Comprehensive evaluation of using computerised provider order-entry system for hospital discharge orders.

Hospitals Humans Medical Order Entry Systems Medication Errors / prevention & control Patient Discharge Prospective Studies
Computerised provider order-entry system Discharge order Electronic Health Record Patient discharge summary Prescribing errors

Journal

International journal of medical informatics
ISSN: 1872-8243
Titre abrégé: Int J Med Inform
Pays: Ireland
ID NLM: 9711057

Informations de publication

Date de publication:
04 2022
Historique:
received: 01 04 2021
revised: 15 09 2021
accepted: 18 01 2022
pubmed: 7 2 2022
medline: 5 4 2022
entrez: 6 2 2022
Statut: ppublish

Résumé

Computerised prescriptions for Hospital Discharge Orders (HDO) are used world-wide to secure medication processes. To evaluate physicians' adoption of computerised provider order-entry (CPOE) for HDO and the prescribing error rate of HDO in an acute medical care unit. A prospective study was conducted in an internal medicine department over a six-month period. The use rate of CPOE for HDO edition, prescription lines concordance between CPOE-edited HDO, exit prescriptions transcribed in the discharge summary (DS), and prescribing error rate in CPOE-edited HDO were all evaluated. A total of 407 patients with HDO were included in the study. HDO were edited via CPOE system for 350 patients (86%), among which 124 (35%) were identically transcribed, 217 (62%) had discrepancies, and nine (3%) were not transcribed in the discharge summary (DS). Prescription errors were analysed using the total of 2,854 drugs prescribed on HDO. Although hospital pharmacists had signalled discrepancies and provided recommendations to the prescribers via alerting pharmaceutical interventions in CPOE 67 prescription errors (error rate of 2.3%) were found. Errors included 53 cases of refractory period disrespected, four cases of drug interactions, three cases of drug redundancies, and two cases of excessive dosage. This study highlights that most HDO were edited via the CPOE system. Together with pharmacist's interventions, the CPOE system contributed to reducing the prescription error rate in HDO. However, discrepancies in the recording process to DS were frequent, calling for reinforcement of error prevention strategies upon the integration of a CPOE system in the hospital's Electronic Health Records. Providing regular training for physicians is also a requirement.

Sections du résumé

BACKGROUND
Computerised prescriptions for Hospital Discharge Orders (HDO) are used world-wide to secure medication processes.
OBJECTIVES
To evaluate physicians' adoption of computerised provider order-entry (CPOE) for HDO and the prescribing error rate of HDO in an acute medical care unit.
SETTING
A prospective study was conducted in an internal medicine department over a six-month period. The use rate of CPOE for HDO edition, prescription lines concordance between CPOE-edited HDO, exit prescriptions transcribed in the discharge summary (DS), and prescribing error rate in CPOE-edited HDO were all evaluated.
RESULTS
A total of 407 patients with HDO were included in the study. HDO were edited via CPOE system for 350 patients (86%), among which 124 (35%) were identically transcribed, 217 (62%) had discrepancies, and nine (3%) were not transcribed in the discharge summary (DS). Prescription errors were analysed using the total of 2,854 drugs prescribed on HDO. Although hospital pharmacists had signalled discrepancies and provided recommendations to the prescribers via alerting pharmaceutical interventions in CPOE 67 prescription errors (error rate of 2.3%) were found. Errors included 53 cases of refractory period disrespected, four cases of drug interactions, three cases of drug redundancies, and two cases of excessive dosage.
CONCLUSION
This study highlights that most HDO were edited via the CPOE system. Together with pharmacist's interventions, the CPOE system contributed to reducing the prescription error rate in HDO. However, discrepancies in the recording process to DS were frequent, calling for reinforcement of error prevention strategies upon the integration of a CPOE system in the hospital's Electronic Health Records. Providing regular training for physicians is also a requirement.

Identifiants

DOI: 10.1016/j.ijmedinf.2022.104703 PMID: 35124391
pubmed: 35124391
pii: S1386-5056(22)00017-X
doi: 10.1016/j.ijmedinf.2022.104703
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

104703

Informations de copyright

Copyright © 2022 Elsevier B.V. All rights reserved.

Auteurs

N Colombini (N)

Pharmacy Department, North Hospital, Public Hospitals of Marseille, France. Electronic address: nathalie.colombini@ap-hm.fr.

M Abbes (M)

Pharmacy Department, North Hospital, Public Hospitals of Marseille, France.

A Cherpin (A)

Pharmacy Department, North Hospital, Public Hospitals of Marseille, France.

D Bagneres (D)

Internal Medicine Department, North Hospital, Public Hospitals of Marseille, Aix-Marseille University, France.

M Devos (M)

Internal Medicine Department, North Hospital, Public Hospitals of Marseille, Aix-Marseille University, France.

M Charbit (M)

Pharmacy Department, North Hospital, Public Hospitals of Marseille, France.

P Rossi (P)

Internal Medicine Department, North Hospital, Public Hospitals of Marseille, Aix-Marseille University, France.

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Classifications MeSH

questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Comprehensive evaluation of using computerised...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Comprehensive evaluation of using computerised...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Systèmes d'entrée des ordonnances médicales › Comprehensive evaluation of using computerised...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Erreurs médicales › Erreurs de médication › Comprehensive evaluation of using computerised...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Comprehensive evaluation of using computerised...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Comprehensive evaluation of using computerised...