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Improving Medication Prescribing Through Computerized Physician Order Entry

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.

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Improving Medication Prescribing Through Computerized Physician Order Entry

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  1. 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

  2. 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.

  3. CLINICAL SIGNIFICANCE MEDICATION ORDER ISSUES OF PHARMACY INTERVENTIONS (CY00) REQUIRING PHARMACIST INTERVENTION (CY00) 2,000 2,000 1,800 1,800 1,600 1,600 1,400 1,400 1,200 1,200 Total Pharmacy Interventions Total Pharmacy Interventions 1,000 1,000 800 800 600 600 400 400 200 200 0 0 Prescribing Prescribing/ Transcribing MAJOR MEDIUM MINOR Transcribing Identification of Most Likely Causes for Pharmacist Interventions Approximately 92% of medication issues identified by pharmacists have the potential for significant clinical consequences. More than 90% of pharmacy interventions relate to prescribing and transcribing issues.

  4. 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

  5. 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

  6. 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.  

  7. Before Implementation Pilot Unit Implementation House-wide Implementation 300 250 200 184 Pharmacy Interventions 150 150 105 100 50 0 Apr-00 Jun-00 Oct-00 Apr-01 Jun-01 Oct-01 Apr-02 Jun-02 Oct-02 Feb-00 Aug-00 Dec-00 Feb-01 Aug-01 Dec-01 Feb-02 Aug-02 Dec-02 Feb-03 Prescription Related Medication Issues

  8. Before Implementation Pilot Unit Implementation House-wide Implementation 150 100 72 56 Pharmacy Interventions 50 4 0 Apr-00 Jun-00 Oct-00 Apr-01 Jun-01 Oct-01 Apr-02 Jun-02 Oct-02 Feb-00 Aug-00 Dec-00 Feb-01 Aug-01 Dec-01 Feb-02 Aug-02 Dec-02 Feb-03 Transcription Related Medication Issues Computerized Physician Order Entry reduced the number of medication issues related to transcribing of medication orders by 98%.

  9. 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.

  10. 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.

  11. 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

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