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At least 397 records · Page 22Linked to original sources
PubMed2003

[Electronic medical prescription at a university hospital: writing failures and users' opinions].

This study analyzed the writing failure of the computerized physician order entry system and its advantages and disadvantages according to users. At a university hospital 1,351 physician orders were analyzed and 84 nursing and medical professionals were interviewed. The results showed that 17.7% of the orders presented measures, medication had been suspended in 16.8%, in 28.2% there was dubious or misleading information and in 25% medication had been prescribed manually. The professionals indicated advantages such as: ease of data reading and the quickness with which the order is entered and released, among others. They also reported disadvantages such as the repetition of orders from previous days without a review and incorrectly typed information. Therefore, it is concluded that, despite representing an important strategy for error reduction, this system must be overhauled and professionals must be trained to use it.

Brazil↗
PubMed1995

Remote communication from a mobile terminal: an adjunct for a computerized intensive care unit order management system.

OBJECTIVES: To develop and implement a fully mobile computer terminal that interfaces with our computerized intensive care unit (ICU) local area network and order management system. This system can provide access to the entire network and to order review and entry and during ICU bedside rounds. DESIGN: Descriptive report. SETTING: Surgical ICU in Department of Veterans Affairs Medical Center. SYSTEM CONFIGURATION: A parallel local area network was configured for the remote mobile computer system. A proprietary remote transmission system (Altair II, Motorola) was used. This high-throughput system minimizes interference and errors by using licensed, nonshared, radiofrequency spectra. CONCLUSION: The resulting mobile system is an economical and time-efficient adjunct to an established ICU computerized network and order management system. Clinical working bedside rounds are now routinely conducted with the mobile terminal, providing immediate access to full network resources.

Computer Terminals↗
PubMedDate not supplied

Computer-enhanced neonatology practice evolution in an academic medical center. NICU Clinical Effectiveness Task Force.

The U.S. health care system is evolving as a result of market-place forces that demand optimal medical outcomes, cost effectiveness, and improved customer service. These demands may be in conflict with the mission of an academic neonatal intensive care unit (NICU). For more than 5 years, we have used computer-enhanced clinical practice evolution to improve quality while reducing costs. The multidisciplinary NICU Clinical Effectiveness Task Force used the Quality/Cost Improvement Cycle in an evidenced-based, data-driven approach to clinical practice change. Merger of the Neonatal Clinical Database permitted birth weight-specific cost reporting. Specific practice patterns in the Pharmacy, Clinical Laboratory, Respiratory Therapy, and Radiology cost centers were targeted for improvement based on the medical literature. Customized interactive physician order-entry pathways were created within the existing medical ordering module of the Medical Information System. Birth weight-specific neonatal survival rates were unchanged. A dramatic reduction in neonatal medication errors from 3.2 to 0.6 errors per 1000 patient days occurred. Changes in targeted clinical practices were documented. A substantial decrease in average total hospital cost per infant and average length of stay was demonstrated for infants whose birth weights were less than 1001 gm. In conclusion, clinical practices can be changed while outcomes are improved and cost is reduced in an academic NICU through implementation of computer-enhanced clinical practice evolution. There are many remaining questions regarding the best neonatal practices to optimize outcome and minimize cost.

Academic Medical Centers↗
PubMed1999

Distributing knowledge maintenance for clinical decision-support systems: the "knowledge library" model.

The maintenance of knowledge-rich clinical decision-support systems is challenging, in particular in the complex setting of a large academic medical center. Distributing the maintenance tasks to the source of expertise can address scalability, accuracy and currency issues. It also helps to foster a more global sense of ownership among the system users. The knowledge maintenance model must provide processes and tools to deal with a wide range of stakeholders (resident and attending physicians, consulting specialists, other care providers, case managers, ancillary departments), with knowledge embedded in legacy departmental systems, and with the continuous evolution of the content and form of the knowledge base. We describe and illustrate the "knowledge library" model in use at Vanderbilt University Medical Center for the distributed maintenance of the integrated knowledge base that drives the WizOrder clinical decision-support, physician order entry, and notes capture system.

Artificial Intelligence↗
PubMed2005

Results of a survey on medical error reporting systems in Korean hospitals.

BACKGROUND: Recent data suggest that medical injuries, or adverse events, represent an important international problem, and that many are caused by errors. Spontaneous reporting is the main tool used to detect errors and adverse events in most countries, and reporting systems are believed to be important for improving patient safety. Increasingly, such reporting can be done using information systems, and information systems are widely used in Korea. However, few data are available regarding the use of electronic medical error reporting systems in Korea. OBJECTIVES: The objectives of this study were to investigate the present status of reporting system of Korean hospitals, and to compare the current status of medical error reporting systems with that of other health information sub systems. METHODS: The chairs of nursing departments of all 283 hospitals nationwide with more than 100 beds were surveyed using a structured questionnaire. The response rate was 35%. In addition, two reports on the national use of health information systems in Korea from 1999 and 2003 were analyzed. RESULTS: Among reporting hospitals (n=99), medical errors were reported on paper in 75 hospitals (77%), verbally in 30 hospitals (30%), using word processing in 13 hospitals (13%), and using the hospital information system in only three hospitals (3%). In contrast, there was widespread and increasing use of health information technology (HIT) in areas such as medication administration, inpatient and outpatient order entry, and radiology. CONCLUSIONS: While HIT is increasingly widely used in Korea in many areas, it is not being used for error reporting. Increasing the use of electronic reporting systems, and systemically evaluating the medical errors and adverse events reported, represent essential steps for reducing systemic errors and improving patient safety.

Health Care Surveys↗
PubMed2003

[Computerized physician order entry--an urgently required modality].

Misread or misinterpreted hand-written prescriptions or medication orders are the most important cause of life-threatening or serious drug related adverse effects occurring in hospital in-patients. There is convincing evidence in the literature showing that computerized systems for physician order entry, with on-line screening of drug related orders for compatibility with patient characteristics (e.g. age, renal function), drug information (e.g. dose limits, drug-drug interactions) and sets of institutional rules of performance can reduce rates of medication related errors by 80% and more. Reduction of error-related hospital costs would generate the funding required for implementation of such systems, a need that must be met without delay.

Decision Support Systems, Clinical↗
PubMed2002

A clinical rules taxonomy for the implementation of a computerized physician order entry (CPOE) system.

Many of the benefits of computerized physician order entry (CPOE) stem from its ability to support medical decision-making and error-reduction during patient care. This automated "intelligence" is typically represented by a network of rules. We describe a taxonomic representation of clinical decision-support rules in the context of developing and implementing a de novo CPOE and decision-support system. In our experience, this clinical rules taxonomy facilitated our implementation goals in the areas of physician acceptance and approval, rules construction and maintenance, and technical development and testing. This rules taxonomy may eventually be used to establish standards by which CPOE-based decision-support is measured.

Academic Medical Centers↗
PubMed2003

A method for subdividing clinical guidelines into process modules with associated triggers and objectives to facilitate implementation.

Representation of multi-step clinical guidelines (CG) and their implementation in computerized decision support (DS) systems are complex and logistically challenging tasks. However, many simple rules based on CGs (e.g., medical logic modules), have been successfully implemented through a few popular DS models (e.g., prevention reminders, order entry systems). To facilitate mapping of CGs to practical DS models, we propose an empirical method for sub-dividing CGs into modules according to the locus in a clinical process flow model where implementation would be most effective (e.g., post-encounter provider order entry). We further propose a classification of triggers and objectives for CG modules that provides a framework for a DS system to implement the module Successful application of the method to ten diverse CGs in the outpatient setting is described.

Decision Support Systems, Clinical↗
PubMed2005

Prevention of prescription errors by computerized, on-line surveillance of drug order entry.

AIMS: The present study was undertaken to quantify the impact of computerized drug order entry system (CDOE) connected to the patients' database, on the incidence and type of prescription errors (PEs) in the medical service, and to delineate the causes for remaining errors. METHODS: Drug orders were reviewed daily by a physician-reviewer, in a department of internal medicine that used for more than 3 years a CDOE (CDOEdept), and in a similar department in which drug orders were handwritten (HWdept). PEs were divided into those not related to the individual patient (type 1 PEs), and PEs resulting from drug-laboratory, drug-disease, and drug-allergy interactions (type 2 PEs). RESULTS: Ten thousand and two hospitalization days were evaluated. The incidence of type 1 PEs was 5.21 and 1.36 per 100 hospitalization days in the HWdept and CDOEdept, respectively (p<0.0001). Type 2 PEs were more common, 7.20 and 3.02 per 100 hospitalization days in the HWdept and CDOEdept, respectively (p<0.0001), and about 75% of them were due to few drug-laboratory interactions. Most of the remaining errors in the CDOEdept were due to inadequate adjustment of drugs and doses to renal function, or failure to perform adequate changes when new laboratory results became available. CONCLUSIONS: We conclude that linking the CDOE with few, specific, laboratory results has a large impact on the prevention of PEs. Combining the CDOE with a drug-laboratory alert system is expected to further reduce the incidence of PEs.

Academic Medical Centers↗
PubMed2006

Preventing medication errors in hospitals through a systems approach and technological innovation: a prescription for 2010.

Medication errors in hospital settings are considered both widespread and costly to the American healthcare system; yet, it is tractable to available solutions. This article offers a novel prescription for the problem that could be implemented by 2010. It consists of a systems approach--failure mode effects analysis (FMEA)--in combination with emerging technologies, such as a decision support system (DDS) with integrated real-time medical informatics, electronic medical records (EMR), computer physician order entry (CPOE), bar coding, automated dispensing machines (ADM), and robotics. Cost and benefit analysis reveals that this proposed integrated solution will radically reduce medication errors in hospitals and save the lives of thousands of Americans who frequent such facilities on an annual basis, as well as reduce healthcare costs.

Diffusion of Innovation↗
PubMed2003

[Computerized physician order entry, a tool for added safety in the hospital].

DRUG-RELATED IATROGENIC NOSOCOMIAL ILLNESS: Remains a matter of concern in the public health area. Responsibility of hospitals is challenged by the ever increasing number of patients' claims. Dysfunction in the drug-prescribing and delivery system account, to a large extent, for medication errors, some of them resulting in adverse drug events. Most generally, medication ordering by the physician is handwritten, without nominative recapitulating prescriptions, and followed by nurse transcriptions and a global medication order is transmitted to the pharmacy. This system does not integrate the pharmaceutical analysis of the prescription, before distribution of the drugs. THE COMPUTERIZED DRUG ORDER ENTRY PROCESS: The prescription is entered directly and is displayed on the computer screen, together with the previous prescriptions for the same patient. Transcription is hence eliminated. Depending on the sophistication of the software, the prescription undergoes a series of tests; warnings and reminders can be displayed online before the physician validates the prescription. Moreover, various guidelines in some aspects of drug therapy may be presented online before the prescription is completed. POSSIBILITIES: The pharmacist's access to the complete prescriptions permits analysis of the quality and safety of the prescriptions and the adequation with eventual current applicable recommendations. Prospective drug utilization review, with immediate feedback to the prescribing physician in case of concern, may be undertaken, further improving the quality of drug therapy. Moreover, a work sheet is printed out for the nurses, further enhancing the safety of drug administration and validation. The computerized drug network also permits the development of other functions. A TOOL FOR SAFETY: Currently available reports in the literature suggest that computerized drug prescription reduces the incidence of prescribing errors, improves the appropriateness of drug choices, optimises therapeutic follow-up, and reduces the incidence adverse drug events and leads to substantial reduction in drug expenditures.

Computers↗
PubMed1998

Effect of computerized physician order entry and a team intervention on prevention of serious medication errors.

CONTEXT: Adverse drug events (ADEs) are a significant and costly cause of injury during hospitalization. OBJECTIVES: To evaluate the efficacy of 2 interventions for preventing nonintercepted serious medication errors, defined as those that either resulted in or had potential to result in an ADE and were not intercepted before reaching the patient. DESIGN: Before-after comparison between phase 1 (baseline) and phase 2 (after intervention was implemented) and, within phase 2, a randomized comparison between physician computer order entry (POE) and the combination of POE plus a team intervention. SETTING: Large tertiary care hospital. PARTICIPANTS: For the comparison of phase 1 and 2, all patients admitted to a stratified random sample of 6 medical and surgical units in a tertiary care hospital over a 6-month period, and for the randomized comparison during phase 2, all patients admitted to the same units and 2 randomly selected additional units over a subsequent 9-month period. INTERVENTIONS: A physician computer order entry system (POE) for all units and a team-based intervention that included changing the role of pharmacists, implemented for half the units. MAIN OUTCOME MEASURE: Nonintercepted serious medication errors. RESULTS: Comparing identical units between phases 1 and 2, nonintercepted serious medication errors decreased 55%, from 10.7 events per 1000 patient-days to 4.86 events per 1000 (P=.01). The decline occurred for all stages of the medication-use process. Preventable ADEs declined 17% from 4.69 to 3.88 (P=.37), while nonintercepted potential ADEs declined 84% from 5.99 to 0.98 per 1000 patient-days (P=.002). When POE-only was compared with the POE plus team intervention combined, the team intervention conferred no additional benefit over POE. CONCLUSIONS: Physician computer order entry decreased the rate of nonintercepted serious medication errors by more than half, although this decrease was larger for potential ADEs than for errors that actually resulted in an ADE.

Clinical Pharmacy Information Systems↗
PubMed2004

CPOE systems: success factors and implementation issues.

The medication error dilemma has come to the forefront of most hospitals' improvement agendas. The most often cited solution to the problem has been computerized provider order entry (CPOE) systems. These systems have significant potential to improve errors associated with illegibility as well as inappropriate drug use and dosing. On the other hand, CPOE system implementation is fraught with barriers that impede acceptance and use of these systems. Knowing what strategies have proven successful and what upfront analysis is required can help increase the chances of success and ultimately improve the quality of patient care.

Attitude of Health Personnel↗
PubMed2002

IT, patient safety, and quality care.

The growing understanding of medical errors as systemic in nature underscores the importance of analyzing and redesigning systems. Best practices in medication safety that promise rapid payback include computerized physician order entry, ongoing tracking and benchmarking, and the creation by leadership of nonpunitive environments where this new culture of safety can thrive.

Health Services Administration↗
PubMed2002

Experiences with knowledge application in medical care.

IT interventions, such as provider order entry and knowledge repositories, are improving the application of medical knowledge. One health system's experiences are reviewed, including challenges faced and organizational factors that supported the process.

Academic Medical Centers↗