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Search results for "United States of America"

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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 > Study

Automated detection of look-alike/sound-alike medication errors.

Rash-Foanio C, Galanter W, Bryson M, et al. Am J Health Syst Pharm. 2017;74:521-527.

Look-alike and sound-alike medications increase the risk of adverse drug events. This retrospective study found that look-alike and sound-alike medications can be identified in an automated fashion by comparing a medication and its known look-alike and sound-alike medications to diagnostic codes at the point of computerized provider order entry. This is a promising strategy for preventing this type of prescribing error.

Journal Article > Study

Learning from errors: analysis of medication order voiding in CPOE systems.

Kannampallil TG, Abraham J, Solotskaya A, et al. J Am Med Inform Assoc. 2017 Feb 17; [Epub ahead of print].

Although computerized provider order entry has been found to prevent some medication errors, simulation studies have also demonstrated that electronic prescribing platforms can introduce or fail to prevent medication errors. This retrospective electronic health record analysis examined medication orders that were canceled. Weekend and overnight orders were less likely to be voided than weekday or daytime orders. Pharmacist, nurse, and student orders were more likely to be canceled than physician orders. Comparing the clinician-provided reason for voiding an order with the more comprehensive information in the medical record, physicians found that clinicians' reported reasons for voiding orders were largely inaccurate. The authors suggest there is unrealized potential to characterize medication ordering errors using voided-order data.

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

Pediatric medication safety in adult community hospital settings: a glimpse into nationwide practice.

Alvarez F, Ismail L, Markowsky A. Hosp Pediatr. 2016;6:744-749.

This survey study found that most pediatric hospitalist programs use computerized provider order entry with weight-based medication dosing, review medication safety events and near misses, require weight-based prescribing, and have maximum doses in place. Larger hospitals are more likely to have a pediatric pharmacist. Variation in medication safety practices suggests that best practices remain incompletely implemented.

Journal Article > Study

The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy.

Battis B, Clifford L, Huq M, Pejoro E, Mambourg S. J Oncol Pharm Pract. 2016 Oct 12; [Epub ahead of print].

Oral chemotherapy regimens are complex and may lead to severe adverse drug events. In this pilot study, nearly half of patients enrolled in a pharmacist-run oral chemotherapy monitoring clinic experienced a medication-related problem. This finding is consistent with prior studies that demonstrated pharmacist oversight improves safety of oral chemotherapy.

Journal Article > Study

Computerized prescriber order entry–related patient safety reports: analysis of 2522 medication errors.

Amato MG, Salazar A, Hickman TT, et al. J Am Med Inform Assoc. 2017;24:316-322.

Computerized provider order entry (CPOE) systems can effectively prevent many prescribing errors, but their overall safety benefit has not yet been fully realized. More widespread implementation of these systems has revealed new safety concerns. A prior study funded by the US Food and Drug Administration found that many of the safety issues associated with CPOE could be ascribed to poor usability of the systems, the lack of interoperability, and failure to track and learn from concerns identified by users. This follow-up study analyzed more than 1300 CPOE error reports to further classify the types of errors and their impact on patient care. Investigators determined that patients experienced delays in receiving medications due to these errors and were at risk of receiving duplicate medications or incorrect doses of medications. Similar to previous studies, the most common types of CPOE errors included problems with transmitting orders to the correct site of care, incorrect dose, or duplicate orders that were not detected by the system. A WebM&M commentary discussed an error that led to patient harm due to an incorrect default CPOE order.

Newspaper/Magazine Article

Prescribing errors that cause harm.

Rider BB, Gaunt MJ, Grissinger M. PA-PSRS Patient Saf Advis. September 2016;13:81-91.

Prescribing errors can have harmful results. Analyzing prescribing error reports submitted over a 12- year period, this article recommends strategies to reduce risks associated with prescribing, including use of computerized provider order entry systems and standard order sets.

Journal Article > Review

Effects of health information technology on patient outcomes: a systematic review.

  • Classic

Brenner SK, Kaushal R, Grinspan Z, et al. J Am Med Inform Assoc. 2016;23:1016-1036.

Health information technology (IT) has had a profound impact on health care. Although health IT has led to efficiency gains and improved safety, unintended consequences remain a concern. In this systematic review, researchers analyzed 69 studies from 2001 through 2012 that examined the use of health IT in a clinical setting and its effect on safety outcomes for patients. About one-third of the studies demonstrated a positive impact of health IT on patient safety outcomes, but many of these focused on the hospital setting, involved a single institution, and looked at decision support or computerized provider order entry. The authors suggest that future studies should focus on other areas in which the impact of health IT remains understudied, such as in outpatient and long-term care settings, and they underscore the need for higher quality research. A recent WebM&M commentary described the unintended consequences of health IT.

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 systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care.

Brown CL, Mulcaster HL, Triffitt KL, et al. J Am Med Inform Assoc. 2017;24:432-440.

The use of computerized provider order entry (CPOE) systems, in which clinicians place orders for tests, labs, and medications electronically, has grown rapidly in both inpatient and outpatient settings. Although research has shown that implementation of CPOE can reduce prescribing errors in both inpatient and outpatient settings, additional studies have found that errors continue to occur. In this systematic review, researchers identified multiple factors linked to CPOE prescribing errors, including flaws in functional design and underlying clinical decision support systems, as well as insufficient system flexibility leading to user workarounds. The authors suggest that further consideration must be given to human factors design principles. A recent Annual Perspective highlighted some of the ongoing challenges associated with CPOE.

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 > Commentary

Using computerized prescriber order entry to limit overrides from automated dispensing cabinets.

Drake E, Srinivas P, Trujillo T. Am J Health Syst Pharm. 2016;73:1033-1035.

Automated dispensing cabinets have been adopted in hospitals to enhance medication safety. These drug dispensing systems enable override functions so that nurses can access medications without pharmacist verification to ensure timeliness, but this workaround requires a reliable process to reduce the potential for errors. This commentary discusses how one hospital designed an oversight process using computerized provider order entry to increase the safety of this practice.

Journal Article > Study

Ambulatory computerized prescribing and preventable adverse drug events.

Overhage JM, Gandhi TK, Hope C, et al. J Patient Saf. 2016;12:69-74.

Adverse drug events (ADEs) are a common source of patient harm in the ambulatory setting. A substantial proportion of ADEs are caused by preventable errors in medication prescribing or monitoring. The introduction of computerized provider order entry (CPOE) has been shown to reduce the rate of medical errors in the inpatient setting. This before–after study examined rates of ADEs in primary care practices that implemented a CPOE system in Boston and Indianapolis. At baseline, the potential ADE rate was more than seven-fold greater in Indianapolis compared to Boston. Following CPOE implementation, this rate decreased by 56% in Indianapolis but increased by 104% in Boston, and there was no change overall in preventable ADEs. A recent PSNet annual perspective reviewed the relationship and current evidence linking CPOE and patient safety.

Web Resource > Government Resource

Attacking the Opioid Crisis Head On With Health IT.

Office of the National Coordinator for Health Information Technology.

Overdoses of opioid medications are considered an epidemic in the United States. This website provides access to various resources for hospitals and clinicians to help them address this patient safety concern. Sections include guidelines, clinical decision support, electronic prescribing, and prescription drug monitoring programs.

Newspaper/Magazine Article

Hardwiring safety into the computer system: one hospital's actions to provide technology support for U-500 insulin.

ISMP Medication Safety Alert! Acute Care Edition. May 5, 2016;21:1-4.

Insulin is a high-alert drug, and its use is becoming more complex due to the insulin resistance in diabetic patients with obesity. This newsletter article describes the experience of one hospital system that worked to ensure safe insulin administration by implementing a strategy that combined single-use pens and health information technology.

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

A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement.

  • Classic

Slight SP, Beeler PE, Seger DL, et al. BMJ Qual Saf. BMJ Qual Saf 2017;26:217-225.

Clinical decision support systems are intended to improve safety by providing clinicians with information about potential harms—principally harmful drug interactions and allergies—at the point of care. Analyzing more than 150,000 drug allergy warnings in the inpatient and outpatient settings within a single health care system, this study examined how often the warnings were overridden and the appropriateness of prescribers' reasons for doing so. Clinicians overrode 81% of warnings in hospitalized patients and 77% of alerts in outpatients. More than 96% of the overrides were judged appropriate by independent clinical reviewers. These proportions are similar to prior studies. A common appropriate reason for overriding was that the patient had actually tolerated the drug in question, leading the authors to call for improving the accuracy of allergy documentation in electronic medical records. A few classes of drugs accounted for a large proportion of overridden alerts, suggesting that enhancing the accuracy of allergy warnings for these drugs could significantly reduce the overall burden of alerts. Given that alert fatigue is an increasingly recognized patient safety hazard, creating tailored alerts could help clinical decision support systems achieve their potential to improve safety.

Journal Article > Study

Displaying radiation exposure and cost information at order entry for outpatient diagnostic imaging: a strategy to inform clinician ordering.

Kruger JF, Chen AH, Rybkin A, et al. BMJ Qual Saf. 2016;25:977-985.

Medical imaging overuse is associated with increased rates of cancer related to radiation exposure. Researchers found that displaying radiation exposure and cost information to clinicians ordering radiologic studies may affect their decision to request diagnostic imaging and raise clinician awareness around radiation risks and study costs.

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