Evaluation of Opioid Reversal with Naloxone before and after Implementation of a Computerized Physician Order Entry System at a Tertiary Medical Center

17058 Background: Computerized physician order entry (CPOE) in electronic medical records (EMR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after outpatient oncology EMR/CPOE system implementation in a hospital based outpatient cancer center within three treatment sites and with sixteen physicians. Methods: A retrospective chart review was conducted on 32 randomly selected patients to date, who received one of the following regimens: FOLFOX, carboplatin-paclitaxel, CHOP-rituximab, or AC between 1999 and 2006. Charts were case matched with physician and regimen to compare documentation completeness. Completeness scores were assigned to each chart based on the number of documented data points found out of the 33 data points assessed. A user satisfaction survey of the paper chart and EMR/CPOE system was conducted among the physicians (n=16), nurses (n=43), and pharmacists (n=8) who worked with both systems. Results: The mean percentage of identified data points successfully found in the EMR/CPOE charts was 94% vs. 68% in the paper charts (p<0.001). Regimen complexity did not alter the number of data points found. The survey response rate was 64% and the results showed that satisfaction was statistically significant in favor of the EMR/CPOE system. The time required to find the data points will be assessed by having a physician, nurse, and pharmacist review the same charts. Data on 112 charts will be presented. Conclusions: Using EMR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. No significant financial relationships to disclose.

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A Baseline Study of Medication Error Rates at Baylor University Medical Center in Preparation for Implementation of a Computerized Physician Order Entry System

Baylor University Medical Center Proceedings ◽

10.1080/08998280.2004.11927993 ◽

2004 ◽

Vol 17 (3) ◽

pp. 357-361 ◽

Cited By ~ 8

Author(s):

Christina E. Seeley ◽

David Nicewander ◽

Robert Page ◽

Peter A. Dysert

Keyword(s):

Medication Error ◽

Medical Center ◽

Error Rates ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Baseline Study ◽

Baylor University ◽

Physician Order Entry

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Medication Administration Variances Before and After Implementation of Computerized Physician Order Entry in a Neonatal Intensive Care Unit

PEDIATRICS ◽

10.1542/peds.2007-0919 ◽

2008 ◽

Vol 121 (1) ◽

pp. 123-128 ◽

Cited By ~ 40

Author(s):

J. A. Taylor ◽

L. A. Loan ◽

J. Kamara ◽

S. Blackburn ◽

D. Whitney

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Medication Administration ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Before And After ◽

Physician Order Entry

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Case Study: Challenges, Successes and Lessons Learned from Implementing Computerized Physician Order Entry (CPOE) at Two Distinct Health Systems: Implications of CPOE on the Pharmacy and the Medication-Use Process

Hospital Pharmacy ◽

10.1177/001857870504000509 ◽

2005 ◽

Vol 40 (5) ◽

pp. 420-429 ◽

Cited By ~ 5

Author(s):

John Manzo ◽

Mark J. Sinnett ◽

Frank Sosnowski ◽

Robert Begliomini ◽

Jill Green ◽

...

Keyword(s):

Health Systems ◽

Medical Center ◽

Medication Management ◽

Lessons Learned ◽

Medication Cost ◽

Computerized Physician Order Entry ◽

Management Process ◽

Order Entry ◽

Physician Order Entry

The purpose of this case study is to provide an understanding of the divergent experiences, challenges, and successes associated with implementing Computerized Physician Order Entry (CPOE) at two distinct health systems utilizing the same software vendor. Pharmacy leaders at Lehigh Valley Hospital and Health Network in Allentown, PA and Montefiore Medical Center in the Bronx, NY describe the various strategies deployed for CPOE planning and implementation, the outcomes and impacts of CPOE implementation, and valuable experience. Improvements and efficiencies in the medication management process and time savings will be described. Additionally, reductions in medication prescribing errors and enhancements in medication cost savings secondary to improved medication utilization are delineated. The authors conclude that while the challenges associated with planning and implementing CPOE for medication management and its impact on the pharmacy are great, pharmacist involvement early in the strategic planning is vital to ensure a successful and safer electronic medication management process.

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Improving adherence to the Epic Beacon ambulatory workflow

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155216637215 ◽

2016 ◽

Vol 23 (4) ◽

pp. 273-277 ◽

Cited By ~ 1

Author(s):

Ellen Chackunkal ◽

Vishnuprabha Dhanapal Vogel ◽

Meredith Grycki ◽

Diana Kostoff

Keyword(s):

Compliance Rate ◽

Medication Administration ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Center Staff ◽

Ambulatory Oncology ◽

Before And After ◽

Henry Ford ◽

Quasi Experimental ◽

Physician Order Entry

Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.

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A Tool to Retrieve Alert Dwell Time from a Homegrown Computerized Physician Order Entry (CPOE) System of an Academic Medical Center: An Exploratory Analysis

Applied Sciences ◽

10.3390/app112412004 ◽

2021 ◽

Vol 11 (24) ◽

pp. 12004

Author(s):

Shuo-Chen Chien ◽

Yen-Po Chin ◽

Chang-Ho Yoon ◽

Chun-You Chen ◽

Chun-Kung Hsu ◽

...

Keyword(s):

Dwell Time ◽

Medical Center ◽

Academic Medical Center ◽

Exploratory Analysis ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Professional Groups ◽

Academic Medical ◽

Physician Order Entry ◽

The Impact

Alert dwell time, defined as the time elapsed from the generation of an interruptive alert to its closure, has rarely been used to describe the time required by clinicians to respond to interruptive alerts. Our study aimed to develop a tool to retrieve alert dwell times from a homegrown CPOE (computerized physician order entry) system, and to conduct exploratory analysis on the impact of various alert characteristics on alert dwell time. Additionally, we compared this impact between various professional groups. With these aims, a dominant window detector was developed using the Golang programming language and was implemented to collect all alert dwell times from the homegrown CPOE system of a 726-bed, Taiwanese academic medical center from December 2019 to February 2021. Overall, 3,737,697 interruptive alerts were collected. Correlation analysis was performed for alerts corresponding to the 100 most frequent alert categories. Our results showed that there was a negative correlation (ρ = −0.244, p = 0.015) between the number of alerts and alert dwell times. Alert dwell times were strongly correlated between different professional groups (physician vs. nurse, ρ = 0.739, p < 0.001). A tool that retrieves alert dwell times can provide important insights to hospitals attempting to improve clinical workflows.

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74: Comparison of Lab and X-ray Turnaround Times Before and After Implementation of Computerized Physician Order Entry in an Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2007.06.106 ◽

2007 ◽

Vol 50 (3) ◽

pp. S24 ◽

Cited By ~ 2

Author(s):

M.J. Henstrom ◽

R.L. Norton ◽

R. Fu

Keyword(s):

Emergency Department ◽

Computerized Physician Order Entry ◽

Order Entry ◽

X Ray ◽

Before And After ◽

Physician Order Entry

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Impact of Computerized Order Entry to Pharmacy Interface on Order-Infusion Pump Discrepancies

Journal of Drug Delivery ◽

10.1155/2015/686598 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Rebecca A. Russell ◽

David Triscari ◽

Kathy Murkowski ◽

Matthew C. Scanlon

Keyword(s):

Intensive Care Unit ◽

Infusion Pump ◽

Healthcare Delivery ◽

Pediatric Intensive Care ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Computerized Order Entry ◽

Before And After ◽

Discrepancy Rate ◽

Physician Order Entry

Background. The ability of safety technologies to decrease errors, harm, and risk to patients has yet to be demonstrated consistently. Objective. To compare discrepancies between medication and intravenous fluid (IVF) orders and bedside infusion pump settings within a pediatric intensive care unit (PICU) before and after implementation of an interface between computerized physician order entry (CPOE) and pharmacy systems. Methods. Within a 72-bed PICU, medication and IVF orders in the CPOE system and bedside infusion pump settings were collected. Rates of discrepancy were calculated and categorized by type. Results were compared to a study conducted prior to interface implementation. Expansion of PICU also occurred between study periods. Results. Of 455 observations, discrepancy rate decreased for IVF (p=0.01) compared to previous study. Overall discrepancy rate for medications was unchanged; however, medications infusing without an order decreased (p<0.01), and orders without corresponding infusion increased (p<0.05). Conclusions. Following implementation of an interface between CPOE and pharmacy systems, fewer discrepancies between IVF orders and infusion pump settings were observed. Discrepancies for medications did not change, and some types of discrepancies increased. In addition to interface implementation, changes in healthcare delivery and workflow related to ICU expansion contributed to observed changes.

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We thought we would be perfect: medication errors before and after the initiation of Computerized Physician Order Entry

Journal of Surgical Research ◽

10.1016/j.jss.2015.03.004 ◽

2015 ◽

Vol 198 (1) ◽

pp. 108-114 ◽

Cited By ~ 8

Author(s):

David Schwartzberg ◽

Sasa Ivanovic ◽

Sheetal Patel ◽

Sathyaprasad C. Burjonrappa

Keyword(s):

Medication Errors ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Before And After ◽

Physician Order Entry

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Examining Perceptions of Computerized Physician Order Entry in a Neonatal Intensive Care Unit

Applied Clinical Informatics ◽

10.4338/aci-2016-09-ra-0153 ◽

2017 ◽

Vol 08 (02) ◽

pp. 337-347 ◽

Cited By ~ 4

Author(s):

Kristyn Beam ◽

Megan Cardoso ◽

Megan Sweeney ◽

Geoff Binney ◽

Saul Weingart

Keyword(s):

Job Satisfaction ◽

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Care Delivery ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Before And After ◽

Physician Order Entry

SummaryBackground: Computerized provider order entry (CPOE) is a technology with potential to transform care delivery. While CPOE systems have been studied in adult populations, less is known about the implementation of CPOE in the neonatal intensive care unit (NICU) and perceptions of nurses and physicians using the system.Objective: To examine perceptions of clinicians before and after CPOE implementation in the NICU of a pediatric hospital.Methods: A cross-sectional survey of clinicians working in a Level III NICU was conducted. The survey was distributed before and after CPOE implementation. Participants were asked about their perception of CPOE on patient care delivery, implementation of the system, and effect on job satisfaction. A qualitative section inquired about additional concerns surrounding implementation. Responses were tabulated and analyzed using the Chi-square test.Results: The survey was distributed to 158 clinicians with a 47% response rate for pre-implementation and 45% for post-implementation. Clinicians understood why CPOE was implemented, but felt there was incomplete technical training. The expectation for increased job satisfaction and ability to recruit high-quality staff was high. However, there was concern about the ability to deliver appropriate treatments before and after implementation. Physicians were more optimistic about CPOE implementation than nurses who remained concerned that workflow may be altered.Conclusions: Introducing CPOE is a potentially risky endeavor and must be done carefully to mitigate harm. Although high expectations of the system can be met, it is important to attend to differing expectations among clinicians with varied levels of comfort with technology. Interdisciplinary collaboration is critical in planning a functioning CPOE to ensure that efficient workflow is maintained and appropriate supports for individuals with a lower degree of technical literacy is available.Citation: Beam KS, Cardoso M, Sweeney M, Binney G, Weingart SN. Examining perceptions of computerized physician order entry in a neonatal intensive care unit. Appl Clin Inform 2017; 8: 337–347 https://doi.org/10.4338/ACI-2016-09-RA-0153

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