Free-Text Computerized Provider Order Entry Orders Used as Workaround for Communicating Medication Information

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Swaminathan Kandaswamy ◽  
Joanna Grimes ◽  
Daniel Hoffman ◽  
Jenna Marquard ◽  
Raj M. Ratwani ◽  
...  
Keyword(s):  
Free Text ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Medication Information

Clinician Perceptions on the Use of Free-Text Communication Orders

2021 ◽  
Vol 12 (03) ◽  
pp. 484-494
Author(s):  
Swaminathan Kandaswamy ◽  
Zoe Pruitt ◽  
Sadaf Kazi ◽  
Jenna Marquard ◽  
Saba Owens ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Records ◽  
Medication Administration ◽  
Free Text ◽  
Primary Reason ◽  
Order Entry ◽  
Health Records ◽  
Medication Information ◽  
Safety Risks ◽  
Electronic Health

Abstract Objective The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. Methods We performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes. Results Participants described eight reasons why clinicians use free-text medication orders, five risks relating to the use of free-text medication orders, and five recommendations for improving EHR medication-related communication. Poor usability, including reduced efficiency and limited functionality associated with structured order entry, was the primary reason clinicians used free-text orders to communicate medication information. Common risks to using free-text orders for medication communication included the increased likelihood of missing orders and the increased workload on nurses responsible for executing orders. Discussion Clinicians' use of free-text orders is primarily due to limitations in the current structured order entry design. To encourage the safe communication of medication information between clinicians, the EHR's structured order entry must be redesigned to support clinicians' cognitive and workflow needs that are currently being addressed via the use of free-text orders. Conclusion Clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks. Thoughtful solutions designed to address these workarounds can improve the medication ordering process and the subsequent medication administration process.

scholarly journals A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care

2016 ◽  
Vol 24 (2) ◽  
pp. 432-440 ◽  
Author(s):  
Clare L Brown ◽  
Helen L Mulcaster ◽  
Katherine L Triffitt ◽  
Dean F Sittig ◽  
Joan S Ash ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Error Rates ◽  
Free Text ◽  
Prescribing Errors ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Computer Screen

Objective: To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems. Materials and Methods: We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken. Results: A total of 1185 publications were identified, of which 34 were included in the review. We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users’ work processes, and clinical decision support systems. Displaying an incomplete list of a patient’s medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments. Users’ misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors. Discussion and Conclusions: Human factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users’ workflow expectations.

scholarly journals Optimized Computerized Order Entry can Reduce Errors in Electronic Prescriptions and Associated Pharmacy Calls to Clarify (CTC)

2016 ◽  
Vol 07 (02) ◽  
pp. 587-595 ◽  
Author(s):  
Richard Ogletree ◽  
Allison Sutterfield ◽  
John Pace ◽  
Laurene Lahr ◽  
Jaimin Patel
Keyword(s):  
Error Rate ◽  
Secondary Analysis ◽  
Cost Savings ◽  
Electronic Prescribing ◽  
Free Text ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Before And After ◽  
Physician Time ◽  
The Cost

SummaryAfter implementation of a system-wide EMR within our university system, e-prescribing is now commonplace.The authors conducted a study to assess whether optimization of computerized provider order entry (CPOE) can reduce errors in these electronically transmitted prescriptions and would require less frequent interventions from pharmacists, in particular the need for them to “call to clarify” (CTC) details of particular prescriptions. Secondary analysis based on cost assumptions was preformed to presume cost differences before and after optimization changes.In order to generate complete, error-free prescriptions, optimization changes were implemented in the form of in line validation messages. These messages were generated if (1) an order did not specify a provider or pharmacy; (2) the DEA requirements were not met; (3) character limits were exceeded in patient sig or demographics or (4) administration instructions had breaks or had both discrete and free text elements. Retrospectively, prescriptions were randomly selected from a nine month period before and after implementing changes. These prescriptions were analyzed by a pharmacist and a nurse to identify types of errors that would require a CTC to a prescribing provider. Errors were compared statistically to determine effectiveness of changes pre and post optimization.A total of 602 prescriptions were analyzed; 301 before changes and 301 after changes. Of these prescriptions, 20.27% had errors before changes and 12.96% had errors after changes. The decline in the error rate was considered statistically significant for p<0.05. The cost savings were estimated at $76 per 100 prescriptions for pharmacist and physician time-cost estimates combined.Implementing optimization changes to the CPOE resulted in a reduction in error rate requiring pharmacist CTC. This study identifies effective optimization changes for electronic prescribing that can reduce prescribing errors and may result in cost saving.

scholarly journals P094: A computerized provider order entry strategy to improve the quality of clinical information on neuroimaging requisitions from the emergency department: an interim analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S90-S90
Author(s):  
K. Lin ◽  
S. K. Dowling ◽  
K. Yiu ◽  
D. Wang ◽  
S. van Gaal ◽  
...  
Keyword(s):  
Clinical Information ◽  
Relative Increase ◽  
Free Text ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Implementation Period ◽  
Implementation Data ◽  
The Impact ◽  
Order Set

Introduction: Clinical context is critical for accurate radiologic interpretation of neuroimaging investigations. The aim of this study was to determine the impact of a change in the Emergency Department (ED) computerized provider order entry (CPOE) interface on the quality of clinical information conveyed in ED neuroimaging requisitions for suspected stroke patients. Methods: Four local EDs utilizing a common CPOE ED Stroke order set were studied before and after the introduction of a mandatory blank free text field requiring clinical information for the radiologist before a computed tomography angiography (CTA) request could be submitted. Prior to this modification, the indication (acute stroke) was pre-filled in the CTA request for convenience with the option of providing additional information at the discretion of the ordering physician. ED physicians were informed of the change as well as the rationale for its implementation. A retrospective pre (90 days) post (30 days) analysis was conducted across four local EDs to evaluate the impact of the CPOE user interface change on the quality of clinical information provided on neuroimaging orders. Patients aged 18 with CTA head and/or neck orders submitted from the order set were included. Patients were excluded if the CTA order was submitted outside of the ED Stroke order set, if order entry was by non-physician personnel, or if the order was modified by the diagnostic imaging department after ED submission. Clinical information from CTA orders were scored as complete, partial, or absent/uninformative based on a standardized rubric of critical elements, including: description of neurological deficit(s), lateralization, and timing of symptom onset or duration. Results were analyzed using chi square analysis. Results: Pre-implementation data from Oct 1, 2015 Jan 1, 2016 (N=652) was compared to post-implementation data from Nov 1 30, 2016 (N=227). The proportion of complete, partial, and absent/uninformative clinical histories were: 45.3%, 31.4%, and 23.3% in the pre-implementation period and 62.6%, 37.4%, and 0% in the post-implementation period respectively. There was a 38.2% relative increase in complete clinical histories, a 19.1% relative increase in partial clinical histories, and a 100% reduction in absent/uninformative clinical histories (p<0.001). Conclusion: The introduction of a mandatory free text field significantly increased the overall quality of clinical information provided on ED neuroimaging orders. This CPOE strategy has the potential to improve diagnostic accuracy and reduce unnecessary delays to imaging interpretation caused by lack of clinical information.

Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system

2015 ◽  
Vol 84 (12) ◽  
pp. 1085-1093 ◽  
Author(s):  
Brian M. Dekarske ◽  
Christopher R. Zimmerman ◽  
Robert Chang ◽  
Paul J. Grant ◽  
Bruce W. Chaffee
Keyword(s):  
Order Entry ◽  
Computerized Provider Order Entry

Computerized Provider Order Entry and Patient Safety

2006 ◽  
Vol 53 (6) ◽  
pp. 1169-1184 ◽  
Author(s):  
Christoph U. Lehmann ◽  
George R. Kim
Keyword(s):  
Patient Safety ◽  
Order Entry ◽  
Computerized Provider Order Entry

scholarly journals CPOE in Non-Surgical Versus Surgical Specialties: A Qualitative Comparison of Clinical Contexts in the Medication Process

2010 ◽  
Vol 4 (1) ◽  
pp. 206-213 ◽  
Author(s):  
Zahra Niazkhani ◽  
Habibollah Pirnejad ◽  
Antoinette de Bont ◽  
Jos Aarts
Keyword(s):  
Information Needs ◽  
Order Entry ◽  
Clinical Context ◽  
Qualitative Comparison ◽  
Computerized Provider Order Entry ◽  
Medication Process ◽  
Positive Attitudes ◽  
Perceived Impact ◽  
The Impact

Background: Computerized provider order entry (CPOE) systems are implemented in various clinical contexts of a hospital. To identify the role of the clinical context in CPOE use, we compared the impact of a CPOE system on the medication process in both non-surgical and surgical specialties. Methods: We conducted a qualitative study of surgical and non-surgical specialties in a 1237-bed, academic hospital in the Netherlands. We interviewed the clinical end users of a computerized medication order entry system in both specialty types and analyzed the interview transcripts to elicit qualitative differences between the clinical contexts, clinicians’ attitudes, and specialty-specific requirements. Results: Our study showed that the differences in clinical contexts between non-surgical and surgical specialties resulted in a disparity between clinicians’ requirements when using CPOE. Non-surgical specialties had a greater medication workload, greater and more diverse information needs to be supported in a timely manner by the system, and thus more intensive interaction with the CPOE system. In turn these factors collectively influenced the perceived impact of the CPOE system on the clinicians’ practice. The non-surgical clinicians expressed less positive attitudes compared to the surgical clinicians, who perceived their interaction with the system to be less intensive and less problematic. Conclusion: Our study shows that clinicians’ different attitudes towards the system and the perceived impact of the system were largely grounded in the clinical context of the units. The study suggests that not merely the CPOE system, the technology itself, influences the perceptions of its users and workflow-related outcomes. The interplay between technology and clinical context of the implementation environment also matters. System design and redesigning efforts should take account of different units’ specific requirements in their particular clinical contexts.

scholarly journals Impact of Computerized Provider Order Entry on Total Parenteral Nutrition in the Neonatal Intensive Care Unit

2016 ◽  
Vol 21 (4) ◽  
pp. 339-345 ◽  
Author(s):  
Kyle A. Franco ◽  
Keliana O'Mara
Keyword(s):  
Parenteral Nutrition ◽  
Neonatal Intensive Care ◽  
Intervention Group ◽  
Preterm Neonates ◽  
Control Group ◽  
Order Entry ◽  
Serum Electrolyte ◽  
Computerized Provider Order Entry ◽  
Electrolyte Disturbances ◽  
Before And After

OBJECTIVES: To determine if computerized provider order entry (CPOE) implementation impacts the time it takes for preterm neonates to reach their parenteral macronutrient goals. METHODS: Retrospective review of neonates &lt;1750 g receiving parenteral nutrition (PN) before and after the implementation of CPOE. Primary outcome was the attainment of parenteral macronutrient goals. Secondary outcomes included time to attainment, the frequency of electrolyte abnormalities, and the incidence of required adjustments made to PN orders by verification pharmacists. RESULTS: Goal PN was achieved by 12/47 (25.5%) intervention vs. 2/44 (4.5%) control group infants (p &lt; 0.05). This goal was attained in 10.8 ± 7.5 days in the intervention group and 10 ± 4.2 days in the control group (p = 0.90). Goal protein was reached by 74.5% of CPOE patients vs. 36.4% of controls, p &lt; 0.05. Lipid goals were achieved by 98% vs. 100% (p = 0.33) of patients and were attained at an average of 1.5 ± 0.8 days vs. 2.0 ± 1.1 days (p &lt; 0.05). Abnormal serum electrolyte values occurred more frequently in the control group (0.79 vs. 1.12/day PN). Adjustments by a verification pharmacist were required in 5.6% of CPOE compared with 30.4% of control group orders (p &lt; 0.05). CONCLUSIONS: CPOE parenteral nutrition increased the proportion of preterm neonates attaining overall macronutrient goals. With CPOE, protein goals were reached by more patients and goal lipids were achieved faster. This system also decreased the number of pharmacist interventions during verification of PN orders and appeared to positively impact the incidence of serum electrolyte disturbances.

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