costs that need to be invested in order to achieve these positive effects. Aim of this study was to study the balance between the effects and costs of CPOE/CDSS compared to the traditional paper-based medication ordering. METHODS The economic evaluation was performed alongside a clinical study (interrupted time series design) on the effectiveness of CPOE/CDSS, including a cost minimization and a cost-effectiveness analysis. Data collection took place between 2005 and 2008. Analyses were performed from a hospital perspective. The study was performed in a general teaching hospital and a University Medical Centre on general internal medicine, gastroenterology and geriatric wards. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) was compared to a traditional paper based system. All costs of both medication ordering systems are based on resources used and time invested. Prices were expressed in Euros (price level 2009). Effectiveness outcomes were medication errors and preventable adverse drug events. RESULTS During the paper-based prescribing period 592 patients were included, and during the CPOE/CDSS period 603. Total costs of the paper-based system and CPOE/CDSS amounted to €12.37 and €14.91 per patient/day respectively. The Incremental Cost-Effectiveness Ratio (ICER) for medication errors was 3.54 and for preventable adverse drug events 322.70, indicating the extra amount (€) that has to be invested in order to prevent one medication error or one pADE. CONCLUSIONS CPOE with basic CDSS contributes to a decreased risk of preventable harm. Overall, the extra costs of CPOE/CDSS needed to prevent one ME or one pADE seem to be acceptable.
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Affiliation(s)
- K M Vermeulen
- Department of Epidemiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - J E van Doormaal
- Department of Clinical Pharmacy and Pharmacology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - R J Zaal
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P G M Mol
- Department of Clinical Pharmacy and Pharmacology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - A W Lenderink
- Department of Clinical Pharmacy, TweeSteden Hospital and St. Elisabeth Hospital, Tilburg, The Netherlands
| | - F M Haaijer-Ruskamp
- Department of Clinical Pharmacy and Pharmacology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - J G W Kosterink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - P M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Urbina O, Ferrández O, Grau S, Luque S, Mojal S, Marin-Casino M, Mateu-de-Antonio J, Carmona A, Conde-Estévez D, Espona M, González E, Riu M, Salas E. Design of a score to identify hospitalized patients at risk of drug-related problems. Pharmacoepidemiol Drug Saf 2014; 23:923-32. [DOI: 10.1002/pds.3634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/30/2014] [Accepted: 04/02/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Olatz Urbina
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Olivia Ferrández
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Santiago Grau
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
- Pharmacy Department; Hospital Universitari del Mar, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Sonia Luque
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Sergi Mojal
- Department of Statistics; Hospital Universitari del Mar; Barcelona Spain
| | | | | | - Alexia Carmona
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | | | - Merce Espona
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Elena González
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Marta Riu
- Department of Epidemiology and Health Services Evaluation; Hospital Universitari del Mar; Barcelona Spain
| | - Esther Salas
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
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We work with them? Healthcare workers interpretation of organizational relations mined from electronic health records. Int J Med Inform 2014; 83:495-506. [PMID: 24845147 DOI: 10.1016/j.ijmedinf.2014.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/11/2014] [Accepted: 04/16/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Models of healthcare organizations (HCOs) are often defined up front by a select few administrative officials and managers. However, given the size and complexity of modern healthcare systems, this practice does not scale easily. The goal of this work is to investigate the extent to which organizational relationships can be automatically learned from utilization patterns of electronic health record (EHR) systems. METHOD We designed an online survey to solicit the perspectives of employees of a large academic medical center. We surveyed employees from two administrative areas: (1) Coding & Charge Entry and (2) Medical Information Services and two clinical areas: (3) Anesthesiology and (4) Psychiatry. To test our hypotheses we selected two administrative units that have work-related responsibilities with electronic records; however, for the clinical areas we selected two disciplines with very different patient responsibilities and whose accesses and people who accessed were similar. We provided each group of employees with questions regarding the chance of interaction between areas in the medical center in the form of association rules (e.g., Given someone from Coding & Charge Entry accessed a patient's record, what is the chance that someone from Medical Information Services access the same record?). We compared the respondent predictions with the rules learned from actual EHR utilization using linear-mixed effects regression models. RESULTS The findings from our survey confirm that medical center employees can distinguish between association rules of high and non-high likelihood when their own area is involved. Moreover, they can make such distinctions between for any HCO area in this survey. It was further observed that, with respect to highly likely interactions, respondents from certain areas were significantly better than other respondents at making such distinctions and certain areas' associations were more distinguishable than others. CONCLUSIONS These results illustrate that EHR utilization patterns may be consistent with the expectations of HCO employees. Our findings show that certain areas in the HCO are easier than others for employees to assess, which suggests that automated learning strategies may yield more accurate models of healthcare organizations than those based on the perspectives of a select few individuals.
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Mozaffar H, Williams R, Cresswell K, Morison Z, Slee A, Team AS. Product diversity and spectrum of choice in hospital ePrescribing Systems in England. PLoS One 2014; 9:e92516. [PMID: 24691517 PMCID: PMC3972198 DOI: 10.1371/journal.pone.0092516] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 02/23/2014] [Indexed: 11/24/2022] Open
Abstract
Background ePrescribing systems have considerable potential for improving healthcare quality and safety. With growing expectations about the benefits of such systems, there is evidence of widespread plans to implement these systems in hospitals in England where hitherto they have had a low uptake. Given the international drive away from developing home-grown to systems to procuring commercial applications, we aimed to identify available ePrescribing systems in England and to use the findings to develop a taxonomy of the systems offered by suppliers. Methods and Findings We undertook a scoping review of the published and grey literature, and conducted expert interviews with vendors, healthcare organisations and national ePrescribing experts in order to identify the spectrum of available systems, identify and map their key features, and then iteratively develop and validate a taxonomy of commercial ePrescribing systems available to English hospitals. There is a wide range of available systems including 13 hospital-wide applications and a range of specialty systems. These commercial applications can be grouped into four sub-categories: standalone systems, modules within integrated systems, functionalities spread over several modules, and specialty systems. The findings also reveal that apart from four packaged applications (two of which are specialty systems), all other systems have none or less than two live implementations across England. Conclusions The wide range of products developed in the last few years by different national and international suppliers, and the low uptake of these products by English hospitals indicate that the English ePrescribing market is still in its infancy. This market is undergoing rapid cycles of change, both with respect to the number of suppliers and their diversity of offerings. Constant renewal of knowledge is needed on the status of this evolving market, encompassing the products development and adoption, to assist implementation decisions and facilitate market maturity.
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Affiliation(s)
- Hajar Mozaffar
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kathrin Cresswell
- School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Zoe Morison
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ann Slee
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh Team
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - the ePrescribing ProgrammeColemanJamieDrSenior Clinical Lecturer, University of BirminghamBatesDavid W.ProfProfessor of Medicine, Harvard Medical SchoolRobertsonAnnDrResearch Fellow, The University of EdinburghAveryTonyProfProfessor of Primary Health Care, The University of NottinghamBlakeLaurenceDrThe University of BirminghamChuterAntonyMrPatient RepresentativeSlightSarah P.DrNIHR Career Development Fellow, The University of NottinghamGirlingAlanDrSenior Research Fellow, The University of BirminghamLeeLisaDrResearch Fellow, The University of EdinburghLilfordRichardProfProfessor of Clinical Epidemiology, The University of BirminghamMcCloughanLucyDreHealth Research Manager, The University of EdinburghSchofieldJillProfHead The York Management School, The University of York
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Cresswell KM, Bates DW, Williams R, Morrison Z, Slee A, Coleman J, Robertson A, Sheikh A. Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two 'early adopter' hospitals. J Am Med Inform Assoc 2014; 21:e194-202. [PMID: 24431334 DOI: 10.1136/amiajnl-2013-002252] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in 'early adopter' hospitals. MATERIALS AND METHODS In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had implemented commercially available systems. Hospital A had implemented a CPOE system (with basic decision support), whereas hospital B invested additional resources in a CDS system that facilitated order entry but which was integrated with electronic health records and offered more advanced CDS. We used a combination of documentary analysis of the implementation plans, audiorecorded semistructured interviews with system users, and observations of strategic meetings and systems usage. RESULTS We collected 11 documents, conducted 43 interviews, and conducted a total of 21.5 h of observations. We identified three major themes: (1) impacts on individual users, including greater legibility of prescriptions, but also some accounts of increased workloads; (2) the introduction of perceived new safety risks related to accessibility and usability of hardware and software, with users expressing concerns that some problems such as duplicate prescribing were more likely to occur; and (3) realizing organizational benefits through secondary uses of data. CONCLUSIONS We identified little difference in the medium-term consequences of a CPOE and a CDS system. It is important that future studies investigate the medium- and longer-term consequences of CPOE and CDS systems in a wider range of hospitals.
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Affiliation(s)
| | - David W Bates
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh, UK
| | - Zoe Morrison
- eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Ann Slee
- eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jamie Coleman
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, UK
| | - Ann Robertson
- eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Aita M, Belvedere O, De Carlo E, Deroma L, De Pauli F, Gurrieri L, Denaro A, Zanier L, Fasola G. Chemotherapy prescribing errors: an observational study on the role of information technology and computerized physician order entry systems. BMC Health Serv Res 2013; 13:522. [PMID: 24344973 PMCID: PMC3878514 DOI: 10.1186/1472-6963-13-522] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used. METHODS Up to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale. RESULTS Eight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome. CONCLUSIONS Chemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.
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Affiliation(s)
- Marianna Aita
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Ornella Belvedere
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
- Department of Oncology, York Teaching Hospital, York, UK
| | - Elisa De Carlo
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Laura Deroma
- Regional Coordinator Centre for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Federica De Pauli
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Lorena Gurrieri
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Angela Denaro
- Department of Medical Oncology, University Hospital of Trieste, Trieste, Italy
| | - Loris Zanier
- Health Directorate, Friuli Venezia-Giulia Region, Trieste, Italy
| | - Gianpiero Fasola
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
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Ayers P, Adams S, Boullata J, Gervasio J, Holcombe B, Kraft MD, Marshall N, Neal A, Sacks G, Seres DS, Worthington P, Malone A, Teitelbaum D, Andris DA, Ayers P, Baroccas A, Compher C, Ireton-Jones C, Jaksic T, Robinson LA, Van Way CW, Ayers P, Adams S, Boullata J, Gervasio J, Holcombe B, Kraft M, Neal T, Sacks G, Seres DS, Taylor B, Worthington PA. A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations. JPEN J Parenter Enteral Nutr 2013; 38:296-333. [DOI: 10.1177/0148607113511992] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Phil Ayers
- Baptist Health Systems, Department of Pharmacy, Jackson, Mississippi
| | - Stephen Adams
- Vitaline Infusion Pharmacy Services, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Jane Gervasio
- Butler University College of Pharmacy and Health Science, Indianapolis, Indiana
| | - Beverly Holcombe
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
| | - Michael D. Kraft
- University of Michigan Health System, Department of Pharmacy Services, Ann Arbor
| | | | - Antoinette Neal
- Infusion Pharmacy, Cleveland Clinic at Home, Independence, Ohio
| | - Gordon Sacks
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
| | - David S. Seres
- Division of Preventive Medicine and Nutrition, New York Presbyterian Hospital–Columbia University Medical Center, New York
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Coleman JJ, van der Sijs H, Haefeli WE, Slight SP, McDowell SE, Seidling HM, Eiermann B, Aarts J, Ammenwerth E, Ferner RE, Slee A. On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop. BMC Med Inform Decis Mak 2013; 13:111. [PMID: 24083548 PMCID: PMC3850158 DOI: 10.1186/1472-6947-13-111] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 09/25/2013] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority. METHODS A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop. RESULTS We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures. CONCLUSIONS We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.
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Affiliation(s)
- Jamie J Coleman
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2SP UK
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Dudley Road, Birmingham B18 7QH UK
| | - Heleen van der Sijs
- Erasmus University Medical Centre, Department of Hospital Pharmacy, PO Box 2040, 3000 CA Rotterdam, Netherlands
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Sarah P Slight
- School of Medicine Pharmacy and Health, The University of Durham, Durham TS17 6BH UK
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA 02120 USA
- Harvard Medical School, Boston, MA 02115 USA
| | - Sarah E McDowell
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB UK
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Birgit Eiermann
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm 14186 Sweden
| | - Jos Aarts
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Elske Ammenwerth
- Institute of Health Informatics, UMIT – University of Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer-Zentrum I, 6060 Hall in Tirol, Austria
| | - Robin E Ferner
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2SP UK
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Dudley Road, Birmingham B18 7QH UK
| | - Ann Slee
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2SP UK
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Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts. Int J Clin Pharm 2013; 35:753-62. [DOI: 10.1007/s11096-013-9798-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
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Abstract
Prescribing errors that occur in hospitals have been a source of concern for decades. This narrative review describes some of the recent work in this field. There is considerable heterogeneity in definitions and methods used in research on prescribing errors. There are three definitions that are used most frequently (one for prescribing errors specifically and two for the broader arena of medication errors), although many others have also been used. Research methods used focus primarily on investigating either the prescribing process (such as errors in the dose prescribed) or the outcomes for the patient (such as preventable adverse drug events). This complicates attempts to calculate the overall prevalence or incidence of errors. Errors have been reported in handwritten descriptions of almost 15% and with electronic prescribing of up to 8% of orders. Errors are more likely to be identified on admission to hospital than at any other time (usually failure to continue ongoing medication) and errors of dose occur most commonly throughout the patients' stay. Although there is evidence that electronic prescribing reduces the number of errors, new types of errors also occur. The literature on causes of error shows some commonality with both handwritten and electronic prescribing but there are also causes that are unique to each. A greater understanding of the prevalence of the complex causal pathways found and the differences between the pathways of minor and severe errors is necessary. Such an understanding would underpin theoretically-based interventions to reduce the occurrence of prescribing errors.
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Affiliation(s)
- Mary P Tully
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, UK.
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Impact of a Computerized Order Set on Adherence to Centers for Disease Control Guidelines for the Treatment of Victims of Sexual Assault. J Emerg Med 2013; 44:528-35. [DOI: 10.1016/j.jemermed.2012.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/09/2012] [Accepted: 06/28/2012] [Indexed: 01/22/2023]
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Schnall R, Sperling JD, Liu N, Green RA, Clark S, Vawdrey DK. The effect of an electronic "hard-stop" alert on HIV testing rates in the emergency department. Stud Health Technol Inform 2013; 192:432-436. [PMID: 23920591 PMCID: PMC4104197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Use of electronic alerts in clinical practice has had mixed effects on providers' prescribing practices. Little research has explored the use of electronic alerts for improving screening practices. New York City has one of the highest rates of HIV in the United States. Recent New York State legislation requires healthcare providers to offer an HIV test to patients aged 13-64 years during a clinical encounter. Adhering to this requirement is particularly challenging in emergency department (ED) settings, which are frequently overcrowded and under-resourced. The purpose of this study was to evaluate the effect of an electronic "hard-stop" alert on HIV testing rates in the ED. Approximately four months of data were reviewed before and after the implementation of the alert. We found that use of the electronic alert significantly increased documentation of offering an HIV test (O.R. = 267.27, p<0.001) and resulted in a significant increase in HIV testing. Findings from this study add to the current knowledge about the use of electronic alertsfor improving disease screening.
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Affiliation(s)
| | - Jeremy D. Sperling
- Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nan Liu
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robert A. Green
- Department of Emergency Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David K. Vawdrey
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Erler A, Beyer M, Petersen JJ, Saal K, Rath T, Rochon J, Haefeli WE, Gerlach FM. How to improve drug dosing for patients with renal impairment in primary care - a cluster-randomized controlled trial. BMC FAMILY PRACTICE 2012; 13:91. [PMID: 22953792 PMCID: PMC3515431 DOI: 10.1186/1471-2296-13-91] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/28/2012] [Indexed: 12/12/2022]
Abstract
Background Patients with chronic kidney disease (CKD) are at increased risk for inappropriate or potentially harmful prescribing. The aim of this study was to examine whether a multifaceted intervention including the use of a software programme for the estimation of creatinine clearance and recommendation of individual dosage requirements may improve correct dosage adjustment of relevant medications for patients with CKD in primary care. Methods A cluster-randomized controlled trial was conducted between January and December 2007 in small primary care practices in Germany. Practices were randomly allocated to intervention or control groups. In each practice, we included patients with known CKD and elderly patients (≥70 years) suffering from hypertension. The practices in the intervention group received interactive training and were provided a software programme to assist with individual dose adjustment. The control group performed usual care. Data were collected at baseline and at 6 months. The outcome measures, analyzed across individual patients, included prescriptions exceeding recommended maximum daily doses, with the primary outcome being prescriptions exceeding recommended standard daily doses by more than 30%. Results Data from 44 general practitioners and 404 patients are included. The intervention was effective in reducing prescriptions exceeding the maximum daily dose per patients, with a trend in reducing prescriptions exceeding the standard daily dose by more than 30%. Conclusions A multifaceted intervention including the use of a software program effectively reduced inappropriately high doses of renally excreted medications in patients with CKD in the setting of small primary care practices. Trial registration Current Controlled Trials ISRCTN02900734
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Affiliation(s)
- Antje Erler
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany.
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Patterson ME, Marken PA, Simon SD, Hackman JL, Schaefer RS. Associations between the concurrent use of clinical decision support and computerized provider order entry and the rates of appropriate prescribing at discharge. Appl Clin Inform 2012; 3:186-96. [PMID: 23646071 DOI: 10.4338/aci-2011-11-ra-0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 05/10/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Electronic health record systems used in conjunction with clinical decision support (CDS) or computerized provider order entry (CPOE) have shown potential in improving quality of care, yet less is known about the effects of combination use of CDS and CPOE on prescribing rates at discharge. OBJECTIVES This study investigates the effectiveness of combination use of CDS and CPOE on appropriate drug prescribing rates at discharge for AMI or HF patients. METHODS Combination use of CDS and CPOE is defined as hospitals self-reporting full implementation across all hospital units of CDS reminders, CDS guidelines, and CPOE. Appropriate prescribing rates of aspirin, ACEI/ARBs, or beta blockers are defined using quality measures from Hospital Compare. Multivariate linear regressions are used to test for differences in mean appropriate prescribing rates between hospitals reporting combination use of CDS and CPOE, compared to those reporting the singular use of one or the other, or the absence of both. Covariates include hospital size, region, and ownership status. RESULTS Approximately 10% of the sample reported full implementation of both CDS and CPOE, while 7% and 17% reported full use of only CPOE or only CDS, respectively. Hospitals reporting full use of CDS only reported between 0.2% (95% CI 0.04 - 1.0) and 1.6% (95% CI 0.6 - 2.6) higher appropriate prescribing rates compared to hospitals reporting use of neither system. Rates of prescribing by hospitals reporting full use of both CPOE and CDS did not significantly differ from the control group. CONCLUSIONS Although associations found between full implementation of CDS and appropriate prescribing rates suggest that clinical decision tools are sufficient compared to basic EHR systems in improving prescribing at discharge, the modest differences raise doubt about the clinical relevance of the findings. Future studies need to continue investigating the causal nature and clinical relevance of these associations.
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Affiliation(s)
- M E Patterson
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri 64108, USA
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Flynn L, Liang Y, Dickson GL, Xie M, Suh DC. Nurses' practice environments, error interception practices, and inpatient medication errors. J Nurs Scholarsh 2012; 44:180-6. [PMID: 22510244 DOI: 10.1111/j.1547-5069.2012.01443.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Medication errors remain a threat to patient safety. Therefore, the purpose of this study was to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses' error interception practices, and rates of nonintercepted medication errors in acute care hospitals. DESIGN This study, using a nonexperimental design, was conducted in a sample of 82 medical-surgical units recruited from 14 U.S. acute care hospitals. Registered nurses (RNs) on the 82 units were surveyed, producing a sample of 686 staff nurses. METHODS Data collected for the 8-month study period included the number of medication errors per 1,000 patient days and the number of RN hours per patient day. Nurse survey data included the Practice Environment Scale of the Nursing Work Index as a measure of environmental characteristics; a metric of nurses' interception practices was developed for the study. All survey measures were aggregated to the unit level prior to analysis with hierarchical linear modeling. FINDINGS A supportive practice environment was positively associated with error interception practices among nurses in the sample of medical-surgical units. Importantly, nurses' interception practices were inversely associated with medication error rates. CONCLUSIONS A supportive practice environment enhances nurses' error interception practices. These interception practices play a role in reducing medication errors. CLINICAL RELEVANCE When supported by their practice environments, nurses employ practices that can assist in interrupting medication errors before they reach the patients.
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Affiliation(s)
- Linda Flynn
- Rutgers College of Nursing, Rutgers the State University of New Jersey, Newark, NJ 07102, USA.
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Summary of Product Characteristics content extraction for a safe drugs usage. J Biomed Inform 2012; 45:231-9. [DOI: 10.1016/j.jbi.2011.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 10/20/2011] [Accepted: 10/30/2011] [Indexed: 11/18/2022]
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