computerized physician order entry (cpoe) and
TRANSCRIPT
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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2
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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