Computerized Physician Order Entry

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When computerized physician order entry (CPOE), the e-prescribing, so the electronic recording and processing designated by therapeutic one instructions physician . The aim is to increase medication safety and reduce costs.

Demarcation

In German, “Computerized Physician Order Entry” can be translated with electronic drug prescription. Computerized Physician Order Entry in the narrower sense only refers to drug prescriptions. Only rarely are other medical orders meant, such as B. Orders for laboratory tests or radiological tests. In this case, CPOE is also advertised as a “Computerized Provider Order Entry”.

meaning

Medication errors can occur at any stage of the medication process. The most common are errors in the prescription, such as double prescriptions, failure to consider necessary dose adjustments, overlooking contraindications or interactions, or simply reading errors, followed by errors in application or ingestion. Around 50% of all medication errors are considered avoidable. In Germany alone, it is estimated that up to 58,000 patients die each year due to errors in drug therapy.

Decision support functions (CPOE-CDS)

CPOE systems can offer decision support functions and thus contribute significantly to medication safety. This includes computer-based support options for the doctor, including electronic verification of the prescription, a function that is integrated in so-called "CPOE-CDS" systems. The "CDS" ("clinical decision support") offers the doctor basic decision support through warnings, prompts and instructions for:

  • Check for the presence of an allergy
  • Offering standard dosages
  • Support in switching to medication recommended in-house (positive list)
  • Check for double prescription of the same drug or drug substance
  • Testing for drug interactions

Extended decision support:

  • Support with the dose calculation taking into account age, weight, body surface, kidney function etc.
  • Support in requesting laboratory tests to monitor the effect
  • Check for contraindications
  • Check for pregnancy.

distribution

Since the action plan for patient safety by the Federal Ministry of Health in 2007, a large number of activities on drug therapy safety have been initiated and coordinated in Germany. According to the IT report on health care, in 2012 27% of all German hospitals used computer-aided documentation of drug therapy. A quarter of the hospitals surveyed stated that at least one organizational unit also used drug-related alarm messages (e.g. allergies, interactions). The prevalence in Germany is therefore less than in the USA, where 34% of acute hospitals already had a CPOE system in use in 2008.

Study situation

Numerous studies and reviews indicate that the electronic drug prescription can reduce medication errors and thus significantly improve patient safety. The positive effects include:

  • Improving the readability of regulations
  • Improving the completeness of regulations
  • Better overview of a patient's medication history
  • Support of dose calculations
  • Support through warning messages (e.g. in the event of interactions, allergies, overdose)
  • Improving medication safety.

Overall, CPOE systems can effectively support the medication process and improve medication safety. Other studies indicate possible problems with the planning, implementation and use of CPOE systems. The problems and risks include:

  • Additional time required for documentation
  • Lack of usability of the CPOE systems
  • Inadequate equipment with mobile tools
  • Insufficient training of CPOE users
  • Error in the parameterization of the CPOE system (e.g. clinical workstation system)
  • Insufficient adaptation of the processes when introducing the CPOE system
  • Missing interfaces to other IT systems
  • Reduced oral communication between people involved
  • Inundation with clinically meaningless warning messages
  • Error in the software
  • Too much trust in the recommendations of the CPOE system

If implemented and used inadequately, CPOE systems can disrupt the medication process, negatively impact medication safety and, under certain circumstances, increase patient mortality.

See also

Web links

Individual evidence

  1. ↑ DW Bates, DJ Cullen, N. Laird, LA Petersen, SD Small, D. Servi, G. Laffel, BJ Sweitzer, BF Shea, R. Hallisey, MV Vliet, R. Nemeskal, LL Leape, for the ADE Prevention Study Group: Incidence of adverse drug events and potential adverse drug events - Implications for prevention. ( Memento of the original from March 4, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) In: Journal of the American Medical Association . 274 (1), 1995, pp. 29-34. @1@ 2Template: Webachiv / IABot / ptsafetyresearch.org
  2. ↑ J. Schnurrer, J. Frölich: On the frequency and avoidability of fatal adverse drug reactions. ( Memento of the original from January 23, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) In: Internist. 44, 2003, pp. 889-895. CPOE systems are discussed as an approach to reduce medication errors. @1@ 2Template: Webachiv / IABot / med-o-card.net
  3. ^ G. Kuperman, A. Bobb, T. Payne, A. Avery, T. Gandhi, G. Burns et al .: Medication-related clinical decision support in computerized provider order entry systems: a review. In: Journal of the American Medical Informatics Association. 14 (1), 2007, pp. 29-24.
  4. ^ A b E. Ammenwerth, AF Aly, T. Bürkle, P. Christ, H. Dormann, W. Friesdorf, C. Haas, WE Haefeli, M. Jeske, J. Kaltschmidt, K. Menges, H. Möller, A . Neubert, W. Rascher, H. Reichert, J. Schuler, G. Schreier, S. Schulz, HM Seidling, W. Stühlinger, M. Criegee-Rieck: On the use of information technology to improve drug therapy safety (Memorandum AMTS-IT) . In: GMS Med Inform Biom Epidemiol. 10 (1), 2014, Doc03.
  5. ↑ D. Grandt, C. Braun, W. Hauser: Frequency, relevance, causes and strategies for avoiding medication errors. In: Journal of Gerontology and Geriatrics. 38, 2005, pp. 196-202.
  6. ^ A b Institute of Medicine Preventing Medication Errors . The National Academic Press, Washington DC 2007.
  7. ^ A b P. M. Cox Jr., S. D'Amato, DJ Tillotson: Reducing medication errors. In: American Journal on Medical Quality. 16 (3), 2001, pp. 81-86.
  8. ↑ Wilfried von Eiff (Ed.): Patient-oriented drug supply - safety and economic efficiency of drug management. Thieme, 2011, p. 108.
  9. ↑ Federal Ministry of Health: Action Plan 2013–2015 of the Federal Ministry of Health to improve drug therapy safety in Germany. Bonn 2013.
  10. ↑ U. Hübner, JD love, N. Egbert, A. Frey: IT report health care - focus: IT in hospitals. (PDF) Lower Saxony Ministry of Economics, Labor and Transport, Hanover 2012, ISBN 978-3-9812490-2-6 .
  11. ↑ DC Radley, MR Wasserman, LE Olsho et al .: Reduction in medication errors in hospitals due to adoption of computerized physician order entry systems. In: Journal of the Medical Informatics Association. 20 (4), 2013, pp. 407-406.
  12. ^ S. Eslami, NF de Keizer, A. Abu-Hanna: The impact of computerized physician medication order entry in hospitalized patients - a systematic review. In: International Journal of Medical Informatics. 77 (6), 2008, pp. 365-376.
  13. ^ E. Ammenwerth, P. Schnell-Inderst, C. Machan, U. Siebert: The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. In: Journal of the Medical Informatics Association. 15 (5), 2008, pp. 585-600.
  14. ↑ JS Ash, DF Sittig, EG Poon et al .: The extent and importance of unintended consequences related to computerized physician order entry. In: Journal of the Medical Informatics Association. 14 (4), 2007, pp. 415-423.
  15. ↑ R. Khajouei, N. Peek, PC Wierenga, MJ Kersten et al .: Effect of predefined order sets and usability problems on efficiency of computerized medication ordering. In: International Journal of Medical Informatics. 79 (10), 2010, pp. 690-698.
  16. ↑ H. van der Sijs, J. Aarts, A. Vulto, M. Berg: Overriding of drug safety alerts in computerized physician order entry. In: Journal of the Medical Informatics Association. 13 (2), 2006, pp. 138-147.
  17. ↑ Yong Y. Han, Joseph A. Carcillo, Shekhar T. Venkataraman, Robert SB Clark, R. Scott Watson, Trung C. Nguyen, Hülya Bayir, Richard A. Orr: Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry system . In: Pediatrics . tape 116 , no. 6 , December 1, 2005, ISSN  0031-4005 , p. 1506–1512 , doi : 10.1542 / peds.2005-1287 , PMID 16322178 ( psu.edu [PDF; accessed June 23, 2019]).