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Search results for "General Hospitals"

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Journal Article > Review

Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis.

Prgomet M, Li L, Niazkhani Z, Georgiou A, Westbrook JI. J Am Med Inform Assoc. 2017;24:413-422.

While prior research has shown that computerized provider order entry and clinical decision support systems have the potential to improve patient safety, less is known about the impact of such systems in intensive care units. In this systematic review and meta-analysis, investigators found an 85% decrease in prescribing errors and a 12% reduction in ICU mortality rates in critical care units that converted from paper orders to commercially available computerized provider order entry systems.

Journal Article > Study

EHR-related medication errors in two ICUs.

Carayon P, Du S, Brown R, Cartmill R, Johnson M, Wetterneck TB. J Healthc Risk Manag. 2017;36:6-15.

Despite the demonstrated success of technology in reducing medication errors, preventable adverse drug events remain a significant source of harm to patients. Researchers analyzed data on medication safety events in 2 ICUs at a medical center and found 1622 preventable adverse drug events among 624 patients. About one third of these events were related to electronic health record use, including duplicate orders.

Journal Article > Commentary

Medication safety in the neonatal intensive care unit: big measures for our smallest patients.

Rostas SE. J Perinat Neonatal Nurs. 2017;31:15-19.

Medication errors are common in the neonatal intensive care unit. This commentary outlines various strategies one teaching hospital has utilized to reduce risks of medication errors in this care setting, such as use of computerized provider order entry and smart pumps.

Journal Article > Study

Electronic prescription writing errors in the pediatric emergency department.

Nelson CE, Selbst SM. Pediatr Emerg Care. 2015;31:368-372.

According to this retrospective chart review study, clinically significant prescription errors continued to occur at an alarming rate in a pediatric emergency department, despite the introduction of computerized provider order entry. Emergency medicine residents made more prescribing errors than pediatric residents.

Journal Article > Study

Understanding the nature of medication errors in an ICU with a computerized physician order entry system.

Cho I, Park H, Choi YJ, Hwang MH, Bates DW. PLoS One. 2014;9:e114243.

This study reviewed prescriptions following implementation of a computerized provider order entry system. More than half of examined prescriptions had medication errors, most often related to incorrect documentation of verbal orders. These results add to concerns about unintended consequences of computerized provider order entry.

Journal Article > Study

Intercepting wrong-patient orders in a computerized provider order entry system.

Green RA, Hripcsak G, Salmasian H, et al. Ann Emerg Med. 2015;65:679-686.

While computerized physician order entry is expected to significantly reduce adverse drug events, systems must be implemented thoughtfully to avoid facilitating certain types of errors. A forcing function that mandated correct patient identification resulted in a moderate decrease in wrong-patient prescribing errors within a computerized provider order entry system.

Journal Article > Study

Computerized dose range checking using hard and soft stop alerts reduces prescribing errors in a pediatric intensive care unit.

Balasuriya L, Vyles D, Bakerman P, et al. J Patient Saf. 2014 Oct 31; [Epub ahead of print].

This before-and-after study found that introduction of a tiered alert system for medication dosages in pediatric patients led to an increase in alerts, but also resulted in fewer overridden alerts and more medication order revisions. This work emphasizes the need to improve electronic medication alerts to make them more actionable and reduce alert fatigue.

Journal Article > Study

Computerized physician order entry in the cardiac intensive care unit: effects on prescription errors and workflow conditions.

Armada ER, Villamañán E, López-de-Sá E, et al. J Crit Care. 2014;29:188-193.

According to this before-and-after study, implementation of computerized physician order entry was associated with fewer medication errors and improved legibility. These findings add to the conflicting evidence about introduction of health information technology and errors.

Journal Article > Study

Characterising the complexity of medication safety using a human factors approach: an observational study in two intensive care units.

  • Classic

Carayon P, Wetterneck TB, Cartmill R, et al. BMJ Qual Saf. 2014;23:56-65.

As the patient safety field matures, there is increasing recognition of the need to incorporate human factors engineering methods into analyzing errors and developing solutions. These methods were used to investigate the types and frequency of medication errors in two intensive care units. Although existing medication safety interventions have mainly targeted errors at individual stages of the medication management process (e.g., computerized provider order entry [CPOE] to prevent prescribing errors), this study found that in many cases, errors occurred in an interdependent fashion at multiple stages of the process. For example, incorrect transcription of an order could then lead to a medication administration error. While CPOE is likely a solution for a significant proportion of errors, this study's results indicate a need for closed-loop systems that can minimize the risk of all types of medication errors.

Journal Article > Study

Medication safety and knowledge-based functions: a stepwise approach against information overload.

Patapovas A, Dormann H, Sedlmayr B, et al. Br J Clin Pharmacol. 2013;76(supp 1):14-24.

An electronic clinical decision support system for prescribing in the emergency department used tiered alerts with higher and lower urgency information in order to avoid alert fatigue.

Journal Article > Government Resource

Adverse drug events in surgical patients: an observational multicentre study.

de Boer M, Boeker EB, Ramrattan MA, et al. Int J Clin Pharm. 2013;35:744-752.

This study found a remarkably high incidence of preventable medication errors in surgical patients, despite universal use of computerized provider order entry.

Journal Article > Commentary

A clinical case of electronic health record drug alert fatigue: consequences for patient outcome.

Carspecken CW, Sharek PJ, Longhurst C, Pageler NM. Pediatrics. 2013;131:e1970-e1973.

This commentary describes an incident involving an inappropriate override of a drug allergy alert and details changes the hospital made in its medication allergy alert system in response to the event.

Journal Article > Review

The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature.

Georgiou A, Prgomet M, Paoloni R, et al. Ann Emerg Med. 2013;61:644-653.

Although use of computerized provider order entry (CPOE) is increasingly widespread, implementation in the busy environment of the emergency department (ED) is still relatively new. This systematic review of the effectiveness of CPOE in the ED found that, consistent with other systematic reviews, it did reduce medication prescribing errors. However, few studies assessed the effect of CPOE on clinician workflow, and there was no clear impact on patient safety. The unique patient safety issues in the ED are discussed in an AHRQ WebM&M perspective.

Journal Article > Study

Computerized prescriber order entry and opportunities for medication errors: comparison to tradition paper-based order entry.

Jozefczyk KG, Kennedy WK, Lin MJ, et al. J Pharm Pract. 2013;26:434-437.

Implementation of computerized provider order entry significantly reduced prescribing errors in a neonatal intensive care unit compared with a paper-based ordering system.

Journal Article > Study

The effects of computerized provider order entry implementation on communication in intensive care units.

Hoonakker PL, Carayon P, Walker JM, Brown RL, Cartmill RS. Int J Med Inform. 2013;82:e107-e117.

Recent studies have suggested that computerized provider order entry (CPOE) may impair nurse–physician communication. In this cross-sectional study, implementing CPOE in intensive care units had a short-term negative effect on communication.

Journal Article > Study

Changes in end-user satisfaction with computerized provider order entry over time among nurses and providers in intensive care units.

Hoonakker PL, Carayon P, Brown RL, Cartmill RS, Wetterneck TB, Walker JM. J Am Med Inform Assoc. 2013;20:252-259.

This study used serial surveys over a 1-year period to assess changes in physician and nurse satisfaction with a new computerized provider order entry system. Though nurses expressed considerable dissatisfaction initially, their satisfaction improved over time, whereas physicians were only moderately satisfied with the system both initially and after gaining more experience.

Journal Article > Study

Conducting an efficient proactive risk assessment prior to CPOE implementation in an intensive care unit.

Hundt AS, Adams JA, Schmid JA, et al. Int J Med Inform. 2013;82:25-38.

This study described the use of proactive risk assessment as a tool to improve the implementation of health information technology interventions such as computerized provider order entry.

Journal Article > Study

Relationship between Leapfrog Safe Practices Survey and outcomes in trauma.

Glance LG, Dick AW, Osler TM, et al. Arch Surg. 2011;146:1170-1177.

The Leapfrog Group, a consortium of public and private employers who purchase health care for more than 30 million Americans, strives to improve patient safety through encouraging hospitals to implement the National Quality Forum's safe practices and 3 other key safety interventions (including computerized provider order entry). More than 1200 hospitals nationwide have joined the Leapfrog Group's effort to date. However, this analysis of hospital-level trauma outcomes found essentially no relationship between adoption of the Leapfrog interventions and outcomes for trauma patients. This study's results mirror the findings of a prior study that found no improvement in mortality at Leapfrog hospitals for a broad range of inpatient diagnoses.

Journal Article > Study

Prevalence of medication administration errors in two medical units with automated prescription and dispensing.

Rodriguez-Gonzalez CG, Herranz-Alonso A, Martin-Barbero ML, et al. J Am Med Inform Assoc. 2012;19:72-78.

Technological solutions such as computerized provider order entry (CPOE) hold promise for reducing medication errors at the prescribing and dispensing stage, but patients may still be harmed by incorrect administration of medications, which have been shown to be disturbingly common in prior studies. Conducted at an academic hospital in Spain that had an established CPOE system, this study found an overall administration error rate of 22%, consistent with prior studies. The hospital in question did not have a barcoding medication administration system. Combining barcoding with CPOE in a closed-loop system has been shown to significantly reduce the overall medication error rate.

Journal Article > Study

Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses' handoffs on medical and surgical units: insights from interviews and observations.

Staggers N, Clark L, Blaz JW, Kapsandoy S. Health Informatics J. 2011;17:209-223.

By enhancing providers' ability to transmit information in a concise and standardized fashion, electronic medical records (EMR) offer great promise for improving handoffs and signouts. However, this analysis of nursing handoffs at an institution with a commercial EMR found that the built-in patient summaries provided inadequate detail and flexibility for clinical signout purposes, forcing nurses to develop workarounds for transmitting key information. This finding reveals the importance of human factors engineering in designing information technology solutions for patient safety problems.

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