improving medication prescribing through computerized physician order entry
DESCRIPTION
Improving Medication Prescribing Through Computerized Physician Order Entry. Team Membership: Loyola University Physician Foundation, Department of Nursing, Medical Center Information Systems, Electronic Health Record Systems, Pharmacy, and the Center for Clinical Effectiveness. - PowerPoint PPT PresentationTRANSCRIPT
Improving Medication PrescribingThrough
Computerized Physician Order Entry
Team Membership:Loyola University Physician Foundation,Department of Nursing, Medical Center Information Systems, Electronic HealthRecord Systems, Pharmacy, and the Centerfor Clinical Effectiveness
Opportunity Statement and Desired Outcome
Goal: Reduce the number of times a pharmacist must intervene to modify or correct an issue related to the handwriting of a medication order.
There is evidence that Computerized Physician Order Entry (CPOE) significantly reduces adverse drug events related to prescribing and transcribing. This leads to improved quality of care and significant savings in pharmacist time.
Identification of Most Likely Causesfor Pharmacist Interventions
More than 90% of pharmacy interventions relate to prescribing and transcribing issues.
Approximately 92% of medication issues identified by pharmacists have thepotential for significant clinical consequences.
MEDICATION ORDER ISSUESREQUIRING PHARMACIST INTERVENTION (CY00)
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
Prescribing Prescribing/Transcribing
Transcribing
To
tal P
har
mac
y In
terv
enti
on
s
0
CLINICAL SIGNIFICANCEOF PHARMACY INTERVENTIONS (CY00)
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
MEDIUMMAJOR MINOR
To
tal P
har
mac
y In
terv
enti
on
s
0
Solutions Implemented
EDUCATION/TRAINING/WORKFLOW:• Educate physicians, nurses and students regarding impact of CPOE on
patient care• Train physicians and students to use CPOE for medications• Redesign nursing and ward secretary workflow and educate staff• Develop process for stat/verbal orders• Develop LUMC policy for CPOE• Develop backup plan for when LUCI is down
Solutions ImplementedTECHNOLOGY ISSUES: • Obtain feedback from residents regarding organization of LUCI screens • Modify LUCI screens to facilitate physician order entry• Develop a LUCI screen of most commonly ordered medications• Install sufficient PC’s and printers in all patient care areas• Create a solution to route orders printed at nursing stations
IMPLEMENTATION: • POE had previously been implemented in NICU and the Burn Unit• Feb-Nov 2001:
- Implement progressively in all ICUs- Nov 2001: Pilot on 7W medical-surgical floor
• Hospital-wide implementation on March 4, 2002
Results
Pharmacy interventions related to transcribed medication orders have decreased from 50-100 per month to approximately 4 per month following house-wide implementation of computerized physician order entry.
Prescription Related Medication Issues
Feb-00Apr-00Jun-00Aug-00Oct-00Dec-00Feb-01Apr-01Jun-01Aug-01Oct-01Dec-01Feb-02Apr-02Jun-02Aug-02Oct-02Dec-02Feb-03
0
50
100
150
200
250
300
Ph
arm
acy
Inte
rven
tio
ns
150
184
105
Before Implementation Pilot Unit Implementation House-wide Implementation
Transcription Related Medication Issues
Computerized Physician Order Entry reduced the number of medication issues related to transcribing of medication orders by 98%.
0
50
100
150
Ph
arm
acy
Inte
rven
tio
ns
Feb-00Apr-00Jun-00Aug-00Oct-00Dec-00Feb-01Apr-01Jun-01Aug-01Oct-01Dec-01Feb-02Apr-02Jun-02Aug-02Oct-02Dec-02Feb-03
72
56
4
Before Implementation Pilot Unit Implementation House-wide Implementation
Helena Wang, M.D., Chief Resident, Internal Medicine, enters a medication order on the 7th Floor nursing unit. Additional PC’sand printers were installed throughout patient care areas toaccommodate physicians and staff, and support the new process.
Computerized Physician Order Entry was successfully implemented for all hospitalized patients at LUMC, and has significantly reduced the number of medication issues related to transcribing of medication orders. Issues related to prescribing have also decreased as a result of standardizing LUCI medication order screens.
Conclusions
• Continued training of physicians, students, nurses, and service associates regarding computerized order entry• Identify areas with sub-optimal compliance and provide education and support• Plan for new Enterprise Clinical Information System to improve medication issues related to prescribing
Next Steps