scholarly journals Implementation of a Computerized Provider Order Entry System in a Pediatric Hospital in Canada

2021 ◽  
Author(s):  
Man Qing Liang ◽  
Amélie Boudjellab ◽  
Hyukjin Kwon ◽  
Philippe Jouvet ◽  
Denis Lebel ◽  
...  
Keyword(s):  
Medication Errors ◽  
Clinical Decision Support System ◽  
Medication Reconciliation ◽  
Clinical Decision ◽  
Tertiary Hospital ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Centre Hospitalier Universitaire ◽  
Implementation Methodology ◽  
The Impact

The Centre Hospitalier Universitaire Sainte-Justine (Montreal, Canada) is a pediatric academic tertiary hospital that has begun the implementation of a commercial computerized provider order entry system (CPOE) in October 2019. The objectives of this paper are 1) to estimate the impact of the CPOE system on medication errors, and 2) to identify vulnerability issues related to the configuration of the CPOE system’s design. Using a pre-post implementation methodology measuring medication errors captured by clinical pharmacists revealed that the implementation of a CPOE has eliminated all prescription conformity (e.g., missing fields) and legibility errors. Pharmacists have continued to detect medication errors, especially inappropriate dosing instructions, and to intervene in similar clinical situations (medication reconciliation, deprescribing, adjusting orders). Additionally, the vulnerability analysis, based on typical clinical order test cases in an inpatient pediatric setting, highlighted the need to configure a clinical decision support system that can identify inappropriate dosing instructions for pediatric patients.

scholarly journals Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis

2016 ◽  
Vol 24 (2) ◽  
pp. 413-422 ◽  
Author(s):  
Mirela Prgomet ◽  
Ling Li ◽  
Zahra Niazkhani ◽  
Andrew Georgiou ◽  
Johanna I Westbrook
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Medication Errors ◽  
Meta Analysis ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Order Entry ◽  
Icu Mortality ◽  
Computerized Provider Order Entry ◽  
The Impact

Objective: To conduct a systematic review and meta-analysis of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay (LOS), and mortality in intensive care units (ICUs). Methods: We searched for English-language literature published between January 2000 and January 2016 using Medline, Embase, and CINAHL. Titles and abstracts of 586 unique citations were screened. Studies were included if they: (1) reported results for an ICU population; (2) evaluated the impact of CPOE or the addition of CDSSs to an existing CPOE system; (3) reported quantitative data on medication errors, ICU LOS, hospital LOS, ICU mortality, and/or hospital mortality; and (4) used a randomized controlled trial or quasi-experimental study design. Results: Twenty studies met our inclusion criteria. The transition from paper-based ordering to commercial CPOE systems in ICUs was associated with an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. Overall meta-analyses of LOS and hospital mortality did not demonstrate a significant change. Discussion and Conclusion: Critical care settings, both adult and pediatric, involve unique complexities, making them vulnerable to medication errors and adverse patient outcomes. The currently limited evidence base requires research that has sufficient statistical power to identify the true effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of CDSSs can be used to provide greater benefit to delivering safe and effective patient care.

scholarly journals The impact of computerized provider order entry on medication errors in a multispecialty group practice

2010 ◽  
Vol 17 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Emily Beth Devine ◽  
Ryan N Hansen ◽  
Jennifer L Wilson-Norton ◽  
N M Lawless ◽  
Albert W Fisk ◽  
...  
Keyword(s):  
Medication Errors ◽  
Group Practice ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Multispecialty Group ◽  
The Impact

Verhindern von unerwünschten Arzneimittelereignissen mit Hilfe von elektronischen Entscheidungsunterstützungssystemen

2015 ◽  
Vol 72 (11/12) ◽  
pp. 693-700
Author(s):  
Ali Reza Salili ◽  
Felix Hammann ◽  
Anne B. Taegtmeyer
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Support System ◽  
Clinical Decision Support System ◽  
Clinical Decision ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Unerwünschte Arzneimittelereignisse ◽  
Physician Order Entry

Zusammenfassung. Unerwünschte Arzneimittelereignisse sind ein grosses Risiko für Patienten und ein alltägliches klinisches Problem mit potentiellen Haftungsfolgen. CPOE-Systeme („Computerized Physician Order Entry“ bzw. „Computerized Provider Order Entry“-Systeme) in Kombination mit elektronischen Systemen zur klinischen Entscheidungsunterstützung („Clinical Decision Support System“ = „CDSS“) sind im Trend und zielen nicht nur auf die Reduktion von Verordnungsfehlern, sondern ermöglichen eine rasche Reaktion auf potentiell vermeidbare Arzneimittelinteraktionen. Der effektive Nutzen solcher Systeme ist aber bis dato noch nicht definitiv geklärt. Dieser Artikel fokussiert auf den aktuellen Stand der Entwicklung von CPOE-/CDS-Systemen, deren Nutzen und Risiken, Zukunftsperspektiven und Verbesserungsmöglichkeiten.

Specifications of Computerized Provider Order Entry and Clinical Decision Support Systems for Cancer Patients Undergoing Chemotherapy: A Systematic Review

Chemotherapy ◽  
2018 ◽  
Vol 63 (3) ◽  
pp. 162-171 ◽  
Author(s):  
Rezvan Rahimi ◽  
Alireza Kazemi ◽  
Hamid Moghaddasi ◽  
Khadijeh Arjmandi Rafsanjani ◽  
Gholamreza Bahoush
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Medication Errors ◽  
Clinical Decision Support ◽  
Safety Information ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Physician Order Entry

Objective: Chemotherapy medication errors are catastrophic. The prescription phase in the chemotherapy process plays a key role in the creation of medication errors, and therefore the use of computerized physician order entry (CPOE) and clinical decision support system (CDS) systems is recommended to reduce chemotherapy medication errors. The purpose of this study was to carry out a systematic review on the specifications of the CPOE and CDS systems for chemotherapy prescription. Materials and Methods: A systematic review on articles published in English up to September 22, 2017, using the 3 databases PubMed, Embase, and Medline was conducted. Those articles that focused on the specifications of CPOE and CDSS in chemotherapy prescription were included in this review. Findings: Of the 2,471 articles identified, 58 articles met the inclusion criteria and were included in this study. Specifications related to chemotherapy CPOE systems were categorized into the following 6 groups: automation and facilitation of the chemotherapy prescription phase, hospital workflow support, documentation and reporting, drug safety, information security, and system communications. The specifications of chemotherapy CDSS were also divided into 4 categories: embedding chemotherapy protocols, automated dose calculations and adjustment, providing alerts/reminders at the time of prescribing, and guiding or asking the user to complete the important prescription parameters. In 12 articles, the chemotherapy prescription CDSS were designed and evaluated independently of the CPOE; 45 articles provided prescription chemotherapy CDSS as part of the CPOE system, and in 1 article CPOE was introduced with no CDSS. Conclusion: In complicated settings such as chemotherapy, simplification of the processes is more imperative. The use of chemotherapy CPOE, which includes specifications for helping the medical staff with their workload, encourages the professionals to use such systems and increases the likelihood for success of these systems.

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.

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