High Rates of Adverse Drug Events in a Highly Computerized Hospital

doi:10.1001/archinte.165.10.1111

Cited by 290 publications

(33 citation statements)

References 41 publications

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“…[50, 51] Finally, several of the barriers identified here, such as usability problems and system slowness, appear in work that describes the unintended consequences of EHR. [52–58]…”

Section: Discussionmentioning

confidence: 99%

What Stands in the Way of Technology-Mediated Patient Safety Improvements? A Study of Facilitators and Barriers to Physicians’ Use of Electronic Health Records

Holden

2011

Journal of Patient Safety

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Objectives For electronic health records (EHR) systems to have a positive impact on patient safety, clinicians must be able to use these systems effectively after they are made available. This study's objective is to identify and describe facilitators and barriers to physicians' use of EHR systems. Methods Twenty research interviews were conducted with attending physicians who were using EHR at one of two Midwest community hospitals and/or at their respective outpatient clinics. Results Analyses yielded over 200 perceived facilitators and barriers, comprising 19 distinct categories. Categories of facilitators/barriers related to user attributes included learning, typing proficiency, understanding the EHR system, motivation/initiative, and strategies/workarounds. Categories related to system attributes were supporting hardware/software and system speed, functionality, and usability. Categories related to support from others were formal technical support, formal training, and informal support from colleagues. Categories of organizational facilitators/barriers were time allowance and inter-institutional integration. Categories of environmental facilitators/barriers were physical space, electricity, wireless connectivity, and the social environment. Conclusion Together, the broad set of discovered facilitators and barriers confirms and expands prior research on the facilitators and barriers to health information technology use. The depth of reported information on each facilitator and barrier made possible by qualitative interview methods contributes to the theoretical understanding of facilitators and barriers to EHR use. Equally as important, this study provides an information base from which relevant policy and design interventions can be launched in order to improve the use of EHR systems and, thus, patient safety.

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“…[50, 51] Finally, several of the barriers identified here, such as usability problems and system slowness, appear in work that describes the unintended consequences of EHR. [52–58]…”

Section: Discussionmentioning

confidence: 99%

What Stands in the Way of Technology-Mediated Patient Safety Improvements? A Study of Facilitators and Barriers to Physicians’ Use of Electronic Health Records

Holden

2011

Journal of Patient Safety

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“…Its implementation has been recommended to improve patient safety and outcomes [2,3] primarily by reducing medication errors [4] that usually arise from faulty prescriptions [5]. However, CPOE itself can lead to new types of errors [6-8], which may be detrimental to patients. This may be more pronounced in critically ill patients, a more vulnerable population due to the severity of their illness, the complexity of interventions done and the diversity of equipments used in the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study

Al‐Dorzi

Tamim

Cherfan

et al. 2011

BMC Med Inform Decis Mak

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BackgroundComputerized physician order entry (CPOE) systems are recommended to improve patient safety and outcomes. However, their effectiveness has been questioned. Our objective was to evaluate the impact of CPOE implementation on the outcome of critically ill patients.MethodsThis was an observational before-after study carried out in a 21-bed medical and surgical intensive care unit (ICU) of a tertiary care center. It included all patients admitted to the ICU in the 24 months pre- and 12 months post-CPOE (Misys®) implementation. Data were extracted from a prospectively collected ICU database and included: demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, admission diagnosis and comorbid conditions. Outcomes compared in different pre- and post-CPOE periods included: ICU and hospital mortality, duration of mechanical ventilation, and ICU and hospital length of stay. These outcomes were also compared in selected high risk subgroups of patients (age 12-17 years, traumatic brain injury, admission diagnosis of sepsis and admission APACHE II > 23). Multivariate analysis was used to adjust for imbalances in baseline characteristics and selected clinically relevant variables.ResultsThere were 1638 and 898 patients admitted to the ICU in the specified pre- and post-CPOE periods, respectively (age = 52 ± 22 vs. 52 ± 21 years, p = 0.74; APACHE II = 24 ± 9 vs. 24 ± 10, p = 0.83). During these periods, there were no differences in ICU (adjusted odds ratio (aOR) 0.98, 95% confidence interval [CI] 0.7-1.3) and in hospital mortality (aOR 1.00, 95% CI 0.8-1.3). CPOE implementation was associated with similar duration of mechanical ventilation and of stay in the ICU and hospital. There was no increased mortality or stay in the high risk subgroups after CPOE implementation.ConclusionsThe implementation of CPOE in an adult medical surgical ICU resulted in no improvement in patient outcomes in the immediate phase and up to 12 months after implementation.

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“…E-prescribing produces legible prescriptions, can provide rapid access to information and decision support, and can reduce prescribing errors and adverse drug events [2-4]. It has also been associated with new types of errors and adverse patient outcomes [5-7]. The effects of e-prescribing on the quality of prescribing depend on a range of factors that include the healthcare setting, user training and behaviour, availability of appropriate hardware and technical support, the computer system used including the availability and quality of decision support, and integration of the system into work practices[8,9].…”

Section: Introductionmentioning

confidence: 99%

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process

Sweidan¹,

Williamson²,

Reeve³

et al. 2010

BMC Med Inform Decis Mak

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BackgroundElectronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines.MethodsSoftware features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia.ResultsA list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases.ConclusionsThis study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries.

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High Rates of Adverse Drug Events in a Highly Computerized Hospital

Abstract: High rates of ADEs may continue to occur after implementation of CPOE and related computerized medication systems that lack decision support for drug selection, dosing, and monitoring.

Cited by 290 publications

References 41 publications

What Stands in the Way of Technology-Mediated Patient Safety Improvements? A Study of Facilitators and Barriers to Physicians’ Use of Electronic Health Records

What Stands in the Way of Technology-Mediated Patient Safety Improvements? A Study of Facilitators and Barriers to Physicians’ Use of Electronic Health Records

Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process

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