scholarly journals Preventing Retention of Vaginal Packing in Obstetrics: Implementation of a Protocol to Improve Patient Safety

2018 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Chart Review ◽  
Improve Patient Safety ◽  
Retrospective Chart Review ◽  
Health Record ◽  
Enhance Patient Safety ◽  
Electronic Health ◽  
Improve Patient

Background: Retained vaginal packing can be associated with serious psychological and physical complications. The purpose of this study was to enhance patient safety by implementing an obstetrical vaginal packing protocol and to evaluate its efficacy. The study occurred in a tertiary maternity center with roughly 6,000 deliveries a year. Methods: A vaginal packing protocol was instituted. The protocol added a “vaginal packing” button to the electronic health record that subsequently prompted a notification to remove and document removal of the packing. A retrospective chart review of compliance with the protocol was performed on all deliveries that occurred during a 1-year period after implementation. Results: Of the 6,118 deliveries, 92% (5625/6117) completed the vaginal packing section of the delivery summary. Vaginal packing was placed in 1% (63/5625) of the deliveries in which the delivery summary was completed. A note documenting removal of the packing occurred in 73% (46/63) of the deliveries. There were no cases of retained vaginal packing. Conclusions: This is an effective and sustainable protocol to prevent retention of vaginal packing. This process could be adopted in the gynecologic setting and among many hospitals.

Automated parenteral chemotherapy dose-banding to improve patient safety and decrease drug costs

2019 ◽  
Vol 26 (2) ◽  
pp. 345-350
Author(s):  
Olivia G Fahey ◽  
Sara M Koth ◽  
Jason J Bergsbaken ◽  
Heather A Jones ◽  
Philip J Trapskin
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Improve Patient Safety ◽  
Cost Savings ◽  
Health Record ◽  
Total Drug ◽  
Implementation Period ◽  
Chemotherapy Dose ◽  
Electronic Health ◽  
Improve Patient

Purpose To improve patient safety and reduce drug waste through implementation of automated parenteral chemotherapy dose-banding within an electronic health record. Methods Parenteral chemotherapy dose-rounding practices were transitioned from a manual, pharmacist-driven workflow to an automated process within the electronic health record. Initial medications transitioned included bevacizumab, rituximab, and trastuzumab. Dose-banding tables were built to standardize rounding within a 10% parameter and then subsequently incorporated into the electronic health record after receiving multidisciplinary approval. Following implementation, a retrospective chart review was performed to compare drug and associated cost savings with manual dose-rounding and automated dose-banding. Medication safety improvements were measured by comparing the change in the number of clicks needed for pharmacist verification as well as by evaluation of submissions to our event reporting system. Results After implementing automated parenteral chemotherapy dose-banding, reported medication errors associated with the parenteral chemotherapy rounding process decreased. The number of event submissions related to incorrect rounding decreased from four submissions in the pre-implementation period to zero in the post-implementation period. Automation saved pharmacists at least 9,297 additional clicks and 11,363 additional keystrokes and also led to notable increases in total drug savings as well as drug cost savings. Conclusion Overall safety of our parenteral chemotherapy ordering processes within our electronic health record was improved after the implementation of automated dose-banding. By standardizing the administered doses for three chemotherapy agents, we were also able to increase total drug savings and associated drug cost savings.

scholarly journals Validation of Electronic Health Record Detection of Patient Safety Outcomes

2019 ◽  
Vol 14 (3) ◽  
pp. 16-22
Author(s):  
Christopher Humphreys ◽  
Sarah Fletcher ◽  
Nishan Sharma ◽  
Rahim Kachra ◽  
Shannon Marie Ruzycki
Keyword(s):  
Patient Safety ◽  
Venous Thromboembolism ◽  
Electronic Health Record ◽  
Sensitivity And Specificity ◽  
Chart Review ◽  
Health Record ◽  
Safety Outcome ◽  
Safety Outcomes ◽  
Medical Inpatients ◽  
Electronic Health

Background: Adverse events (AE) are common for hospitalized Canadians, and lead to worse patient outcomes. Monitoring patient safety is logistically challenging. We aimed to validate the use of our electronic health record (EHR) to monitor important patient safety. Methods: EHR data was used to identify patients who were exposed to one of four high-priority safety outcomes: venous thromboembolism, dysglycemia, Clostridium difficile(C. difficile) infection, and prolonged nil per os(NPO) orders. A manual chart review was performed to determine the sensitivity and specificity of the EHR for each patient safety outcome. Results: The sensitivity and specificity ranged from 38.4% to 78.1% and 88.1 to 99.2%, respectively, for the prespecified patient safety outcomes. Conclusion: The EHR is reasonably sensitive and specific to monitor rates of dysglycemia, C. difficileinfection, and prolonged NPO in medical inpatients, but does not have adequate sensitivity to be used to capture venous thromboembolism safety outcomes.

What Can Human Factors Contribute to Improve Electronic Health Record Usability and Patient Safety?

2012 ◽  
Author(s):  
Robert Schumacher ◽  
Robert North ◽  
Matthew Quinn ◽  
Emily S. Patterson ◽  
Laura G. Militello ◽  
...  
Keyword(s):  
Patient Safety ◽  
Human Factors ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health

Uji Validitas Dan Reliabilitas Kuesioner Pengukuran Kompetensi Sistem Informasi Keperawatan: NICAT Dalam Bahasa Indonesia

2019 ◽  
Vol 8 (1) ◽  
pp. 39-43
Author(s):  
Stephanie Dwi Guna ◽  
Yureya Nita
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Assessment Tool ◽  
Competency Assessment ◽  
Health Record ◽  
Nursing Informatics ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Electronic Health ◽  
Bahasa Indonesia

Integrasi Teknologi Informasi (TI) di bidang kesehatan terbukti meningkatkan kualitas pelayanan kesehatan dengan meningkatkan patient safety serta mempercepat waktu layanan. Salah satu inovasi TI di bidang kesehatan yaitu rekam medik elektronik (electronic health record). Rekam medik jenis ini sudah umum digunakan di negara maju namun masih jarang digunakan di negara berkembang termasuk Indonesia. Sebelum pengimplementasian suatu sistem informasi baru di pelayanan kesehatan, perlu dipastikan bahwa user dapat mengoperasikannya dengan baik sehingga hasil dari sistem tersebut optimal. Perawat sebagai tenaga kesehatan dengan jumlah paling banyak di suatu pelayanan kesehatan seperti Rumah Sakit merupakan user terbesar bila rekam medik elektronik ini diterapkan.  Oleh karena itu diperlukan suatu alat untuk mengukur kemampuan atau literasi sistem informasi keperawatan (SIK). Salah satu alat ukur kompetensi SIK yaitu NICAT (Nursing Informatics Competency Assessment Tool) yang memiliki 3 bagian serta 30 item pertanyaan. Penulis melakukan alih bahasa pada kuesioner ini, kemudian melakukan uji validitas dan reliabilitas. Jumlah sampel pada penelitian ini yaitu 233 perawat di salah satu Rumah Sakit Pemerintah di Pekanbaru, Indonesia. Hasil uji validitas pada 30 item dengan r tabel 0.128 menunjukkan r hitung diatas nilai tersebut dengan Cronbach’s Alpha 0,975. Dapat disimpulkan kuesioner pengukuran kemampuan SIK (NICAT versi Bahasa Indonesia) telah valid dan reliabel sehingga dapat digunakan mengukur kemampuan SIK perawat Indonesia.

scholarly journals Validation of an Internationally Derived Patient Severity Phenotype to Support COVID-19 Analytics from Electronic Health Record Data

2021 ◽  
Author(s):  
Jeffrey G Klann ◽  
Griffin M Weber ◽  
Hossein Estiri ◽  
Bertrand Moal ◽  
Paul Avillach ◽  
...  
Keyword(s):  
Machine Learning ◽  
Electronic Health Record ◽  
Chart Review ◽  
Learning Approach ◽  
Health Record ◽  
Learning Approaches ◽  
Electronic Health Record Data ◽  
Icu Admission ◽  
Machine Learning Approach ◽  
Electronic Health

Abstract Introduction The Consortium for Clinical Characterization of COVID-19 by EHR (4CE) is an international collaboration addressing COVID-19 with federated analyses of electronic health record (EHR) data. Objective We sought to develop and validate a computable phenotype for COVID-19 severity. Methods Twelve 4CE sites participated. First we developed an EHR-based severity phenotype consisting of six code classes, and we validated it on patient hospitalization data from the 12 4CE clinical sites against the outcomes of ICU admission and/or death. We also piloted an alternative machine-learning approach and compared selected predictors of severity to the 4CE phenotype at one site. Results The full 4CE severity phenotype had pooled sensitivity of 0.73 and specificity 0.83 for the combined outcome of ICU admission and/or death. The sensitivity of individual code categories for acuity had high variability - up to 0.65 across sites. At one pilot site, the expert-derived phenotype had mean AUC 0.903 (95% CI: 0.886, 0.921), compared to AUC 0.956 (95% CI: 0.952, 0.959) for the machine-learning approach. Billing codes were poor proxies of ICU admission, with as low as 49% precision and recall compared to chart review. Discussion We developed a severity phenotype using 6 code classes that proved resilient to coding variability across international institutions. In contrast, machine-learning approaches may overfit hospital-specific orders. Manual chart review revealed discrepancies even in the gold-standard outcomes, possibly due to heterogeneous pandemic conditions. Conclusion We developed an EHR-based severity phenotype for COVID-19 in hospitalized patients and validated it at 12 international sites.

Critical Values in Anatomic Pathology

2006 ◽  
Vol 130 (5) ◽  
pp. 638-640 ◽  
Author(s):  
Jan F. Silverman ◽  
Telma C. Pereira
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Clinical Pathology ◽  
Critical Values ◽  
Surgical Pathology ◽  
Anatomic Pathology ◽  
Wide Range ◽  
Enhance Patient Safety ◽  
Pathology Reports ◽  
Improve Patient

Abstract Similar to critical values (CVs) in clinical pathology, occasional diagnoses in surgical pathology and cytology could require immediate notification of the physician to rapidly initiate treatment. However, there are no established CV guidelines in anatomic pathology. A retrospective review of surgical pathology reports was recently conducted to study the incidence of CVs in surgical pathology and to survey the perceptions of pathologists and clinicians about CVs in surgical pathology, with a similar analysis of CVs performed in cytology. The results indicated that CVs in surgical pathology and cytology are uncommon but not rare and that there is a wide range of opinion among pathologists and between pathologists and clinicians about the need for an immediate telephone call and about the degree of urgency. It was obvious from the study that there is a lack of consensus in identifying what constitutes surgical pathology and cytology CV cases. Since the Institute of Medicine's report on medical errors, there has been an increasing number of initiatives to improve patient safety. Having guidelines for anatomic pathology CVs could enhance patient safety, in contrast to the current practice in which CV cases are managed based on common sense and on personal experience. Therefore, a discussion involving the pathology community might prove useful in an attempt to establish anatomic pathology CV guidelines that could represent a practice improvement.

scholarly journals Using electronic health record audit logs to study clinical activity: a systematic review of aims, measures, and methods

2019 ◽  
Vol 27 (3) ◽  
pp. 480-490 ◽  
Author(s):  
Adam Rule ◽  
Michael F Chiang ◽  
Michelle R Hribar
Keyword(s):  
Systematic Review ◽  
Access Control ◽  
Electronic Health Record ◽  
Chart Review ◽  
Observational Research ◽  
Clinical Activity ◽  
Health Record ◽  
Problem List ◽  
Inclusion Criteria ◽  
Electronic Health

Abstract Objective To systematically review published literature and identify consistency and variation in the aims, measures, and methods of studies using electronic health record (EHR) audit logs to observe clinical activities. Materials and Methods In July 2019, we searched PubMed for articles using EHR audit logs to study clinical activities. We coded and clustered the aims, measures, and methods of each article into recurring categories. We likewise extracted and summarized the methods used to validate measures derived from audit logs and limitations discussed of using audit logs for research. Results Eighty-five articles met inclusion criteria. Study aims included examining EHR use, care team dynamics, and clinical workflows. Studies employed 6 key audit log measures: counts of actions captured by audit logs (eg, problem list viewed), counts of higher-level activities imputed by researchers (eg, chart review), activity durations, activity sequences, activity clusters, and EHR user networks. Methods used to preprocess audit logs varied, including how authors filtered extraneous actions, mapped actions to higher-level activities, and interpreted repeated actions or gaps in activity. Nineteen studies validated results (22%), but only 9 (11%) through direct observation, demonstrating varying levels of measure accuracy. Discussion While originally designed to aid access control, EHR audit logs have been used to observe diverse clinical activities. However, most studies lack sufficient discussion of measure definition, calculation, and validation to support replication, comparison, and cross-study synthesis. Conclusion EHR audit logs have potential to scale observational research but the complexity of audit log measures necessitates greater methodological transparency and validated standards.

scholarly journals Electronic Health Record Use among Ophthalmology Residents while on Call

2020 ◽  
Vol 12 (02) ◽  
pp. e143-e150
Author(s):  
Christopher P. Long ◽  
Ming Tai-Seale ◽  
Robert El-Kareh ◽  
Jeffrey E. Lee ◽  
Sally L. Baxter
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Chart Review ◽  
Health Record ◽  
Physician Burnout ◽  
Single Institution ◽  
Clinical Exposure ◽  
Future Studies ◽  
After Hours ◽  
Electronic Health

Abstract Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours. Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks. Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents' on-call EHR activities. Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.

Sign in / Sign up

Export Citation Format

Share Document