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PubMed2004

Using BPI and emerging technology to improve patient safety.

Capitalizing on existing IT investments, INTEGRIS Health, a 15-hospital system in Oklahoma, is applying business process integration (BPI) methodology and technology to leverage legacy systems and staff resources. The resulting project uses manual (human) and system tasks to compare real-time information across systems to eliminate preventable adverse drug events caused by medication ordering errors. Clinicians can quickly see where potential safety risks are occurring and change medication orders to prevent harm to the patient.

Clinical Pharmacy Information Systems↗
PubMed2004

Immediate steps toward patient safety.

Patient safety should be a fundamental element in any hospital's philosophy, mission, and vision. Use of barcode point-of-care technology (BPOC) to reduce medication errors is a patient-safety approach that hospitals can implement within a short time frame and obtain immediate benefits. Advantages of BPOC are that it is intuitive, cost-effective, and conducive to improved patient satisfaction.

California↗
PubMed2004

Implementation and initial evaluation of a Web-based nurse order entry system for multidrug-resistant tuberculosis patients in Peru.

Socios En Salud uses directly observed therapy to treat a majority of the multidrug-resistant tuberculosis in Peru. The nurses play an important role in this community-based model as the patients' primary care givers. Since nurses, rather than physicians, are involved in patients' daily care, we developed a nurse-order entry system to test whether such a system would improve the accuracy and quality of medication data. We compared regimen information from patient electronic medical records, paper charts and pharmacy records. After a two-month training period on the new system, we conducted the trial for 52 days in two of Lima's six geographic treatment areas, and re-reviewed the three sources of medication data. We measured the error rates after the trial period and found there was no significant difference in the control group's (Lima Este), error rate (8.6% vs. 6.9%, P=0.66) after the trial. The intervention group (Lima Callao), however, showed a significant drop in the error rate (17.4% vs. 3.1%, P=0.0074) after the same time interval. Additionally, the nurse expressed satisfaction with the order entry system and its ease of use. The decrease in error rates and user satisfaction regarding the system are promising measures of our order entry system's success.

Antitubercular Agents↗
PubMed2004

VA National Drug File Reference Terminology: a cross-institutional content coverage study.

BACKGROUND: Content coverage studies provide valuable information to potential users of terminologies. We detail the VA National Drug File Reference Terminology's (NDF-RT) ability to represent dictated medication list phrases from the Mayo Clinic. NDF-RT is a description logic-based resource created to support clinical operations at one of the largest healthcare providers in the US. METHODS: Medication list phrases were extracted from dictated patient notes from the Mayo Clinic. Algorithmic mappings to NDF-RT using the SmartAccess Vocabulary Server (SAVS) were presented to two non-VA physicians. The physicians used a terminology browser to determine the accuracy of the algorithmic mapping and the content coverage of NDF-RT. RESULTS: The 509 extracted documents on 300 patients contained 847 medication concepts in medication lists. NDF-RT covered 97.8% of concepts. Of the 18 phrases that NDF-RT did not represent, 10 were for OTC's and food supplements, 5 were for prescription medications, and 3 were missing synonyms. The SAVS engine properly mapped 773 of 810 phrases with an overall sensitivity (precision) was 95.4% and positive predictive value (recall) of 99.9%. CONCLUSIONS: This study demonstrates that NDF-RT has more general utility than its initial design parameters dictated

Abstracting and Indexing↗
PubMed2004

A usability study of CPOE's medication administration functions: impact on physician-nurse cooperation.

Implementation of CPOE systems in Healthcare Institutions has proven efficient in reducing medication errors but it also induces hidden side-effects on Doctor-Nurse cooperation. We propose a usability engineering approach to this problem. An extensive activity analysis of the medication ordering and administration process was performed in several departments of 3 different hospitals. Two of these hospitals are still using paper-based orders, while the 3rd one is in the roll-out phase of medication functions of its CPOE system. We performed a usability assessment of this CPOE system. The usability assessment uncovered usability problems for the entry of medication administration time scheduling by the physician and revealed that the information can be ambiguous for the nurse. The comparison of cooperation models in both situation shows that users tend to adopt a distributed decision making paradigm in the paper-based situation, while the CPOE system supports a centralized decision making process. This analysis can support recommendation for the re-engineering of the Human-Computer Interface.

Attitude of Health Personnel↗
PubMed2004

Computer-based drug ordering: evaluation of interaction with a decision-support system.

Provider order entry systems (POE) often incorporate active decision-support component for drug dosing. The efficacy of automated alerts that suggest dose amounts to the clinician in real time depends in part on how well they are timed to fit into the decision process and on their representational structure. We have conducted a cognitive evaluation of an interaction with a POE system that offered active decision support for heparin dosing with the goal of characterizing its effectiveness and opportunities for error. Two researchers completed a cognitive walk-through of an ordering task based on a clinical scenario. In addition, seven clinicians were asked to enter a set of orders in an experiment using the same scenario. The analysis revealed that users without a solid conceptual knowledge of the ordering system followed patterns of inefficient interactive behavior resulting in delays and some errors. Physicians often did not take full advantage of automatic dose computation provided by a decision support component and used it largely as reference. The calculated dose was not perceptually salient in the generated alert and required users to engage in meaning interpretation of the displayed information. Better visual presentation of the alert message would likely result in faster and less cognitively demanding interaction.

Anticoagulants↗
PubMed2004

Differing faculty and housestaff acceptance of an electronic health record one year after implementation.

In order to determine whether differences exist between housestaff and faculty physician acceptance of an electronic health record system, we conducted a written survey of attitudes towards new electronic medical record at the University of Illinois at Chicago. We surveyed 330 faculty and housestaff physicians. User acceptance of the EHR was high for both faculty physicians and housestaff. 88.0% of the housestaff and 64.7% of the faculty preferred the EHR over a paper record. Although both housestaff and faculty acceptance of an EHR was high, housestaff showed greater approval ratings than faculty. Central to acceptance of an EHR is conservation of physician time including improving system speed, reducing time spent waiting for a computer to become available, and minimizing time spent documenting care

Attitude of Health Personnel↗