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

doi:10.2146/sp100011e

Cited by 18 publications

(8 citation statements)

References 45 publications

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“…Computerized provider order entry (CPOE) is an electronic system that health care professionals can use to enter drugs, treatments, and test orders, and transmit the orders directly to the department responsible for fulfilling the order. 8 The recent availability of these programs, which allow physicians to introduce prescriptions in the electronic medical record (EMR), and their use in routine drug therapy monitoring, together with pharmacy warning systems (PWS) that enhance safety in hospitalized patients, have helped in identifying DRP and their causes, 9 , 10 thus improving the medication process. Nevertheless, there are patients with certain clinical and/or demographic characteristics who are at higher risk for developing a DRP and whose treatment needs to be more closely monitored.…”

Section: Introductionmentioning

confidence: 99%

Patient risk factors for developing a drug-related problem in a cardiology ward

Urbina¹,

Ferrández²,

Luque³

et al. 2014

TCRM

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BackgroundBecause of the high incidence of drug-related problems (DRPs) among hospitalized patients with cardiovascular diseases and their potential impact on morbidity and mortality, it is important to identify the most susceptible patients, who therefore require closer monitoring of drug therapy.PurposeTo identify the profile of patients at higher risk of developing at least one DRP during hospitalization in a cardiology ward.MethodWe consecutively included all patients hospitalized in the cardiology ward of a teaching hospital in 2009. DRPs were identified through a computerized warning system designed by the pharmacy department and integrated into the electronic medical record.ResultsA total of 964 admissions were included, and at least one DRP was detected in 29.8%. The variables associated with a higher risk of these events were polypharmacy (odds ratio [OR]=1.228; 95% confidence interval [CI]=1.153–1.308), female sex (OR=1.496; 95% CI=1.026–2.180), and first admission (OR=1.494; 95% CI=1.005–2.221).ConclusionMonitoring patients through a computerized warning system allowed the detection of at least one DRP in one-third of the patients. Knowledge of the risk factors for developing these problems in patients admitted to hospital for cardiovascular problems helps in identifying the most susceptible patients.

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Section: Introductionmentioning

confidence: 99%

Patient risk factors for developing a drug-related problem in a cardiology ward

Urbina¹,

Ferrández²,

Luque³

et al. 2014

TCRM

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“…The CDS features of chemotherapy CPOE should include alerts for drug–drug interactions, duplicate therapy alerts, dose limit alerts, and the ability to direct prescribers to order appropriate laboratory tests, supportive care, and hydration requirements. 10 , 39 The choice and programming of CDS features should have the goal of minimizing “alert fatigue”, and it is recommended that CDS alerts be reviewed on a regular basis with the goal of removing those alerts with little clinical value and introducing new alerts that are deemed important. 10 , 39 Implementation of the CPOE system should occur in a way and at a pace that does not compromise the safety of the medication use process.…”

Section: Resultsmentioning

confidence: 99%

“… 10 , 39 The choice and programming of CDS features should have the goal of minimizing “alert fatigue”, and it is recommended that CDS alerts be reviewed on a regular basis with the goal of removing those alerts with little clinical value and introducing new alerts that are deemed important. 10 , 39 Implementation of the CPOE system should occur in a way and at a pace that does not compromise the safety of the medication use process. A phased implementation approach has been reported in a number of studies.…”

Section: Resultsmentioning

confidence: 99%

Chemotherapy e-prescribing: opportunities and challenges

Elsaid

Garguilo

Collins

2015

IPRP

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Chemotherapy drugs are characterized by low therapeutic indices and significant toxicities at clinically prescribed doses, raising serious issues of drug safety. The safety of the chemotherapy medication use process is further challenged by regimen complexity and need to tailor treatment to patient status. Errors that occur during chemotherapy prescribing are associated with serious and life-threatening outcomes. Computerized provider order entry (CPOE) systems were shown to reduce overall medication errors in ambulatory and inpatient settings. The adoption of chemotherapy CPOE is lagging due to financial cost and cultural and technological challenges. Institutions that adopted infusional or oral chemotherapy electronic prescribing modified existing CPOE systems to allow chemotherapy prescribing, implemented chemotherapy-specific CPOE systems, or developed home-grown chemotherapy electronic prescribing programs. Implementation of chemotherapy electronic prescribing was associated with a significant reduction in the risk of prescribing errors, most significantly dose calculation and adjustment errors. In certain cases, implementation of chemotherapy CPOE was shown to improve the chemotherapy use process. The implementation of chemotherapy CPOE may increase the risk of new types of errors, especially if processes are not redesigned and adapted to CPOE. Organizations aiming to implement chemotherapy CPOE should pursue a multidisciplinary approach engaging all stakeholders to guide system selection and implementation. Following implementation, organizations should develop and use a risk assessment process to identify and evaluate unanticipated consequences and CPOE-generated errors. The results of these analyses should serve to further enhance the chemotherapy electronic prescribing process and improve the quality and safety of cancer care.

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“…Technologic solutions (e.g., CPOE, EHR/EMR, CDS, eMar, BCMA) are critical components in an ideal medication-use process 13 , 14 , 22 , 56 , 57 , 59 , 60 . Such technologies should be designed to support clinicians and promote improved patient care processes, combining process, information systems, and supporting technologies that work together to allow desired improvements 59 . As noted elsewhere in this white paper, current technologies support identification and alerting of cumulative acetaminophen dosage as part of the medication-use process and system.…”

Section: Background and Current Statementioning

confidence: 99%

NCPDP recommendations for dose accumulation monitoring in the inpatient setting: Acetaminophen case model, version 1.0

2016

American Journal of Health-System Pharmacy

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Purpose. Best practices and guidance are provided for improved electronic detection and alerting of inadvertent supratherapeutic cumulative doses of acetaminophen and other medications with narrow therapeutic ranges in inpatient settings.Summary. Despite the use of medication safety technologies, overdosage and associated sentinel events continue to be serious problems in many inpatient settings. The tools needed to monitor and employ dose alerts, accumulators, and warning systems are available to reduce inadvertent overdose. Required are staff training and the implementation of processes that provide guidance and documentation of the drug reconciliation process from admittance to discharge for safe patient passage through the various transitions of care. Recommendations to achieve optimal patient safety outcomes include the adoption and integration of available technologies with full functionality configured to meet the institution's policies and processes, initial training and retraining of all staff who use these systems, continuing education of the patient care staff on the dosing safety requirements, and assigning a prominent role to the clinical pharmacist in the entire drug-use and reconciliation process. Conclusion.The key factors contributing to inadvertent overdosage in inpatient settings include a lack of recognition of recommended maximum daily dosages; failure to optimally communicate medication information at transitions of care; failure to optimally implement medication safety technologies, particularly dose accumulator calculation features and associated alerts; and alert fatigue and override.

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

Cited by 18 publications

References 45 publications

Patient risk factors for developing a drug-related problem in a cardiology ward

Patient risk factors for developing a drug-related problem in a cardiology ward

Chemotherapy e-prescribing: opportunities and challenges

NCPDP recommendations for dose accumulation monitoring in the inpatient setting: Acetaminophen case model, version 1.0

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