Transcript Document

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
Opportunity Statement and Desired Outcome
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.
Goal: Reduce the number of times a pharmacist must intervene to
modify or correct an issue related to the handwriting of a medication
order.
Identification of Most Likely Causes
for Pharmacist Interventions
CLINICAL SIGNIFICANCE
OF PHARMACY INTERVENTIONS (CY00)
2,000
2,000
1,800
1,800
Total Pharmacy Interventions
Total Pharmacy Interventions
MEDICATION ORDER ISSUES
REQUIRING PHARMACIST INTERVENTION (CY00)
1,600
1,400
1,200
1,000
800
600
1,600
1,400
1,200
1,000
800
600
400
400
200
200
0
0
Prescribing
Prescribing/
Transcribing
Transcribing
More than 90% of pharmacy interventions
relate to prescribing and transcribing issues.
MAJOR
MEDIUM
MINOR
Approximately 92% of medication issues
identified by pharmacists have the
potential for significant clinical consequences.
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 Implemented
TECHNOLOGY 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
Pilot Unit Implementation
Before Implementation
House-wide Implementation
Pharmacy Interventions
300
250
200
184
150
150
100
50
0
105
Transcription Related Medication Issues
Before Implementation
Pilot Unit Implementation
House-wide Implementation
Pharmacy Interventions
150
100
72
56
50
0
Computerized Physician Order Entry reduced the number of medication issues related to
transcribing of medication orders by 98%.
4
Helena Wang, M.D., Chief Resident, Internal Medicine, enters a
medication order on the 7th Floor nursing unit. Additional PC’s
and printers were installed throughout patient care areas to
accommodate physicians and staff, and support the new process.
Conclusions
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.
Next Steps
• 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