A Risk Analysis Method to Evaluate the Impact of a Computerized Provider Order Entry System on Patient Safety

Bonnabry, Pascal; Despont-Gros, Christelle; Grauser, Damien; Casez, Pierre; Despond, Magali; Pugin, Déborah; Rivara-Mangeat, Claire; Koch, Magali; Vial, Martine; Iten, Anne; Lovis, Christian

doi:10.1197/jamia.m2677

Cited by 99 publications

(62 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among such methods, "failure modes, effects and criticality analysis" (FMECA) is a well-described tool that systematically assesses a given process. FMECA is recommended both by Veterans Affairs National Center for Patient Safety and the Institute for Healthcare Improvement [25], and it is now being used in health care to assess risk of failure and harm in processes as well as to prioritize the most relevant areas for process improvements [26][27][28]. FMECA has been used by hundreds of hospitals in a variety of Institute for Healthcare Improvement programs, including Idealized Design of Medication Systems (IDMS), Patient Safety Collaboratives and Patient Safety Summit.…”

Section: Introductionmentioning

confidence: 99%

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Gschwind

Rollason

Lovis

et al. 2012

Eur J Clin Pharmacol

Self Cite

View full text Add to dashboard Cite

Purpose The objective of this study was to identify the most clinically relevant drug-drug interactions (DDIs) at risk of affecting acenocoumarol safety in our tertiary care university hospital, a 2,000 bed institution. Methods We identified DDIs occurring with acenocoumarol by combining two different sources of information: a 1-year retrospective analysis of acenocoumarol prescriptions and comedications from our Computerized Physician Order Entry (CPOE) system (n = 2,439 hospitalizations) and a retrospective study of clinical pharmacology consultations involving acenocoumarol over the past 14 years (1994-2007) (n = 407). We classified these DDIs using an original risk-analysis method. A criticality index was calculated for each associated drug by multiplying three scores based on mechanism of interaction, involvement in a supratherapeutic international normalized ratio (INR) (≥ 6) and involvement in a severe bleeding.Results One hundred and twenty-six DDIs were identified and weighted. Twenty-eight drugs had a criticality index ≥ 20 and were therefore considered at high risk for interacting with acenocoumarol by increasing its effect: 75% of these drugs involved a pharmacokinetic mechanism and 14 % a pharmacodynamic mechanism. An unknown mechanism of interaction was involved in 11 % of drugs. Conclusion Twenty-eight specific drugs were identified as being at high risk for interacting with acenocoumarol in our hospital using an original risk-analysis method. Most analyzed drugs interact with acenocoumarol via a pharmacokinetic mechanism. Actions such as the implementation of alerts in our CPOE system should be specifically developed for these drugs.

show abstract

Section: Introductionmentioning

confidence: 99%

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Gschwind

Rollason

Lovis

et al. 2012

Eur J Clin Pharmacol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Internal [17] and external benchmarking [18] might help to support a longitudinal improvement. Especially for external benchmarking, self-assessment tools can be used, such as Failure Mode and Effects Analysis (FMEA) used at the University Hospital in Geneva [19]. These are available in a standardized version, e.g.…”

Section: Discussionmentioning

confidence: 99%

Best practice strategies to safeguard drug prescribing and drug administration: an anthology of expert views and opinions

et al. 2016

View full text Add to dashboard Cite

show abstract

“…A safety analysis of the future state design should be done prior to implementation to identify unintended or unidentified consequences. 41 Failure mode and effects analysis (FMEA) is a useful tool to prospectively evaluate the potential risks associated with the new process and identify inconsistencies or omissions that may have the unwanted effect of increasing risk to patient safety rather than reducing it. [41][42][43][44] Other design considerations.…”

Section: Medication Order Typesmentioning

confidence: 99%

“…41 Failure mode and effects analysis (FMEA) is a useful tool to prospectively evaluate the potential risks associated with the new process and identify inconsistencies or omissions that may have the unwanted effect of increasing risk to patient safety rather than reducing it. [41][42][43][44] Other design considerations. It should be determined whether there are required elements at provider order entry in order for the pharmacy to verify orders (e.g., patient allergies, weight).…”

Section: Medication Order Typesmentioning

confidence: 99%

ASHP Guidelines on Pharmacy Planning for Implementation of Computerized Provider-Order-Entry Systems in Hospitals and Health Systems

2011

American Journal of Health-System Pharmacy

View full text Add to dashboard Cite

Am J Health-Syst Pharm. 2011; 68:e9-31 Purpose and scopeThe purpose of these guidelines is to provide guidance to pharmacists in hospitals and health systems on planning for, implementing, and enhancing safe computerized providerorder-entry (CPOE) systems. To date, most CPOE guidelines have concentrated on the functionality required of a CPOE system, despite the fact that most CPOE system implementations occur using commercial systems whose functionality is largely pre-determined. These guidelines are intended to help pharmacy directors, managers, informaticists, and project managers successfully engage in this type of CPOE system implementation. CPOE is commonly part of a larger A work group of the ASHP Section of Pharmacy Informatics and Technology Section Advisory Group on Clinical Information Systems is gratefully acknowledged for developing these guidelines: health information technology (IT) plan or system implementation. Though many health care technologies impact patient care and pharmacy practice, this guideline will focus on CPOE only. This document is the first of a planned series of ASHP guidelines on CPOE and related technologies and addresses the planning phase of a health-system CPOE implementation, primarily focusing on acute care and associated ambulatory care clinics. The guideline will focus on using CPOE in the medication-use process, though it is important to realize that CPOE includes all orders for patient care (laboratory, nursing, respiratory, and others). Topics covered in these guidelines include • Developing an interdisciplinary planning and implementation team, • Defining the vision, goals, and objectives of the CPOE system, • Establishing essential metrics to measure the success of CPOE system implementation, • Understanding current and future workflow in order to reengineer the medication-use process as part of CPOE system implementation, • Planning for scope and depth of clinical decision support (CDS), • Determining the functionality that ensures the safety of the CPOE system, and • Educating and training health care providers to use the CPOE system.Terms used in these guidelines are defined in the appended glossary.

show abstract

A Risk Analysis Method to Evaluate the Impact of a Computerized Provider Order Entry System on Patient Safety

Cited by 99 publications

References 30 publications

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Best practice strategies to safeguard drug prescribing and drug administration: an anthology of expert views and opinions

ASHP Guidelines on Pharmacy Planning for Implementation of Computerized Provider-Order-Entry Systems in Hospitals and Health Systems

Contact Info

Product

Resources

About