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PubMed2006

Strong IT effort underpins MOE/MAR success.

During the MOE/MAR implementation, the University Health Network's IT department faced a range of issues as it attempted to take advantage of recent technological advances and satisfy users within budget constraints. The challenges of doing so in this large, academic hospital organization are identified, drawing on both successful and less successful design and implementation efforts.

Diffusion of Innovation↗
PubMed2004

An algorithmic computerised order entry approach to assist in the prescribing of new therapeutic agents: case study of activated protein C at an academic medical centre.

BACKGROUND: Academic medical centres face the need to care for patients with complex medical conditions, educate physicians-in-training and conduct research, all with increasingly constrained budgets. The adoption of new therapeutic technology presents challenges and opportunities in each of these areas. Severe sepsis remains a major cause of morbidity and mortality, especially in tertiary-care facilities. Recombinant human activated protein C reduces mortality in patients with severe sepsis, but trial data indicate that the benefit of the drug is confined to the more seriously ill patients, while the risk of bleeding complications can be considerable. The cost of the drug is approximately USD 6000-8000 per treated patient. Integration of this product into routine care has produced unique challenges concerning clinical decision making, safety and cost. OBJECTIVES: To describe one hospital's multidisciplinary approach to the adoption of this new medication. METHODS: Before activated protein C was approved for use, Brigham and Women's Hospital (BWH) convened a working group to formulate clinical guidelines proactively. This new agent did not fit into an obvious therapeutic category but cut across multiple clinical disciplines requiring the involvement of several hospital departments in developing policy. As new data on efficacy emerged during the US FDA review of the drug, the working group had to devise a method for using the available information to assist clinical decision making while placing appropriate restrictions on the use of activated protein C. The goal was to make accurate information available to guide ordering physicians' decision making interactively, 24 hours a day. RESULTS: The committee developed a utilisation policy for activated protein C that provided guidance on patient selection, contraindications and risk stratification. Interactive computer-based order entry screens were developed to guide physicians through a complex set of clinical criteria to ensure appropriate evidence-based use. A careful review of contraindications is required as a second step. To risk stratify patients in accordance with the trial subset analyses and the FDA labelling guidelines, ordering physicians are guided in calculating an APACHE II (Acute Physiology and Chronic Health Evaluation) score for the patient. Physicians from several specialties are available for advice and consultation on patients with difficult or controversial conditions. Approximately two-thirds of completed orders passed the clinical algorithm; an additional 35% of patients did not meet the medication criteria but received the drug after the attending physician requested an override of the guidelines. CONCLUSION: The BWH approach to activated protein C used an innovative multidisciplinary approach and computer-assisted order entry to guide clinical use of a new agent with substantial clinical efficacy, risks and costs. This approach provides a model for strategies to deal with other new and complex medical technologies.

Academic Medical Centers↗
PubMed2006

Prescribing practice in a Swiss primary and secondary acute care hospital.

QUESTIONS UNDER STUDY: Little is known about the prescribing behaviour of physicians in hospitals. This analysis, using data based on Computerised Physician Order Entry (CPOE), was performed to evaluate prescription patterns, to analyse possible over-prescribing of drugs and to assess the compliance with therapy-guidelines. METHODS: Within a 12 month period, 68,133 prescriptions in three departments were analysed with respect to drug class, duration of therapy, dosage, administration route, patient's age, patient's length of stay and number of prescriptions per patient. RESULTS: On average, each patient received 12 drugs. A steady increase in the number of prescribed drugs can be seen between the age of 20 and 85. The median duration of intravenously administered antibiotics was 4.0 days, the median duration of antibiotic therapy was 9.5 days. DISCUSSION: On average, patients were taking 5 drugs on a regular basis on admission to hospital. This number was doubled during the hospital stay where patients were prescribed 12 drugs on average. On discharge 6 drugs were prescribed and thus a reasonable reduction was made. Surgical and Internal Medicine wards were using very similar drug classes. Concerning the use of low molecular-weight heparin, guidelines were widely adhered to whereas proton-pump-inhibitors were prescribed too often and the duration of intravenous antibiotic therapy tended to be too long.

Adolescent↗
PubMed2005

Sound-alike drug names produce risk of medication interchange errors.

Due to the risk of medications errors from inadvertent interchange of drugs for which names look alike or sound alike, the Joint Commission on Accreditation of Healthcare Organizations now requires that accredited health care organizations develop and maintain programs to minimize these risks. This report lists drug names that can lead to such errors.

Drug Prescriptions↗
PubMed2006

[Prescription errors--dimension and measures].

BACKGROUND: A prescription should contain sufficient information to dispense the right medicine with correct instructions for use. The information given on the prescription also forms the basis for reimbursement of drug expenses. Knowledge of prescription errors may improve the procedures of the prescribing physician and the pharmacy. MATERIAL AND METHOD: Prescriptions without information on the indication of the drug therapy were registered in ten Norwegian pharmacies during two days in the autumn of 2004. Other errors and omissions on prescriptions were registered in nine of the pharmacies during a five week period. RESULTS AND INTERPRETATION: A total of 1884 (39%) of the 4667 prescriptions included in the first part of the study contained no information on the indication. A total of 1696 other errors and omissions were registered on 1359 (2%) of the 69,315 prescriptions included in the second part of the study. The most common errors and omissions were incomplete instructions for use (26%), missing information about the patient (17%), and errors and omissions related to reimbursement of drug expenses. 294 (17%) of the errors were judged to have potential clinical significance if they had not been corrected. The most common intervention was to interview the patient or to contact the prescribing physician. The most common changes were to change or clarify drug and dose.

Drug Information Services↗
PubMed2006

E-prescribing can be new tool in quality-care arsenal.

Electronic prescribing is one of the newest tools in health care's arsenal to help "Renew our Mission of Quality Patient Care," the theme of this year's National Medical Group Practice Week. Physicians--who can be reluctant to change their paper-based ways--are learning to write and send prescriptions via electrons rather than by pen or voice. Is your practice ready for e-prescribing?

Diffusion of Innovation↗