Clinical Decision Support for Use in a CPOE System - Coursework Example

? RUNNING HEADING: Developing and implementing clinical decision support for use in a CPOE system School Total Word Count(Excluding Headings, Subheading, In-text citations, References): 1,250 Developing and implementing clinical decision support for use in a CPOE system SUMMARY This is concerned with the implementation of a CPOE system in a 900-bedded urban tertiary care hospital in the US, so as to improve patient safety, reduce medical errors, improve cost efficiency and promote a paperless-system. The main aim would be to replace the paper system that would fill with errors during transcription and placing orders for drugs. A computerized system would enable further checks and studying evidences. Healthcare professionals can utilize various tools whilst placing orders. In the past, medication errors have been troubling the organization, and this would be a step towards improvement with quality, patient safety, cost-effectiveness, and greater efficiency. The system selected should be user-friendly and involve training and creating awareness before implementing it. The organization should be spending on the implementation, and once the system is stabilized, should further consider upgrading the system. INTRODUCTION OF THE PROBLEM/ANALYSIS The hospital proposed to implement the CPOE system in a 750-bedded tertiary care hospital that has specialty and super-specialty services. The hospital has been providing medical and nursing care to people since the last 25 years, and has been accredited by the JCAHO. The management and owners of the hospital has been changing hands several time, but the overall focus of the hospital has been on quality care, patient safety initiatives and using technology. The CPPE implementation project has the objective of ensuring patient safety by changing prescribing and administration of medication orders from the handwritten-based or manual processes to the computerised and paperless computerized physician order entry (CPOE) system. As the chances of medication error would be reduced through lesser problems during transcription and using system checks, the patient safety would be improved. Leapfrog Group in 2004, first suggested the use of the electronic prescription system, as the human factors for error are effectively prevented or reduced (The Leapfrog Group, 2011). The aim of this project would be to transform the current manual prescriptions to an electronic format, but the same would be faced with a lot of challenges and resistance from the specialists and practitioners of the hospital (Kopec, 2001). To overcome these problems, it is proposed to develop the program in coordination with the physicians and specialists, conduct extensive training and awareness programs, procure all resources and support system vital to the functioning of the system, and resolve all issues at hand so that the implementation goes on smoothly. The management also proposes to incrementally implement upgrades and system advancements (Metzger, 2001). There is a major problem occurring in the US Healthcare system. It is found that 60% of the errors that occur by the physician in fact can be prevented by having computerised processes and system checks (Maganelli, 2009). In this hospital, in the past medication errors have been plaguing the system mainly because, the hostile follows a manual system without any system checks to identify and prevent medication errors. Most drugs that are administered during prescription are actually for benefiting the patient, but unintentional errors can cause adverse events for the patient (Dixon, 2009). On the advice of the IOM, many hospitals have converted to computerised systems for order placement so that health technologies can help remove errors (Virginia Board of Health Professionals, 2010). The CPOE system can also help improve the efficiencies concerned with medication administration (Dixon, 2009). With this application, the healthcare provider can place orders for medications either in an inpatient or outpatient setting. It effectively replaces the paper-based or oral-based system for prescribing the drugs (Magnelli, 2009). The CPOE System can also be utilised for other purposes such as placing laboratory tests, dietary orders, X-rays and CT scans, referring the patients to the specialists, etc. Currently, it is not required to have an advanced system, as the organisation can implement the same in increments, but currently, the needs is to have a legible and evidence-based system to enable proper decision making in the hospital and permit feedback and promote cross-checking of the details on the patient electronic medical records. The CPOE system would also contain various logic modules, rules, formulae, algorithms, etc, that can enable screening and prevention of errors. The user would be alerted when there are chances of any error such as wrong dosage, indicating a drug when the patient’s condition actually contra-indicates the same, drug-drug interactions, improper dosage, etc (Dixon, 2009). Error with drugs can occur at various processes including administration of drugs, interventions and procedures, using Systems, Prescription, Placement of orders, Bar code Labeling, Packaging the medications (Maganelli, 2009), Dispensing of drugs, using Drug Nomenclature System, distribution & transferring, Education and patient awareness and using and monitoring drug administration (Patel, 2004) There are good chances that the CPOE system would improve the quality of care, patient safety, help the physicians and nurses to function effectively and also bring about a cost saving. Besides, the level of monitoring, compliance would be higher (MHA, 1999). About 5% of the hospitals in the US have CPOE systems, and about 50% of the physicians actually use the same. It may take the hospital about 20 years to get fully used to the CPOE (Dixon, 2009). IMPLEMENTATION 60% of the errors have occurred by physicians and other healthcare professionals in the US, and most of them can be prevented if an EMR or CPOE system is utilized properly (Magnelli, 2009). 80% of all patients who visit the hospital get a prescription, and about 30% receive 5 or more drugs, and here the chances of medical error is higher (Virginia Board of Health Professionals, 2010). Drugs are given for the benefit of the patient, and in some instances may not actually cause any harm. However, unintentional medication error during administration, consumption or pattern of administration can cause adverse effects, which to a larger extent are preventable (Dixon, 2009). The IOM has recommended the use of improved processes and health information technologies to reduce medical error that would replace the manual system (Virginia Board of Health Professionals, 2010). The CPOE system can significantly reduce the medication error and improve the efficiency of the ordering processes in the hospital (Dixon, 2009). IT can be used effectively in both inpatient and outpatient settings and replace the oral or paper based ordering systems (Magnelli, 2009). They can be used for various processes including prescribing drugs, orders, referral for specialists, placing special dietary requests, requesting laboratory tests, ordering X-rays and CT scan, and ordering various other procedures or treatment protocols. Different issues would be taken care of by the CPOE s including drug interactions, drug allergies, medical contraindications (from medical conditions), dosing rules and the physician would be alerted about the same (Dixon, 2009). PROPOSED SOLUTIONS The solution for the Hospital is to implement a CPOE system with the following objectives. The system should help reduce medical errors as errors are a part of human behavior and having a computerized system in place would help to effectively cover this deficit. The workflows should be further modified so that an effective CPOE-driven system is present in the hospital. Prescriptions and drug ordering protocols would be implemented that are more legible ensure accurate dosing, system and double checks, minimizing adverse drug events. A database would be created to handle the information and would be used by the clinical staff, pharmacy and administrative staff. The medical errors noted would be used as a guide for future learning by the other staff of the hospital. Wherever possible, manual systems would be removed and machines would be used to perform calculation, measuring, preparing, labeling and dispensing more accurately, faster and without errors. High-risk patients or transactions involving high-risk drugs would effectively be handled by having an extra level of precautions, such as double system checks at all levels (Mac, 2009). Physicians and nurses would be able to access evidence-based information in the form of guidelines, protocols and recommendations and this would highly improve the quality of care. Besides, cost-effectiveness would be ensured through faster transmission of lab tests and results, using cheaper generic substitutes, faster decision making, prevention of duplicates, and removal of redundancies (Doolan and Bates, 2002). BIBLIOGRAPHY Dixon, B. E. (2009). “Inpatient Computerized Provider Order Entry (CPOE) Findings from the AHRQ Health IT Portfolio.” Retrieved on February 27, 2012, from Web http://healthit.ahrq.gov/images/jan09cpoereport/cpoe_issue_paper.htm Doolan, D. F. & Bates, D. W. (2002). “CPOE Entry Systems in Hospital: Mandates and Incentives.” Health Affairs, 21(4): 180-188. http://www.healthaffairs.org/CMWF/Doolan.pdf Kopec, D. (2007). “The State of the Art in the Reduction of Medical Errors.” CUNY. http://www.sci.brooklyn.cuny.edu/~kopec/Publications/Publications/R_28_M.pdf Manganelli, J. (2009). “Preventing Medication Errors.” Retrieved on February 27, 2012, from Web http://www.bapainfo.org/html/documents/med-errors.ppt Massachusetts Coalition for the Prevention of Medical Errors (2006). “MHA Best Practice Recommendations to Reduce Medication Errors.” Retrieved on February 27, 2012, from Web http://www.macoalition.org/documents/Best_Practice_Medication_Errors.pdf Metzger, J. & Turisco, F. (2004). “Computerized Physician Order Entry: A Look at the Vendor Marketplace and Getting Started.” Retrieved on February 27, 2012, from Web http://www.premierinc.com/quality-safety/tools-services/safety/safety-share/01-02_downloads/Leapfrog-VendorMktGuide.pdf Patel, R. B. (2004). “Reduction in Medication Errors in Hospitals.” CWRU. http://www.cwru.edu/med/epidbio/mphp439/Reduction%20in%20Medication%20Errors%20in%20Hospitals.htm The Leapfrog Group (2011). “Leapfrog CPOE Evaluation Tool.” Retrieved on February 27, 2012, from Web https://www.leapfroghospitalsurvey.org/cpoe/index.asp Read More