Computerized Physician Order Entry (CPOE) Systems
Computerized Physician Order Entry (CPOE) Systems Reduce Medication Errors for Young Patients
In late 2003, the National Academies, the nation's advisers on science, engineering and medicine, released a report that strongly recommended healthcare organizations adopt information technology systems capable of collecting and sharing health information about patients and their care. For some organizations, the first step may involve computerized physician order entry (CPOE) systems, which are electronic prescribing systems that intercept errors when medications are ordered -- the time when errors most commonly occur.
The 1999 Institute of Medicine (IOM) report, To Err is Human, estimated 7,000 deaths occur from medication errors alone each year. According to the Washington, DC-based Leapfrog Group for Patient Safety, an initiative of corporations and public and private health benefit purchasers,more than a million serious medication errors occur each year in U.S. hospitals. Leapfrog estimates that computerizing prescriptions can reduce that number by 88 percent. First, because the doctor enters the prescription on the computer, handwriting errors and missed decimal points are a thing of the past. Also, a computerized system can automatically alert for past drug allergies, potential drug interactions with medications the patient is already taking, and incorrect dosing.
Case Study:
Children's Hospital of Pittsburgh (Children's) launched Children'sNet in October, 2002. Although it had already begun studying how to achieve a completely electronic patient record many years earlier, the IOM report and its recommendations helped the hospital determine where to start. Because age- and weight-appropriate dosage of medicine represents a special challenge to care for children, CPOE appeared to be the logical first step.
"We had no idea how much improvement to expect with regard to weight-related adverse drug events. We just wanted to see the needle move," said Sharon Yeager, a member of Children's CPOE implementation team.
Children's hoped CPOE would help them in other areas as well. Healthcare regulatory bodies often require compliance with specific standards in order for the institution to reach certain benchmarks. Children's was challenged to reach compliance with these goals:
- Verbal orders had to be co-signed by physicians within 24 hours
- Respiratory therapists had to complete documentation in the patient's record
- Physicians had to order nutrition screens
Children's built these into its CPOE so that the system would prompt physicians or allied health professionals to address these concerns on the spot. Finally, physician surveys at Children's showed that the doctors were not happy with turn-around times for lab and diagnostic tests.
The CPOE system at Children's consists of wireless computers on mobile carts that can travel on rounds with the physician. Doctors can show parents lab or diagnostic test results at the child's bedside, because a charting function easily enables doctors to graph progress. Of course, the calculator tool helps obtain a clear weight/dosing picture, and its warning system provides an alert if a dose seems out of line, based on predetermined standards.
In addition to the mobile computers, each floor also accommodates four wall computers and, where possible, additional desktop computers. These provide ample opportunity for allied health professionals to complete their charts as well.
Two-Year Results:
Having completed its second year with CPOE, Children's has eradicated handwriting transcription errors completely and cut harmful medication errors by 75 percent. By electronically requiring that a child's weight be entered before a medication order may be placed, Children's virtually eliminated weight-related adverse drug events. On the compliance issues, Children's saw a significant improvement: both physician sign-off of verbal orders within 24 hours and documentation by respiratory therapists have reached the 97 percent level. Physicians are now ordering nutrition screens 90 percent of the time, and a post-CPOE survey showed that physician satisfaction with response times for lab and diagnostic test results is dramatically better.
Improving patient safety was Children's primary goal, but the hospital staff soon learned that patients benefit in a variety of ways. Clinicians are redirecting time previously spent on administrative tasks to patient care. They have instantaneous and reliable access to information that enables better patient care, including lab tests, imaging results and drug information. By enhancing the ability to provide better care, Children's has created a safer environment for its young patients.
|