computerized physician order entry (cpoe) and

Computerized Physician Order

Entry (CPOE) and Medication

Safety

Azmi Nor Mohd Farez bin Ahmat

B. Pharm (UKM), M. Clinical Pharmacy (UKM), BCPS.

CPOE?

……Is the process of a medical

professional entering medication

orders or other physician

instructions electronically

instead of on paper charts.

Institute of Medicine (IOM)

……E-prescribing is a subset of

full CPOE, with order entry

limited to prescribing.

HIS

Fisicien

Fisicien-LIS

InfinittNMIS

Mosaiq

CPOE in IKN

CPOE….where did they came from?

To Err is Human:

Building a Safer Health System

Human beings, in all lines of work, make

errors.

Errors can be prevented by designing systems

that make it hard for people to do the wrong

things and easy for people to do the right

thing.

In health care, building a safer system means

designing processes of care to ensure that

patient are safe from accidental injury. IOM, National Academy of Sciences, 2000.

To Err is Human..

Errors!

..approximately 200k people die every year in the US as a result of preventable medical errors.

..Medication errors are estimated to account forat least 7,000 deaths in the United States aloneevery year.

..Medication error is one of the most commoncauses of unintentional harm in Australia whichresults in an estimated 80,000 hospitaladmissions every year

Kohn et al. 1999. Institute of Medicine;

Federal Minister for Health and Ageing Australia, 9 September

2003

.. a 2013 Meta-analysis found that the likelihood of a

prescribing error was reduced by 48% when using CPOE compared with paper-based

orders.

..estimated 17.4million medication errors

averted in the USA in one year.

Why CPOE?

Radley et al. 2013. J. Am Med Inform Assoc.

.. A study done at a pediatrics hospital in Canada

showed a decrease by 40% in medication

error rates.

..identify 62% of potential

medication errors including drug-allergy

interactions, dosing limits and inappropriate

routes of administration.

Why CPOE?

Chaparro et al. 2016. J. Am Med Inform Assoc.

King et al. 2003. Pediatrics.

.. A study done at a pediatrics hospital in Canada

showed a decrease by 40% in

medication error rates.

…Mortality and LOS decreased in medical and

surgical ward.

Why CPOE?

Lyons et al. 2016. J. Am Med Inform Assoc.

King et al. 2003. Pediatrics.

.. A study done at a pediatrics hospital in Canada

showed a decrease by 40% in

medication error rates.

…Mortality and LOS decreased in medical and

surgical ward.

Why CPOE?

Lyons et al. 2016. J. Am Med Inform Assoc.

King et al. 2003. Pediatrics.

Improving both efficiency

and accuracy of orders… Reduce errors from poor handwriting.

Reduced Incorrect transcription

Reduced incomplete prescription

Allow direct transmittal of prescription to pharmacies.

..The majority of medical mistakes happen when the physician orders services and prescriptions for the patients.

..Physicians using a paper prescription pad often do not have legible handwriting, and prescriptions often not able to be read by the individuals who process and prepare them for the patient.

Charles et al, 2014. Perspectives in health information

management

…If the pharmacist is not able to read a

prescription handwritten by the physician, the

patient is at risk of ADEs.

…A CPOE may be the solution to decrease the

number of ADEs in a hospital, enhanced patient

safety and decrease preventable medical errors.

Charles et al, 2014. Perspectives in health information

management

Process In Which The Error Occur

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398

326

2

5 41

37

31

32

0

42 134

108

119

182

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Combination

Others

Administration

Dispensing

Prescribing

2009 2010 2011 2012 2013 2014

E-prescribing

..Remove abbreviations and acronyms and

increasing order speed through the used of E-

prescribing.

..Remove the need of transcribing.

..Remove in-complete prescription.

..Increased accessibility of patients medical

records.

E-prescribing

..Warning and alert system.

..Improved formulary adherence.

..Increased patient convenience by reducing waiting time.

..Provider mobility – can approved medication from any desktop.

…….Who want to try???

Electronic prescription..

Incomplete prescription..

Which one look batter??

PRN dosing..

Warning and alert systems

DUR- Patient current

drugs

- Interaction

- Drug allergy

- Diagnosis

- Body weight

- Age

- Drug

appropriateness

- Correct dosing

- Contraindications

- Duplicate orders

Overlapping medication..

Reduced duplicate orders

Overlapping investigation..

Dosage support

Adverse interaction

alerts

Clinical decision support

Dosage Support

Allergy alert..

Allergy alert..

But this only

can happen if

allergy history

are UPDATED!

Interaction alert…

..Alert system managed to prevent a large

number of inappropriate medication orders for

the older patient.Massachusetts Medical Centre. 2004

Clinical decision support..

Drug infusion

For Infusion Therapy

Drug infusion

For Infusion Therapy

THANK YOU…

Pusat Maklumat Ubat: 3434/3435

AE..

…The number of ADR/ADE decreased by

84%.

…If the pharmacist is not able to read a

prescription handwritten by the physician, the

patient is at risk of ADEs.

…A CPOE may be the solution to decrease the

number of ADEs in a hospital, enhanced patient

safety and decrease preventable medical errors. Charles et al, 2014. Perspectives in health information

management