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

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.

Development of a Minimum Data Set for Drug Module of Computerized Physician Order Entry System

Introduction: One way to reduce medication errors in the cardiovascular settings is to electronically prescribe medication through the computerized physician order entry system (CPOE). Improper design and non-compliance with users' needs are obstacles to implementing this system. Therefore, it is necessary to consider the standard minimum data set (MDS) of this system in order to meet the basic needs of its users. The aim of this study was to introduce MDS in the cardiovascular CPOE drug system to standardize data items as well as to facilitate data sharing and integration with other systems.Material and Methods: This study was a survey study conducted in 1399 in Iran. The study population was all cardiologists in Iran. The data collection tool was a researcher-made questionnaire consisting of 33 questions. Data were analyzed in SPSS-24 using descriptive statistics.Results: A total of 31 cardiologists participated in this study. The participants identified 19 of the 25 drug data items as essential for drug MDS. Five data items (Medication name, Medication dosage, Medication frequency, Medication start date and Patient medication history) were considered essential by more than 90% of the participants.Conclusion: The results of this study identified drug MDS for the cardiovascular CPOE system. The results of this study can be a model for CPOE system designers to develop new systems or upgrade existing systems.

The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study

Background The medication process is complex and error-prone. To avoid medication errors, a medication order should fulfil certain criteria, such as good readability and comprehensiveness. In this context, a computerized physician order entry (CPOE) system can be helpful. This study aims to investigate the distinct effects on the quality of prescription documentation of a CPOE system implemented on general wards in a large tertiary care hospital. Methods In a retrospective analysis, the prescriptions of two groups of 160 patients each were evaluated, with data collected before and after the introduction of a CPOE system. According to nationally available recommendations on prescription documentation, it was assessed whether each prescription fulfilled the established 20 criteria for a safe, complete, and actionable prescription. The resulting fulfilment scores (prescription-Fscores) were compared between the pre-implementation and the post-implementation group and a multivariable analysis was performed to identify the effects of further covariates, i.e., the prescription category, the ward, and the number of concurrently prescribed drugs. Additionally, the fulfilment of the 20 criteria was assessed at an individual criterion-level (denoted criteria-Fscores). Results The overall mean prescription-Fscore increased from 57.4% ± 12.0% (n = 1850 prescriptions) before to 89.8% ± 7.2% (n = 1592 prescriptions) after the implementation (p < 0.001). At the level of individual criteria, criteria-Fscores significantly improved in most criteria (n = 14), with 6 criteria reaching a total score of 100% after CPOE implementation. Four criteria showed no statistically significant difference and in two criteria, criteria-Fscores deteriorated significantly. A multivariable analysis confirmed the large impact of the CPOE implementation on prescription-Fscores which was consistent when adjusting for the confounding potential of further covariates. Conclusions While the quality of prescription documentation generally increases with implementation of a CPOE system, certain criteria are difficult to fulfil even with the help of a CPOE system. This highlights the need to accompany a CPOE implementation with a thorough evaluation that can provide important information on possible improvements of the software, training needs of prescribers, or the necessity of modifying the underlying clinical processes.

Characteristics of pharmacist’s interventions triggered by prescribing errors related to computerised physician order entry in French hospitals: a cross-sectional observational study

ObjectivesComputerised physician order entry (CPOE) systems facilitate the review of medication orders by pharmacists. Reports have emerged that show conception flaws or the misuse of CPOE systems generate prescribing errors. We aimed to characterise pharmacist interventions (PIs) triggered by prescribing errors identified as system-related errors (PISREs) in French hospitals.DesignThis was a cross-sectional observational study based on PIs prospectively documented in the Act-IP observatory database from January 2014 to December 2018.SettingPISREs from 319 French computerised healthcare facilities were analysed.ParticipantsAmong the 319 French hospitals, 232 (72.7%) performed SRE interventions, involving 652 (51%) pharmacists.ResultsAmong the 331 678 PIs recorded, 27 058 were qualified as due to SREs (8.2%). The main drug-related problems associated with PISREs were supratherapeutic (27.5%) and subtherapeutic dosage (17.2%), non-conformity with guidelines/contraindications (22.4%) and improper administration (17.9%). The PI prescriber acceptation rate was 78.9% for SREs vs 67.6% for other types of errors. The PISRE ratio was estimated relative to the total number of PIs. Concerning the certification status of CPOE systems, the PISRE ratio was 9.4% for non-certified systems vs 5.5% for certified systems (p<0.001). The PISRE ratio for senior pharmacists was 9.2% and that for pharmacy residents 5.4% (p<0.001). Concerning prescriptions made by graduate prescribers and those made by residents, the PISRE ratio was 8.4% and 7.8%, respectively (p<0.001).ConclusionComputer-related prescribing errors are common. The PI acceptance rate by prescribers was higher than that observed for PIs that were not CPOE related. This suggests that physicians consider the potential clinical consequences of SREs for patients to be more frequently serious than interventions unrelated to CPOE. CPOE medication review requires continual pharmacist diligence to catch these errors. The significantly lower PISRE ratio for certified software should prompt patient safety agencies to undertake studies to identify the safest software and discard software that is potentially dangerous.

Financial Impact of an Automated Oncology Dose-Rounding Initiative: One-Year Analysis

PURPOSE Infusion drugs are regarded as one of the high-cost health care expenditures. One approach to decrease drug expenditures is by dose-rounding biologics and cytotoxic agents. The Hematology/Oncology Pharmacy Association recommends that biologic and cytotoxic agents are rounded to the nearest vial size if they are within 10% of the ordered dose. The purpose of this initiative is to determine the impact of an automated dose-rounding algorithm on drug expenses. METHODS The dose-rounding algorithm was developed and integrated into the computerized physician order entry system for automated dose rounding to minimize impact on current workflow and to reduce medication errors. Twenty-four medications were preselected for dose rounding and included in the analysis. Ordered doses were automatically rounded to the nearest vial size if the dose was within 10% of the original dose. Prescribers then either reviewed and signed the rounded dose or manually entered the nonrounded dose. Cost savings were calculated as drug expense savings from doses rounded down. RESULTS From July 2018 to June 2019, 10,206 doses of the selected medications were administered. Dose rounding occurred in 5,069 doses (49.7%). All 24 medications within the initiative were administered within the time of analysis. Of the rounded doses administered, 2,516 (49.6%) were rounded down to a commercially available vial size. Using wholesale acquisition cost pricing, the drug expense savings was approximately $3.6 million US dollars (USD). The medications with the highest savings were trastuzumab and ipilimumab, with annual savings of $756,780 USD and $494,517 USD, respectively. CONCLUSION The automated dose-rounding algorithm at Michigan Medicine reduced drug expenditures substantially, and its integration within the computerized physician order entry system had minimal impact on current workflow.

Design, Implementation, and Evaluation of Compliance With Pharmacy Workflow During a Pediatric Oncology Computerized Provider Order Entry (CPOE) Launch

OBJECTIVE There is a lack of published literature detailing how computerized physician order entry (CPOE) pharmacy workflow is designed and implemented. The intent of this project was to design, implement, and assess compliance with the pharmacy workflow required for launching CPOE to improve the safety and efficiency of chemotherapy order entry for pediatric patients. METHODS This process implementation project took place in 2 phases, which included the design and implementation of pharmacy workflow education, and retrospective chart review of patients who received chemotherapy ordered through CPOE. An anonymous survey was also distributed to pharmacy staff, nurses, and physicians, and an assessment of any CPOE-related safety reports was completed. RESULTS Eighty-three patients received intravenous and/or intrathecal chemotherapy ordered via the CPOE software, Beacon, within the electronic medical record system, Epic, in the first 30 days post-launch across both the inpatient and outpatient settings. Overall compliance with the CPOE workflow for entering chemotherapy plans was 77% and &gt;66% compliance with the order preparation process. Pharmacists provided an average of 1.6 interventions per review. The pharmacy was able to prepare chemotherapy within the allotted institutional time benchmarks in most cases. An overall combined multidisciplinary survey response rate of 30.6% was achieved. Twenty-eight Beacon-related patient safety reports were filed in the first 2 weeks post-launch. CONCLUSIONS The Beacon launch at this single pediatric institution was successful, and the pharmacy workflow was shown to greatly affect the overall success of the launch of CPOE. The careful prospective design, education, implementation, and retrospective review of the pharmacy workflow is key to process implementation related to chemotherapy CPOE.

Scoping Review of Computerized Physician Order Entry Systems in Reducing Medical Errors

Background: Medical errors have dramatic clinical and economic consequences. Using various information technology can reduce medical errors and improve services’ quality via preventing medical errors. In this study, the role of a computerized medical order entry system was investigated in reducing medical errors. Methods: This study was conducted as a scoping review. The research question was formulated; then, the inclusion and exclusion criteria, keywords (such as medical errors, adverse event, physician order entry system and control) and search strategy were determined. International databases(Scopus, ProQuest, and PubMed) and manual searches were used. The studies that had the inclusion criteria were entered into the study and were evaluated qualitatively, then information of studies was extracted and summarized. Results: In total, 16 studies were included. Most studies were about medication errors and adverse medication events. So, it is possible to claim more confidently about reducing medication errors to adverse medication events, since in studies, the impact of this system on medication errors had been further discussed. Some studies have pointed to an increase in error reports due to better checking and error entry with this system, and in general, the positive impact of this action has been mentioned in minimizing errors, especially medication errors and adverse medication events. Positive and significant effects have also been reported on prescribing errors, especially medication prescriptions. Conclusion: Computerization of medical orders through its positive effects, can be considered a useful and appropriate intervention in increasing patient safety if implemented completely and correctly.