|
ICU study finds overall decline in errors with CPOE
Story originally published March 3, 2006
In a side-by-side competition between computers and paper at a Belgian hospital intensive-care unit, doctors using a computerized physician order-entry system achieved medication error rates nearly eight times lower than when they used a paper-based system, but, the doctors still needed to tweak the CPOE system after it introduced its own unique forms of errors and precipitated a handful of potential adverse drug events, according to a nine-page report published online by Critical Care, an international peer-reviewed clinical medical journal.
The research was conducted by physicians and pharmacists at Ghent University Hospital in Belgium, where its 22-bed ICU was divided into three parts, an eight-bed section in which a clinical IT system, including CPOE, had been in use for about 10 months before the study began, and two other sections of eight and six beds that were still using paper-based record-keeping and ordering systems. The comparisons of the two systems took place over a five-week period in March and April 2004 before the two paper-using sections of the ICU were switched over to the computerized system.
Five senior intensivists and three residents rotated through the three units during the test period, generally working one-week shifts in each unit. The physicians and nursing staff were unaware of the study while their work was being analyzed. Researchers evaluated 2,510 randomly selected prescriptions from the ICU during the period; 1,286 in the computerized section; and 1,224 from the paper-based sections.
An independent pharmacist initially reviewed all the prescriptions and recorded possible medication prescribing errors, or MPEs, which were identified within 24 hours of occurrence. Then an independent panel made up of a second pharmacist and two physician intensivists evaluated the errors for severity and placed them in one of three categories: minor MPEs, which presented no potential harm to the patient; intercepted MPEs, which had the potential to cause harm but were intercepted; and serious MPEs, a group that included errors that were not intercepted and had the potential of causing harm and errors prompting adverse drug events, or ADEs, which did cause patient harm.
"Implementing CPOE with a moderate level of (computerized decision support) showed a significant reduction in incidence and severity of MPEs, and significance found through all levels of severity," the researchers concluded. "Furthermore, evaluation of the CPOE enabled us to identify newly introduced problems, and gave us the opportunity to take corrective actions."
Researchers documented 44 errors in the ICU section where IT/CPOE was deployed for an error rate of 3.4% compared with 331 errors in the sections with a paper-based order system and an error rate of 27%.
The CPOE system was most effective in reducing minor errors. Researchers found just nine minor errors in the IT-enabled section for an error rate of 0.7%, compared with 225 minor errors in the paper-using units and a rate of 18%.
There were 21 nonintercepted potential adverse drug events (1.6%) and two actual ADEs (0.15%) in the IT-enabled sections compared with 48 nonintercepted potential ADEs (3.9%) and 12 actual ADEs (1.0%) in the paper-based sections.
According to the researchers, "Dosing errors were the most frequent type of errors in both groups, followed by double-prescription and drug monitoring errors in the (computerized section). These types of errors did not occur in the (paper-use section), meaning they were caused by the CPOE system itself."
"All double prescription errors, in both groups, were minor or intercepted MPEs, whereas the drug monitoring errors were also classified as nonintercepted potential ADEs," their report said.
"The two ADEs that occurred in the (IT-enabled section) involved an antibiotic overdose (level 2, error occurred, resulted in increased patient monitoring, but no harm) and a vasopressin infusion overdose causing cardiac ischemia (level 3.5, error occurred with temporary harm, needing treatment or intervention)," the report said, referring to severity levels on the scale developed by the National Coordinating Council for Medication Error Reporting and Prevention. Both IT-section ADEs "could not have been avoided by our current CPOE," according to the report.
For CPOE-induced errors, researchers concluded that, "By performing this study, we identified problems with the CPOE system and were able to correct them."
The IT system used by the hospital was Centricity Critical Care Clinisoft by GE Healthcare, according to the reports. See the full report.
Full Article URL : http://ccforum.com/content/10/1/R21
---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] |
_______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
