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Physician order entry system cuts error rate, improves path compliance, tracks data.

Installing physician order entry systems goes a long way to reducing expensive adverse drug events. Brigham and Women's Hospital's automated physician order entry system identifies potential drug interaction problems and flags dosage errors--plus it enables data collection to track prescribing practices and encourages physicians to follow standardized pathways. Here are the details on BWH's system, its study on how adverse drug events waste health care dollars, and advice on minimizing adverse events at your institution.

Adverse Drug Reaction Reporting Systems↗

User needs and demands of a computer-based patient record.

Prior to the implementation of a computer-based patient record, it is necessary to outline the requirements of the medical personnel. The paper is an account of a survey on information needs and demands on computer-based patient records. The study was conducted among physicians, nursing staff and therapists in two Dutch hospitals. In order to conduct the study, a measuring-instrument in form of a questionnaire was developed. Based on the results, it may be concluded, that health service staff does not only require improved input- and consultation uses with regard to the hard copy, but is also in need of additional functions. The developed measuring instrument appeared to be a proficient aid in outlining the information needs and demands of the health service staff. Through the developed questionnaire, the staff was able to obtain an idea of the possibilities of the computer-based patient record and state their own interest in same.

Adult↗

Housestaff attitudes toward computer-based clinical decision support.

OBJECTIVE: To measure housestaff attitudes towards computer-based decision support and their threshold for having CDSS messages displayed. DESIGN: 770 self-administered surveys were distributed to housestaff physicians. RESULTS: 209 surveys were returned. 63% of respondents agreed or strongly agreed that CDSS would improve quality of care, while 52% agreed or strongly agreed that it would decrease adverse drug events. Respondents were neutral regarding the impact of CDSS on productivity and on their autonomy. Sixty percent approved of a reminder to consider surgical consultation in a patient with abdominal pain, while 88% approved of alerts about hypokalemia. Respondents felt both reminders should be triggered when their PPV exceeded 67%. Attitudes toward POE correlated positively with attitudes toward CDSS (Pearson's rho 0.56; p < 0.0001). Respondents who were dissatisfied with POE had a higher threshold PPV for seeing reminders. CONCLUSION: The majority of housestaff favor the implementation of a CDSS. Housestaff with favorable POE experiences were more likely to endorse CDSS, and those with negative POE experience were more likely to oppose it. The results suggest that a carefully designed CDSS with rules constructed to exceed a threshold PPV would be accepted by housestaff.

Attitude to Computers↗

The transition to automated practitioner order entry in a teaching hospital: the VA Puget Sound experience.

We recently installed an automated practitioner order entry system on our busiest inpatient wards and critical care units. The installation followed 20 months preparation in which we created the workstation, network, and host infrastructure, developed requisite policies, recruited personnel to support the system, and installed the software in areas where the pace of order entry was less intense. Since implementing automated order entry, we have experienced problems such as an increase in time required for practitioners to enter orders, workflow changes on inpatient units, difficulties with patient transfers, and others. Our user support system has been heavily used during the transition period. Software tailoring and enhancements designed to address these problems are planned, as is installation of the order entry system in remaining clinical units in our medical centers.

Attitude to Computers↗