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At least 451 records · Page 25Linked to original sources
PubMed2003

Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients.

OBJECTIVES: Medication errors in pediatric inpatients occur at similar rates as in adults but have 3 times the potential to cause harm. Error prevention strategies in this setting remain largely untested. The objective of this study was to classify the major types of medication errors in pediatric inpatients and to determine which strategies might most effectively prevent them. METHODS: A prospective cohort study was conducted of 1020 patients who were admitted to 2 academic medical centers during a 6-week period in April and May 1999. Medication errors were characterized by subtype. Physician raters evaluated error prevention strategies and identified those that might be most effective in preventing errors. RESULTS: Of 10 778 medication orders reviewed, 616 contained errors. Of these, 120 (19.5%) were classified as potentially harmful, including 115 potential adverse drug events (18.7%) and 5 preventable adverse drug events (0.8%). Most errors occurred at the ordering stage (74%) and involved errors in dosing (28%), route (18%), or frequency (9%). Three interventions might have prevented most potentially harmful errors: 1) computerized physician order entry with clinical decision support systems (76%); 2) ward-based clinical pharmacists (81%); and 3) improved communication among physicians, nurses, and pharmacists (86%). Interrater reliability of error prevention strategy assignment was good (agreement: 0.92; kappa: 0.82). CONCLUSIONS: Of the assessed interventions, computerized physician order entry with clinical decision support systems; ward-based clinical pharmacists; and improved communication among physicians, nurses, and pharmacists had the greatest potential to reduce medication errors in pediatric inpatients. Development, implementation, and assessment of such interventions in the pediatric inpatient setting are needed.

Adult↗
PubMedDate not supplied

Controlled trial of direct physician order entry: effects on physicians' time utilization in ambulatory primary care internal medicine practices.

OBJECTIVE: Direct physician order entry (POE) offers many potential benefits, but evidence suggests that POE requires substantially more time than traditional paper-based ordering methods. The Medical Gopher is a well-accepted system for direct POE that has been in use for more than 15 years. The authors hypothesized that physicians using the Gopher would not spend any more time writing orders than physicians using paper-based methods. DESIGN: A randomized controlled trial of POE using the Medical Gopher system in 11 primary care internal medicine practices. MEASUREMENTS: The authors collected detailed time use data using time motion studies of the physicians and surveyed their opinions about the POE system. RESULTS: The authors found that physicians using the Gopher spent 2.2 min more per patient overall, but when duplicative and administrative tasks were taken into account, physicians were found to have spent only 0.43 min more per patient. With experience, the order entry time fell by 3.73 min per patient. The survey revealed that the physicians believed that the system improved their patient care and wanted the Gopher to continue to be available in their practices. CONCLUSIONS: Little extra time, if any, was required for physicians to use the POE system. With experience in its use, physicians may even save time while enjoying the many benefits of POE.

Attitude of Health Personnel↗
PubMed2002

Quantifying value for physician order-entry systems: a balance of cost and quality.

Healthcare CFOs commonly demand hard data to prove that an investment in computerized physician order entry (CPOE) will be worthwhile. However, a balanced analysis of cost and quality of the CPOE system has advantages over traditional return-on-investment appraisals. Montefiore Medical Center (MMC), Bronx, New York, assessed the value of its CPOE system by quantifying cost and quality measures rather than relying solely on dollar returns. MMC collected process times for medication ordering before and after the CPOE system was introduced and demonstrated that the use of CPOE increased medication ordering efficiency by 92 percent. MMC calculated additional process times for ward clerks, nurses, and pharmacists before and after CPOE implementation and determined the time saved per employee. From that number, the dollars potentially saved per employee and total potential dollar value of time savings per year were calculated.

Capital Expenditures↗
PubMed2001

Usability evaluation of the progress note construction set.

OVERVIEW: The Veterans Administration (VA) Computerized Patient Record System (CPRS) is a nationally deployed software product that integrates provider order entry, progress notes, vitals, consults, discharge summaries, problem lists, medications, labs, radiology, transcribed documents, study reports, and clinical reminders. Users rapidly adopted the graphical user interface for data retrieval, but demanded options to typing for data entry. We programmed "point and click" forms that integrate with CPRS individually, but were soon overwhelmed by requests. Subsequently, we developed the Progress Note Construction Set (PNCS); a tool suite that permits subject matter experts without programming skills to create reusable "point and click" forms. In this study, we evaluate the usability of these user-constructed forms. METHODS: An untrained, non-VA subject matter expert used the PNCS to create a graphical form for "skin tear" documentation. Ten VA nurses used the skin tear form to document findings for 7 standardized clinical scenarios. Following each scenario the subjects answered usability questions about the form. RESULTS: The subject matter expert created the skin tear form in 78 minutes. Users found the form to facilitate their data entry (p 0.0265), and to be at least as fast (p 0.0029) and as easy to use as expected (p 0.0166). Average note entry time was 3.4 minutes. CONCLUSION: The PNCS allowed a non-programmer to quickly create a usable, CPRS-integrated point and click form. Users found the subject matter expert s form fast and easy to use. The tool suite is a more scaleable form creation method because capacity is no longer limited by programmer availability.

Medical Records Systems, Computerized↗
PubMedDate not supplied

National Quality Forum 30 safe practices: priority and progress in Iowa hospitals.

The National Quality Forum (NQF) recently released a list of "30 Safe Practices" that were identified as relevant for all hospitals. The purpose of the present analysis was to assess hospitals' perceptions of each of the NQF 30 Safe Practices in terms of priority and progress. One hundred of Iowa's hospitals (86%) completed a survey. The highest progress ratings were for items involving hand washing, unit-dose medication dispensing, influenza vaccinations, implementing protocols to prevent wrong-site procedures, and standardized methods for labeling and storing medications. The lowest progress ratings were for intensive care units staffed by intensivists and implementing a computerized provider order entry system. Overall, safe practices that have been recommended for some time had higher priority and progress ratings. Most safe practices were equally endorsed by large and small hospitals, suggesting that the NQF goal of identifying safe hospital practices may be attainable for most of the safe practices.

Data Collection↗
PubMed2002

Gaining MD buy-in: physician order entry.

Computerized physician order entry (CPOE) eliminates illegible handwriting, reduces medical errors, and improves patient care. The administration, medical staff, nursing, and health information systems departments of a community teaching hospital cooperated to achieve organization-wide use of its CPOE system.

Attitude of Health Personnel↗
PubMed2006

Recent study lauds automated surveillance.

ADEs detected at a rate 3.6 times that of voluntary reporting at a university hospital and 12.3 times that at a community hospital. Goal of system is not just to detect ADEs, but to measure whether they are being reduced. Automated surveillance is much less costly than computerized physicians order entry.

Adverse Drug Reaction Reporting Systems↗
PubMed1992

Investigational drug information through a hospitalwide computer system.

A hospitalwide computer system that combines protocol-specific information on investigational drugs with order entry is described. A large university teaching hospital had in place a computerized clinical information system. Among other uses, physicians used the system for direct entry of total parenteral nutrient solution orders and associated laboratory tests; labels are produced automatically. Personnel from the pharmacy and information services departments met to discuss how to apply the computer system to investigational drug information. The application they designed has three components: protocol information, order entry, and patient monitoring. Protocol information, including all the standard drug data plus regulatory and investigator information, is displayed as a report on the user's terminal. The order-entry pathway allows the research pharmacist to predesign medication labels that are specific to each study and include all required information. This saves time, ensures accurate labeling, and provides a means for generating patient charges. The patient-monitoring component provides information to the research pharmacist in a daily report to assist in locating subject patients and to monitor compliance with protocols. The system has improved the access of health-care professionals to investigational drug information and decreased the time pharmacists spend dispensing these agents. The system has been well received, although up to three weeks is needed to bring the information online. A hospitalwide information system is effective in disseminating information on investigational drugs and facilitating order entry.

California↗
PubMed2001

Guided medication dosing for inpatients with renal insufficiency.

CONTEXT: Usual drug-prescribing practices may not consider the effects of renal insufficiency on the disposition of certain drugs. Decision aids may help optimize prescribing behavior and reduce medical error. OBJECTIVE: To determine if a system application for adjusting drug dose and frequency in patients with renal insufficiency, when merged with a computerized order entry system, improves drug prescribing and patient outcomes. DESIGN, SETTING, AND PATIENTS: Four consecutive 2-month intervals consisting of control (usual computerized order entry) alternating with intervention (computerized order entry plus decision support system), conducted in September 1997-April 1998 with outcomes assessed among a consecutive sample of 17 828 adults admitted to an urban tertiary care teaching hospital. INTERVENTION: Real-time computerized decision support system for prescribing drugs in patients with renal insufficiency. During intervention periods, the adjusted dose list, default dose amount, and default frequency were displayed to the order-entry user and a notation was provided that adjustments had been made based on renal insufficiency. During control periods, these recommended adjustments were not revealed to the order-entry user, and the unadjusted parameters were displayed. MAIN OUTCOME MEASURES: Rates of appropriate prescription by dose and frequency, length of stay, hospital and pharmacy costs, and changes in renal function, compared among patients with renal insufficiency who were hospitalized during the intervention vs control periods. RESULTS: A total of 7490 patients were found to have some degree of renal insufficiency. In this group, 97 151 orders were written on renally cleared or nephrotoxic medications, of which 14 440 (15%) had at least 1 dosing parameter modified by the computer based on renal function. The fraction of prescriptions deemed appropriate during the intervention vs control periods by dose was 67% vs 54% (P<.001) and by frequency was 59% vs 35% (P<.001). Mean (SD) length of stay was 4.3 (4.5) days vs 4.5 (4.8) days in the intervention vs control periods, respectively (P =.009). There were no significant differences in estimated hospital and pharmacy costs or in the proportion of patients who experienced a decline in renal function during hospitalization. CONCLUSIONS: Guided medication dosing for inpatients with renal insufficiency appears to result in improved dose and frequency choices. This intervention demonstrates a way in which computer-based decision support systems can improve care.

Decision Support Systems, Clinical↗
PubMed2003

Medication errors in the emergency department: a systems approach to minimizing risk.

Adverse drug events caused by medication errors represent a common cause of patient injury in the practice of medicine. Many medication errors are preventable and hence particularly tragic when they occur, often with serious consequences. The enormous increase in the number of available drugs on the market makes it all but impossible for physicians, nurses, and pharmacists to possess the knowledge base necessary for fail-safe medication practice. Indeed, the greatest single systemic factor associated with medication errors is a deficiency in the knowledge requisite to the safe use of drugs. It is vital that physicians, nurses, and pharmacists have at their immediate disposal up-to-date drug references. Patients presenting for care in EDs are usually unfamiliar to their EPs and nurses, and the unique patient factors affecting medication response and toxicity are obscured. An appropriate history, physical examination, and diagnostic workup will assist EPs, nurses, and pharmacists in selecting the safest and most optimum therapeutic regimen for each patient. EDs deliver care "24/7" and are open when valuable information resources, such as hospital pharmacists and previously treating physicians, may not be available for consultation. A systems approach to the complex problem of medication errors will help emergency clinicians eliminate preventable adverse drug events and achieve a goal of a zero-defects system, in which medication errors are a thing of the past. New developments in information technology and the advent of electronic medical records with computerized physician order entry, ward-based clinical pharmacists, and standardized bar codes promise substantial reductions in the incidence of medication errors and adverse drug events. ED patients expect and deserve nothing less than the safest possible emergency medicine service.

Adult↗
PubMed2005

ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing--2004.

PURPOSE: Results of the 2004 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented. METHODS: A stratified random sample of pharmacy directors at 1183 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. RESULTS: The response rate was 41.7%. Compared with the results of the 2001 survey, the number of times pharmacy and therapeutics committees met increased, suggesting an increase in efforts to monitor and manage medication use in hospitals. There was an increase in the use of quality-of-life information to make formulary decisions, indicating a shift away from cost-based formularies. There was a decrease in the rates of formulary compliance, but an increase in the use of evidence-based clinical practice guidelines, suggesting the emergence of more comprehensive approaches to improving prescribing. The use of medication-use evaluations increased in smaller hospitals, suggesting greater use of best practices is occurring in these institutions. The use of drug information services continues to decline, as the use of more efficient and easily accessible online sources of drug information increases. Reading back oral orders to improve accuracy dramatically increased since 2001. The adoption of computerized prescriber-order-entry systems continues to be slow, with fewer than 5% of hospitals reporting their use. CONCLUSION: The 2004 ASHP survey results indicate that pharmacists are continuing to improve medication use at the prescribing and transcribing steps of the medication-use system.

Computer Systems↗
PubMed1992

Evolving to provide pharmaceutical care without additional resources in a university hospital.

Our department is committed to a process of continuous quality improvement focusing on delivering the best possible pharmaceutical care services. Three committees, each with representation from pharmacists and pharmacy technicians from all areas of the department, were convened in 1991 to 1992 to further identify areas for service enhancement and to plan for the future. Based on the recommendations of these committees, further expansion in ambulatory services is a priority. Other changes will include further automation of the drug-distribution system, examination of the role of the pharmacy technician, development of an automated patient-care system with direct physician order entry, computerized documentation of clinical interventions, and reaffirmation of the role of the pharmacist as the professional responsible for proper use of medications at UMHC.

Centralized Hospital Services↗
PubMed1982

A computerized assisted pharmacy automatic stop order procedure.

Automatic stop orders, which still seem to plague many hospitals, can be instituted with the cooperation of the medical staff, legal counsel, nursing service, and administration. The use of a computerized assisted pharmacy system, described here, allows compliance with Joint Commission on Accreditation of Hospitals' regulations and also prevents possible legal complications. By utilizing computer-generated reports, appropriate labels, and a drug order entry system for entering a discontinue/renewal time and date, compliance with established policies is possible.

Computers↗
PubMed1975

[The setting up of a computer system for records of first entries at the emergency medical assistance service in Montpellier].

The setting up of a computing device to exploit the files of first transports at the MONTPELLIER SAMU was started essentially in order to constitute a document both accurate and of easy access, able to memorize the physical and mental behaviour of a patient in a transient state. The results thus obtained include: 1 -- An analytical study with a part devoted to general data such as the number of injured people or of patients, the number of calls from various sources, the means of intervention etc. and a more specific part dealing with type of accident the determination of the traumatic impacts, the first therapy etc.; 2 -- A synthetical study that constitutes the second phase of the dealing with information thanks to the drawing up of graphs indicating the number of calls per accident according to the time, the age, the number of serious cases etc.

Computers↗