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Search results for "Information Professionals"

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Journal Article > Study

Role of computerized physician order entry usability in the reduction of prescribing errors.

Peikari HR, Zakaria MS, Yasin NM, Shah MH, Elhissi A. Healthc Inform Res. 2013;19:93-101.

Computerized provider order entry users felt that the usability of the system was the most important factor in its ability to prevent medication prescribing errors.

Journal Article > Study

Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects.

Magrabi F, Li SY, Day RO, Coiera E. J Am Med Inform Assoc. 2010;17:575-583.

Interruptions during the medication administration process have been linked to an increased risk of error. This simulation study investigated the effect of interruptions on medication prescribing errors, using a controlled experimental design during which physicians were interrupted while prescribing within a computerized provider order entry system. Interruptions did not result in an increase in prescribing errors, but did significantly increase the time needed to complete complex prescribing tasks. The investigators hypothesize that CPOE systems provide visual cues that may help providers resume interrupted tasks without increasing the potential for error.

Journal Article > Study

Prescription errors related to the use of computerized provider order-entry system for pediatric patients.

Alhanout K, Bun SS, Retornaz K, Chiche L, Colombini N. Int J Med Inform. 2017;103:15-19.

Computerized provider order entry has been shown to decrease adverse drug events, but it can also introduce new medication errors. This retrospective study examined medication ordering errors intercepted by pharmacists for pediatric patients. As with prior studies in pediatrics, this investigation uncovered dosing errors associated with weight-based dosing, including calculation errors and missing weight information. The most common medication associated with errors was acetaminophen, which can cause severe harm if incorrectly dosed. The authors call for improving electronic health record prescribing interfaces, better user training, and enhancing communication among providers to prevent medication errors.

Journal Article > Study

Analysis of variations in the display of drug names in computerized prescriber-order-entry systems.

Quist AJL, Hickman TT, Amato MG, et al. Am J Health Syst Pharm. 2017;74:499-509.

Evidence suggests that computerized provider order entry (CPOE) systems improve medication safety by mitigating prescribing errors. However, CPOE systems may contribute to errors when user-centered design is not taken into account. In this study, researchers standardized the assessment of 10 distinct inpatient and ambulatory CPOE systems across 6 health care institutions to determine how variation in drug name display may increase the risk of medication errors. Using test patient scenarios, they found significant variation in drug name display, including inconsistencies with regard to the display of brand and generic names. Providers could theoretically prescribe both the brand and generic drug, increasing the risk for patient harm. A recent Annual Perspective discussed the benefits and limitations of CPOE with regard to patient safety.

Journal Article > Commentary

Responsible e-prescribing needs e-discontinuation.

Fischer S, Rose A. JAMA. 2017;317:469-470.

E-prescribing is a key strategy to improve medication safety by addressing illegible prescriptions, order omissions, and dosage confusion. However, there have been unintended consequences such as the inability to discontinue medications ordered electronically. This commentary reviews problems associated with this unintended consequence and suggests that enabling electronic cancellation of prescriptions can help address the issue. A WebM&M commentary discussed a case involving an electronic prescribing error.

Newspaper/Magazine Article

Is an indication-based prescribing system in our future?

ISMP Medication Safety Alert! Acute Care Edition. November 17, 2016;21:1-5.

Health information technology has enhanced prescribers' ability to document the purpose of medications they order. This newsletter article reviews weaknesses in electronic prescribing systems and recommends incorporating indication-based prescribing as the "sixth right" of safe medication use. The piece highlights how making indication information available can help inform medication communication, selection, adherence, and reconciliation.

Book/Report

Report on the Safe Use of Pick Lists in Ambulatory Care Settings.

Rizk S, Oguntebi G, Graber ML, Johnston D. Research Triangle Park, NC: RTI International; 2016.

Standard term selection tools—like pick lists or drop-down menus—in information technology can create opportunities for user error due to human factors. This publication explores how mistakes such as selecting the wrong drug from an ordering pick list can occur in the ambulatory environment. The report includes recommendations and resources to help enhance medication safety when using these tools.

Journal Article > Review

A literature review of the training offered to qualified prescribers to use electronic prescribing systems: why is it so important?

Brown CL, Reygate K, Slee A, et al. Int J Pharm Pract. 2017;25:195-202.

Insufficient training on electronic health record systems can hinder user satisfaction. This literature review assessed the evidence on training methods, such as simulation scenarios and classroom-based sessions, for electronic prescribing systems. The authors suggest that future research should examine how to educate users about challenges associated with electronic systems.

Journal Article > Commentary

Incorporating indications into medication ordering—time to enter the age of reason.

Schiff GD, Seoane-Vazquez E, Wright A. N Engl J Med. 2016;375:306-309.

Clear communication during medication prescribing can enhance safety. This commentary advocates for indications-based prescribing coupled with health information technology as a way to improve team communication, medication reconciliation, and patient education and compliance.

Journal Article > Study

Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England.

  • Classic

Cresswell KM, Mozaffar H, Lee L, Williams R, Sheikh A. BMJ Qual Saf. 2017;26:530-541.

Electronic prescribing is an important component of health information technology–related patient safety efforts. Some health care systems have invested in hospital-wide integrated programs that include prescribing modules, whereas others have linked standalone systems through interfacing mechanisms. This intensive study integrated data from six hospitals (including multiple interviews, observations, implementation documents, and expert round-table discussions) to explore the tradeoffs between these technologic strategies. The authors describe various integration and interfacing issues with both standalone and multimodular systems, such as increased workloads due to lack of timely information and insufficient information transfer necessitating manual data entry between modules. A recent PSNet perspective focused on the many advances and remaining challenges of electronic prescribing.

Journal Article > Study

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting.

Her QL, Amato MG, Seger DL, et al. J Am Med Inform Assoc. 2016;23:924-933.

Users often bypass alerts meant to enhance the safety of medication ordering and dispensing technologies. This observational study at a large academic medical center found approximately one in five nonformulary medication alerts are inappropriately overridden. The authors suggest strategies that future research should examine for improving the design of nonformulary alerts.

Journal Article > Study

Analysis of prescribers' notes in electronic prescriptions in ambulatory practice.

  • Classic

Dhavle AA, Yang Y, Rupp MT, Singh H, Ward-Charlerie S, Ruiz J. JAMA Intern Med. 2016;176:463-470.

Many ambulatory practices have recently introduced electronic prescribing, which has the potential to improve medication safety. In this large cross-sectional study, researchers analyzed more than 26,000 electronic prescriptions that included free-text notes sent to community pharmacies. Two-thirds of free-text notes contained inappropriate content, despite the availability of a standard data field. Nearly 1 in 5 of these notes included conflicting administration instructions from the designated structured field, creating an important source of potential medication errors. In addition, approximately 5% of notes contained irrelevant information, which may distract or confuse pharmacy staff. The authors outline recommended solutions based on the information most commonly included in prescription free-text notes.

Journal Article > Commentary

Automatic errors: a case series on the errors inherent in electronic prescribing.

Lourenco LM, Bursua A, Groo VL. J Gen Intern Med. 2016;31:808-811.

Inadvertent dispensing of discontinued medications can result in patient harm. Examining incidents involving such medication errors, this commentary spotlights the need for enhanced electronic medical records to reduce risks related to discontinuation orders.

Journal Article > Study

Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink.

Stocks SJ, Kontopantelis E, Akbarov A, Rodgers S, Avery AJ, Ashcroft DM. BMJ. 2015;351:h5501.

Prescribing errors are a serious source of patient harm in primary care. This cross-sectional study in the United Kingdom found wide variation in the prevalence of potentially hazardous prescribing ranging from nearly zero to 10%, and for inadequate medication monitoring ranging from 10% to 42% between practices.

Journal Article > Commentary

Computerised prescribing for safer medication ordering: still a work in progress.

Schiff GD, Hickman TT, Volk LA, Bates DW, Wright A. BMJ Qual Saf. 2016;25:315-319.

The unintended consequences related to implementation of health information technologies have been widely documented. In this commentary, the authors offer insights regarding a government-funded investigation of 10 computerized provider order entry systems, discuss weaknesses in these systems, and make recommendations to focus on designing around human factors, enhancing workflow, and improving reporting.

Journal Article > Study

Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system.

Dekarske BM, Zimmerman CR, Chang R, Grant PJ, Chaffee BW. Int J Med Inform. 2015;84:1085-1093.

Alert fatigue is the Achilles heel of medication ordering with computerized physician order entry. This randomized controlled trial found that the appropriateness of alert overrides increased with implementation of a customized list of alert override reasons, compared with default options, in a CPOE system. This demonstrates the need to develop more clinically relevant reasons for overriding alerts in order to enhance the safety of medication prescribing.

Journal Article > Study

Implementation of a custom alert to prevent medication-timing errors associated with computerized prescriber order entry.

Idemoto LM, Williams BL, Ching JM, Blackmore CC. Am J Health Syst Pharm. 2015;72:1481-1488.

This study examined the effect of a custom alert intended to reduce medication-timing errors associated with introduction of computerized provider order entry, which can lead to too-frequent or missed doses of medications. Using a rigorous interrupted time-series design, researchers found fewer medication-timing errors after implementation of this alert. This work demonstrates how custom alerts developed by clinicians can harness the electronic health record to improve safety.

Journal Article > Study

Frequency and severity of parenteral nutrition medication errors at a large children's hospital after implementation of electronic ordering and compounding.

MacKay M, Anderson C, Boehme S, Cash J, Zobell J. Nutr Clin Pract. 2016;31:195-206.

Computerized provider order entry with clinical decision support can be a powerful tool for alerting clinicians to potential prescribing errors. In this study at a large pediatric institution, implementation of a computerized provider order entry program for total parenteral nutrition resulted in a reduction in prescribing errors.

Cases & Commentaries

Baffled by Botulinum Toxin

  • Web M&M

Krishnan Padmakumari Sivaraman Nair, DM; July/August 2015

A 5-year-old boy with transverse myelitis presented to the rehabilitation medicine clinic for scheduled quarterly botulinum toxin injections to his legs for spasticity. Halfway through the course of injections, the patient's mother noted her son was tolerating the procedure "much better than 3 weeks earlier"—the patient had been getting extra injections without the physicians' knowledge. Physicians discussed the risks of too-frequent injections with the family. Fortunately, the patient had no adverse effects from the additional injections.

Journal Article > Study

The effect of provider characteristics on the responses to medication-related decision support alerts.

Cho I, Slight SP, Nanji KC, et al. Int J Med Inform. 2015;84:630-639.

Prior studies have shown that prescribing clinicians frequently override computerized alerts warning them of potentially harmful drug interactions. This study found that house staff and physicians with fewer patient encounters were more likely to ignore alerts—as were physicians who graduated from one of the top five medical schools in the United States. Understanding why clinicians override warnings is critical to combating alert fatigue.

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