domingo, 7 de abril de 2013

Indication-based prescribing prevents ... [J Am Med Inform Assoc. 2013] - PubMed - NCBI

Indication-based prescribing prevents ... [J Am Med Inform Assoc. 2013] - PubMed - NCBI

Study Finds Indication-Based Prescribing Prevents Errors, Keeps Problem Lists Current

Requiring a clinician to link medication orders to patients’ health problems prevents wrong orders and keeps problem lists up to date, according to a study supported by AHRQ. Researchers at the University of Illinois implemented a computerized provider order entry system that required the clinician placing the order to link the medicine to an indication in the patient’s problem list. The purpose of this requirement was to help ensure that orders were being placed for the correct patient by cross-referencing the main reasons that a medication is normally prescribed with the patient’s identified health problems. If no matching problem was found in the medical record, the prescriber saw an alert and was prompted to enter the condition. Over a 6-year period, researchers found an interception rate of one wrong-patient order per 4,000 electronic alerts. In 59 percent of the intercepted errors, the prescriber had more than one chart open when they started the medication order. The study, “Indication-Based Prescribing Prevents Wrong Patient Medication Errors in Computerized Provider Order Entry,” appeared in the March issue of the Journal of the American Medical Informatics Association. Select to access the abstract on PubMed.®
2013 Feb 9. [Epub ahead of print]

Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE).


Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.



To determine whether indication-based computer order entry alerts intercept wrong-patient medication errors.


At an academic medical center serving inpatients and outpatients, we developed and implemented a clinical decision support system to prompt clinicians for indications when certain medications were ordered without an appropriately coded indication on the problem list. Among all the alerts that fired, we identified every instance when a medication order was started but not completed and, within a fixed time interval, the same prescriber placed an order for the same medication for a different patient. We closely reviewed each of these instances to determine whether they were likely to have been intercepted errors.


Over a 6-year period 127 320 alerts fired, which resulted in 32 intercepted wrong-patient errors, an interception rate of 0.25 per 1000 alerts. Neither the location of the prescriber nor the type of prescriber affected the interception rate. No intercepted errors were for patients with the same last name, but in 59% of the intercepted errors the prescriber had both patients' charts open when the first order was initiated.


Indication alerts linked to the problem list have previously been shown to improve problem list completion. This analysis demonstrates another benefit, the interception of wrong-patient medication errors.


Indication-based alerts yielded a wrong-patient medication error interception rate of 0.25 per 1000 alerts. These alerts could be implemented independently or in combination with other strategies to decrease wrong-patient medication errors.

[PubMed - as supplied by publisher]

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