scholarly journals Impact of Computerized Provider Order Entry Systems on hospital staff pharmacist workflow productivity: A three site comparative analysis based on level of CPOE implementation

2017 ◽  
Vol 7 (1) ◽  
pp. 1
Author(s):  
Benjamin D. Lewing ◽  
Mark D. Hatfield ◽  
Sujit S. Sansgiry
Keyword(s):  
Hospital Staff ◽  
Order Entry ◽  
Short Term ◽  
Computerized Provider Order Entry ◽  
Time And Motion ◽  
Motion Study ◽  
Time Allotment ◽  
Post Hoc ◽  
Order Entry Systems

Objective: Computerized Provider Order Entry (CPOE) is a system that enables physicians to send medication orders electronically rather than physically writing out the order. CPOE can reduce handwriting and transcription related medication errors and has been a major implementation goal for health systems. The objective of this study was to quantify and examine differences seen in the workflow of pharmacists at hospitals, with different levels of CPOE implementation.Methods: An observational, prospective time and motion study was conducted among three hospitals within the same health system: one classified as a non-CPOE system, one as short-term CPOE, and one as long-term CPOE. Pharmacists were observed in one-hour blocks, in which a data instrument was used to record 38 different tasks, which were grouped into four activities: clinical, distributive, administrative, and miscellaneous. The distributive category was further divided into three sub-categories. The average time associated with performing activities across the three hospitals was compared by descriptive and comparative analyses using ANOVAs and the post-hoc Tukey’s range test.Results: A total of 252 hours were collected and 235 met the inclusion criteria. The significant differences in time spent on task categories among hospitals were as follows: Non-CPOE vs. short term CPOE vs. long-term CPOE (mean ± SD in min/h) clinical tasks: (6.55 ± 6.40) vs. (4.95 ± 4.15) vs. (3.79 ± 4.91), respectively, (p < .05); order entry tasks: (29.62 ± 11.24) vs. (17.44 ± 10.73) vs. (10.27 ± 8.88) respectively, (p < .05); order verification tasks: (0.88 ± 1.77) vs. (13.93 ± 8.50) vs. (16.60 ± 9.63) respectively, (p < .05); other distributive tasks: (13.60 ± 10.04) vs. (15.86 ± 8.38) vs. (19.66 ± 8.42) respectively, (p < .05); and miscellaneous: (3.78 ± 4.64) vs. (1.54 ± 3.20) vs. (2.23 ± 3.51) respectively, (p < .05).Conclusions: The presence of a CPOE system could affect pharmacists’ workflow and time allotment on different types of pharmacy activities. Further, the time spent on certain activities was associated with the amount of time the CPOE system was implemented.

scholarly journals 14 Long-term Efficacy of Brexpiprazole in Patients with Schizophrenia with Clinically Relevant Levels of Negative Symptoms

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 180-180
Author(s):  
Catherine Weiss ◽  
Peter Zhang ◽  
Ross A Baker ◽  
Mary Hobart ◽  
Nanco Hefting ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Extension Study ◽  
Short Term ◽  
Open Label ◽  
Term Study ◽  
Post Hoc Analysis ◽  
Long Term Study ◽  
Open Label Extension ◽  
Post Hoc

AbstractBackgroundEffective treatments for patients with high levels of negative symptoms of schizophrenia are lacking. Brexpiprazole is a serotonin–dopamine activity modulator that is a partial agonist at 5-HT1A and dopamine D2 receptors, and an antagonist at 5-HT2A and noradrenaline alpha1B/2C receptors, all with subnanomolar potency. Long-term treatment with brexpiprazole demonstrated broad efficacy across all five Marder factor groupings, including positive, negative, disorganized thoughts, uncontrolled hostility/excitement, and anxiety/depression. This post-hoc analysis of long-term effects of brexpiprazole in patients with clinically relevant levels of negative symptoms of schizophrenia is based on data from two similarly designed short-term, placebo-controlled studies (Vector; NCT01396421 or Beacon; NCT01393613) for the brexpiprazole-treated patients who continued into an open-label extension study (Zenith; NCT01397786).MethodsIn the short-term studies, patients with acute schizophrenia were randomly assigned to fixed once-daily doses of brexpiprazole 0.25mg (Vector), 1mg (Beacon), 2mg , 4mg or placebo for 6weeks. The long-term study was an open-label, 52-week (amended to 26weeks), safety extension study with flexible-dose (1–4mg/day) brexpiprazole. The post-hoc analyses were performed on brexpiprazole-treated patients from the short-term studies who continued into the long-term study, and who had clinically relevant negative symptoms, defined as PANSS Factor Score for Negative Symptoms (PANSS-FSNS; N1, N2, N3, N4, G7, G16) of ≥24, and score of ≥4 on at least two of three core negative symptom PANSS items at randomization in the parent study. The outcome of the analysis included change from baseline to up to 58weeks in PANSS-FSNS, PANSS Total, and PSP. Safety was also assessed.ResultsA total of 187 patients with clinically relevant levels of negative symptoms in the parent study rolled-over into the open-label extension study and were available for analysis. Eighty-three of these patients remained in the studies for 58weeks. Due to the study amendment, not all patients had the opportunity of complete 52weeks of open-label treatment. Baseline PANSS Total score was 104.4, while baseline PANSS-FSNS was 27.6 and baseline PSP Total score was 41.3. Mean change (SD) from baseline in PANSS-FSNS was –10.9 (5.0), and –44.2 (17.5) for PANSS Total score at Week 58. Change from baseline (SD) to Week 58 for PSP Total score was 24.8 (12.9) with improvement in all domains (socially useful activities, personal and social relationship, self-care, and disturbing and aggressive behaviors). The TEAEs reported ≥5% were schizophrenia (18.9%), insomnia (8.6%), weight increased (5.9%) and akathisia (5.9%).ConclusionThis post-hoc analysis suggests that brexpiprazole has long-term effectiveness on negative symptoms and functioning in patients with schizophrenia and clinically relevant levels of negative symptoms.Funding Acknowledgements: The study was funded by Otsuka Pharmaceutical Development & Commercialization Inc. and H. Lundbeck A/S

scholarly journals 160 Lurasidone and Metabolic Syndrome: Results from Short- and Long-Term Clinical Studies in Patients with Bipolar Depression

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 302-303
Author(s):  
Michael Tocco ◽  
John W. Newcomer ◽  
Yongcai Mao ◽  
Andrei Pikalov
Keyword(s):  
Metabolic Syndrome ◽  
Adjunctive Therapy ◽  
Bipolar Depression ◽  
Prevention Study ◽  
Short Term ◽  
Post Hoc Analysis ◽  
Short And Long Term ◽  
Post Hoc ◽  
Therapy Studies

Abstract:Background:Among patients with depressive disorders, the prevalence of metabolic syndrome (MetS) is estimated to range from 35-40% and has been associated with increased mortality rates. The aim of this post-hoc analysis was to assess the effect of treatment with lurasidone on the prevalence of MetS in patients with bipolar depression.Method:Lurasidone data (dose range, 20-120 mg/d) used in the current analyses consisted of 3 double-blind (DB), placebo-controlled, 6-week studies in adults with bipolar I depression (total N=1,192), consisting of 1 monotherapy, and 2 adjunctive therapy trials with lithium or valproate. Patients who completed the short-term trials continued into a 6-month open-label (OL) extension study, with 6-month (LOCF-endpoint) data available on 274 patients treated with lurasidone monotherapy, and 436 patients treated with lurasidone adjunctive therapy. Also analyzed was a recurrence prevention study in stabilized bipolar patients who completed up to 20 weeks of OL adjunctive treatment with lurasidone, and then were randomized to 28 weeks of DB adjunctive therapy with lurasidone or placebo (N=497). MetS was defined based on NCEP ATP III criteria (2005 revision).Results:In the short-term monotherapy and adjunctive therapy studies, the proportion of patients at baseline meeting NCEP III criteria for MetS were 27.6% and 23.6%, respectively, for lurasidone, and 23.8% and 25.1%, respectively, for placebo; and at week 6 (LOCF) the proportion with MetS was 27.5% and 26.6%, respectively, for lurasidone and 29.9% and 20.2%, respectively, for placebo. The proportion of patients who did not meet MetS criteria at baseline but developed MetS at week 6 (LOCF) was similar for lurasidone vs. placebo in the monotherapy study (9.9% vs. 11.6%); and in the two adjunctive therapy studies (10.3% vs. 8.3%). During the 6-month OL extension study, the proportion of patients treated with lurasidone monotherapy and adjunctive therapy who did not meet MetS criteria at OL baseline but developed MetS at month 6 (LOCF) was 11.7% and 11.9%, respectively. Conversely, the proportion of patients who met MetS criteria at OL baseline, but no longer met criteria at month 6 (LOCF) was 9.5% and 7.7%, respectively. In the 20-week, OL phase of the recurrence prevention study, the proportion of patients treated with adjunctive lurasidone who did not meet MetS criteria at OL baseline but developed MetS at endpoint was 11.5% (LOCF). After up to 28 weeks of DB treatment, the proportion of patients who did not meet MetS criteria at DB baseline but developed MetS at endpoint was 9.0% in the adjunctive lurasidone group, and 10.5% in the adjunctive placebo group (LOCF).Conclusion:This post-hoc analysis found that short- and long-term treatment with lurasidone was associated with a relatively low risk for the development of metabolic syndrome in patients with bipolar I disorder. These findings are consistent with similar analyses in patients with schizophrenia.Funding Acknowledgements:Supported by funding from Sunovion Pharmaceuticals Inc.

Health care aides use of time in a residential long-term care unit: A time and motion study

2013 ◽  
Vol 50 (9) ◽  
pp. 1229-1239 ◽  
Author(s):  
Anastasia A. Mallidou ◽  
Greta G. Cummings ◽  
Corinne Schalm ◽  
Carole A. Estabrooks
Keyword(s):  
Long Term Care ◽  
Term Care ◽  
Time And Motion Study ◽  
Use Of Time ◽  
Time And Motion ◽  
Motion Study ◽  
Health Care Aides ◽  
Care Aides ◽  
Residential Long Term Care

scholarly journals Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems

2013 ◽  
Vol 20 (3) ◽  
pp. 470-476 ◽  
Author(s):  
D. C. Radley ◽  
M. R. Wasserman ◽  
L. E. Olsho ◽  
S. J. Shoemaker ◽  
M. D. Spranca ◽  
...  
Keyword(s):  
Medication Errors ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Order Entry Systems

scholarly journals Effect of Different Denture Base Cleansers on Surface Roughness of Heat Polymerised Acrylic Materials with Different Curing Process

2020 ◽  
pp. 281-289
Author(s):  
Kubra Degirmenci ◽  
Mustafa Hayati Atala ◽  
Canan Sabak
Keyword(s):  
Surface Roughness ◽  
Base Material ◽  
Chlorhexidine Gluconate ◽  
Distilled Water ◽  
Short Term ◽  
Denture Base ◽  
Cleaning Agents ◽  
Significant Difference ◽  
Post Hoc

Avoiding biofilm formation on dentures is associated with maintaining the surface properties of acrylic-based dentures. The aim of the study is to investigate the effects of two different cleaning agents (Corega and Klorhex 0.2% chlorhexidine gluconate) on surface roughness of the denture regarding efficacy of curing procedures. A total of sixty disc-shaped specimens were prepared with two different methods as long and short curing processes. The specimens were divided into subgroups according to the immersion solutions (distilled water, Corega tablet group and Klorhex 0.2% chlorhexidine gluconate group) (n=10). The samples were kept in a solution for 8 hours per day during a month. The average Ra1 (before exposure to the cleanser agent) and Ra2 (after exposure to the cleanser agent) of each sample was measured. A two-way ANOVA and post hoc Tukey test was used for statistical analysis. The solutions significantly increased the Ra values in both acrylic groups (p<0.001). While the effect of the distilled water group was significantly lower than Corega and Klorhex in the long-term curing group (p<0.05), no significant difference was found in the short-term curing group (p>0.05). The long-term curing time is highly effective in decreasing the surface roughness of the acrylic base material.

Test Turnaround Times and Mortality Rates 12 and 24 Months after the Introduction of a Computerised Provider Order Entry System

2009 ◽  
Vol 48 (02) ◽  
pp. 211-215 ◽  
Author(s):  
A. Georgiou ◽  
M. I. Rob ◽  
J. I. Westbrook
Keyword(s):  
Work Practice ◽  
Mortality Rates ◽  
Turnaround Time ◽  
Practice Change ◽  
Long Term Effects ◽  
Order Entry ◽  
Influenza Outbreak ◽  
System Use ◽  
Order Entry Systems

Summary Objectives: Few studies have measured the long-term effects of computerised provider order entry systems on pathology test turnaround time. Further, a recent study has raised the possibility that such systems, which require significant work practice change, may be associated with an increase in mortality rates. Our study answered two questions in relation to system introduction in a major Australian teaching hospital: i) are improvements in turnaround times achieved in the first 12 months after system introduction sustained 24 months post-implementation; and ii) do mortality rates change following the introduction of an order entry system? Methods: Turnaround time and mortality rates 5 months before and 12 and 24 months after implementation of a computerised order entry system were measured. Turnaround time was defined as the time from receipt of a specimen and order in a laboratory to availability of a result. Results: Improvements in turnaround time achieved in the first 12 months were sustained with a further significant 12.6% reduction at 24 months post-implementation, with no change in average number of tests per patient. The mortality rate significantly increased in the year following system introduction but returned to the pre-system rate in the second year of system use. Review of the excess deaths demonstrated these were most likely attributable to a coincidental influenza outbreak and not to system introduction. Conclusions: The computerised provider order entry system produced sustained and continuing improvements in laboratory efficiency over a two-year period. Associations between increased mortality rates and system introduction should be investigated carefully to ascertain any likely association.

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