Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit

Potts, Amy; Barr, Frederick E.; Gregory, D. W.; Wright, Lorianne; Patel, Neal

doi:10.1542/peds.113.1.59

Cited by 348 publications

(246 citation statements)

References 12 publications

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Order By: Relevance

“…The measures for medical quality were identified and further classified into categories based on ordering practice in HGSD and published literature (Potts et al, 2004). The main outcome measures include length of stay and medical errors.…”

Section: Evaluation Methodsmentioning

confidence: 99%

Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Liu

Yang

et al. 2014

European Journal of Information Systems

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Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

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Section: Evaluation Methodsmentioning

confidence: 99%

Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Liu

Yang

et al. 2014

European Journal of Information Systems

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“…18,19 VLBW infants receiving intravenous PN were identified by Kaushal et al 20 as one of the highest risk groups for medical error related injury because of their multiple complex intravenous infusions, narrow therapeutic range and low tolerance for pharmaceutical errors. Electronic order entry and design can significantly reduce medical errors 21,22 and improve PN mineral content. 23 Merging neonatal PN design with complex ordering algorithms would be difficult using paper order forms, but is possible using electronic physician order entry.…”

Section: Discussionmentioning

confidence: 99%

Practice ordering guidance for neonatal parenteral nutrition

Porcelli

2007

J Perinatol

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Objective: Neonatal parenteral nutrition (PN) is designed for very low birth weight infants (BWp1500 g) for whom enteral feedings are inadequate. Evaluating the clinical practice guidance (CPG) content of printed paper order forms could provide a baseline for comparison and serve as a reference for electronic neonatal nutrition order design systems.Methods: A scoring system for clinical practice guidance was developed and applied to nine institutions printed paper PN order forms. CPG scores were assigned as: (1) generic reminder only, (2) prompt with order entry space, (3) patient specific reminder only, (4) patient specific recommendation with order entry space. User-friendliness and form completion time were also recorded.Results: The overall CPG score for the six most common PN components was 1.85±0.68 (mean±1s.d.), consistent with a generic reminder, but short of a specific nutrient dose order field. Amino acid received the highest CPG score, 2.05±0.64; vitamins rated the lowest. The institution of origin was an independent predictor of the CPG score.Conclusions: Paper neonatal PN order forms offer relatively little CPG. Significant form variation and format reflects the need to standardize neonatal PN design as the neonatal PN design moves from paper to electronic ordering systems.

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“…CDS tools used in outpatient care document improved adherence to recommended vaccine schedules and adherence to recommended asthma care [14,15] . CPOE, with integrated CDS, decreases medical errors and improves pharmacy costs over time [16][17][18][19][20] . CDS tools have improved care in time-sensitive disease states including septic shock [21] .…”

Section: History and Overview Of Comput-erized Decision Supportmentioning

confidence: 99%

Computerized decision support in adult and pediatric critical care

Williams¹,

Bratton²

2013

WJCCM

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Computerized decision support (CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization of meaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future.

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Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit

Abstract: The implementation of CPOE resulted in almost a complete elimination of MPEs and RVs and a significant but less dramatic effect on potential ADEs.

Cited by 348 publications

References 12 publications

Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Practice ordering guidance for neonatal parenteral nutrition

Computerized decision support in adult and pediatric critical care

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