Antimicrobial Stewardship: Rationale for and Practical Considerations of Programmatic Institutional Efforts to Optimize Antimicrobial Use
Robert C. Owens, Lautenbach Ebbing in Antimicrobial Resistance, 2007
Direct computerized physician order entry (CPOE) is rapidly becoming the standard of care, and has been adopted as one of the Leapfrog initiatives to avoid medication errors and improve the quality of care (20). Computer-assisted decision support programs have been designed to provide real-time integrated patient and institutional data including culture and susceptibility results, laboratory measures of organ function, allergy history, drug interactions, as well as cumulative or customized location-specific antibiogram data, and cost information. They provide therapeutic choices for clinicians and allow for the incorporation of clinical judgment by overriding suggestions. Autonomy is preserved while insuring that important variables in the choice of antimicrobial therapy are considered. This topic is covered in depth by Pestotnik in this book.
Simple, Complicated, and Complex Phenomena in Health Care
Paul Batalden, Tina Foster in Sustainably Improving Health Care, 2022
In selected patient populations, electronic health records with computerized provider order entry have been shown to improve patient outcomes and system performance. EHRs can also help with professional development by incorporating education into patient care orders and the inclusion of evidence-based order sets to help improve the medical knowledge of providers. A new EHR eliminates the need for paper documentation and keeps all the required patient data in a single location. EHRs also have the ability to include safety checks for medications – checking allergies, drug interactions, and alerting providers of best practices based on a patient’s medications and diagnoses. Use of CPOE with clinical decision support systems has been shown to reduce medical errors and adverse drug events, improve health outcomes, reduce health-care costs, and improve management of certain chronic conditions.3–7
Diagnostic Support from Information Technology
Pat Croskerry, Karen S. Cosby, Mark L. Graber, Hardeep Singh in Diagnosis, 2017
We have experienced improvements, but even with our new-fangled technology the fact remains that nothing is perfect. Automated notifications of abnormal laboratory results still fail in up to 10% of cases [75]. The VA alert system, designed to track radiology reports, notes that 40% of its alerts go unacknowledged, and even with aggressive tracking and referral, 4% of abnormal reports are still lost to follow-up at four weeks [17]. Although not related to diagnosis per se, the use of computerized provider order entry has proved to have its own inherent risks, which tend to be difficult to detect and correct [76]. Some of the problems now traced to HIT are old ones known to plague healthcare even in our pre-EHR era, namely, patient identification, medication errors, wrong site surgery, and delays in treatment [73,74]. Some safety issues are new to HIT and are yet to be elucidated.
A scoping review of legibility of hand-written prescriptions and drug-orders: the writing on the wall
Published in Expert Review of Clinical Pharmacology, 2023
Anderson Ariaga, Dustin Balzan, Stephen Falzon, Janet Sultana
Finally, yet another way to address the issues of poorly legible or incomplete drug orders is to use a computerized provider order entry system (CPOE), also known as a computerized prescriber order entry system. This option would address the practical issue at the root, removing the need for hand-written instructions and notes; it would also ensure ‘loop closure’ if used properly, allowing complete data capture of a patient’s pharmaceutical care, from prescribing, to filling of dispensary order to administration. Indeed, there are many studies reporting that CPOE addresses legibility well, ultimately improving patient safety, in particular once the implementation of such a system has stabilized. Although findings are not all consistent, a systematic review has shown a strong trend in the reduction of medication errors with the use of CPOE compared to hand-written drug orders [22]. This reduction is likely driven by clarity in drug orders, along with other systematic tools to improve drug safety more broadly, such as integration with clinical decision support software. However, CPOE systems have their limitations, such as the need for intensive training in order to avoid e-iatrogenesis and the high reliance of such systems on highly functional IT systems. In short, there is likely no one-size-fits all approach to stem the issue of poorly legible or incomplete drug orders but a combination of multiple elements is most likely to reduce the risk of medication errors arising from this practice.
Comparison of multimodal, sliding scale acute pain protocols with traditional prescribing in non-surgical patients
Published in Postgraduate Medicine, 2020
Jayne Pawasauskas, Michelle Kelley, Christian Gill, Michael Facente
In addition to analgesic medications, each protocol also contains options for laxatives, anti-emetics, antacids, sedatives, and naloxone. Lastly, the medium and high dose protocols contain an option for the user to request a pharmacy consult for optimizing safety and effectiveness of the regimen. This feature was included by request of medical staff, with primary intent to have a pharmacist verifies the patient’s pre-admission opioid use and that the proper regimen was ordered. For the high dose protocols, this feature defaults as an automatic order. Following administrative approval of the protocols, the hospital’s information technology personnel built order sets for their use within the computerized physician order entry system. Once functionality in the computer systems was available, prescribers could voluntarily utilize one of the acute pain protocols for managing their medical patients.
A Paradigm Shift in Healthcare: An Open Door for Organizational Behavior Management
Published in Journal of Organizational Behavior Management, 2018
David P. Kelley, Nicole Gravina
However, to date, little known OBM research has been conducted to address the caregiver behavior associated with these clinical processes. One study conducted by Cunningham, Geller, and Clarke (2008) evaluated the effects of a computerized provider order entry (CPOE) system (compared to the traditional approach of hand-writing and hand-delivering orders) in a hospital on compliance with medication-ordering protocols and the amount of time until a patient’s first dose of antibiotics. The study looked specifically at the percentage of complete compliance with medication orders and percentage of first doses of antibiotics delivered within 240 minutes of arrival. Results showed that CPOE orders had 59.8% complete compliance compared to paper orders with 46.6% complete compliance. Additionally, 78.4% of antibiotics were delivered within 240 minutes when using CPOE compared to paper orders at 55.1%. This study is a great example of how OBM researchers can begin addressing some of the complex challenges healthcare providers face in relation to clinical processes of care. Yet, more work is needed to develop behavior change techniques to support compliance with clinical processes of care. This could be an excellent avenue for OBM to add value within the healthcare field.
Related Knowledge Centers
- Adverse Drug Reaction
- Clinical Decision Support System
- Hospital
- Pharmacy
- Radiology
- Transcription
- Patient Management Software
- Medical Guideline
- Medical Logic Module
- Electronic Signature