Print This Article | 
Share this Page |
Getting It Right: Allegiance Health Manages CPOE Alerts to Reduce Errors and Maintain Physician AdoptionBy Jonathan Sykes, MD Chief Medical Informatics Officer Allegiance Health Jackson, Mich.  The Quality Buzz In our community, quality of care and patient safety are not only hospital boardroom issues, they are topics that frequently work their way into kitchen table talk as well. Consumers in the central Michigan region are very tuned into medical safety issues. Many work for an automaker or one of the companies that founded the Leapfrog Group, a coalition of large employers dedicated to improving the nation's care quality. In addition, they see quality-of-care messages in mainstream media. One of our competing hospitals even runs radio and TV advertisements touting its use of a computerized physician order entry (CPOE) system and its impact on safety. As a result, at Allegiance Health, we recognized the need to elevate our patient safety efforts. Simply having a CPOE system was not enough. We wanted to use our system to provide support at the point of decision-making, which would help improve patient safety. The fact that the government is calling for drug-interaction checking as part of the "meaningful use" requirements to qualify for American Recovery and Reinvestment Act (ARRA) funds simply steeled our resolve. A Medication Mission We quickly defined our mission: Minimize medication errors, especially prescribing errors, by implementing a CPOE system. While we wanted to add drug interaction checking to CPOE rules, we did not want to generate so many alerts that we would experience a loss in physician CPOE adoption. We decided to add medication safety alerts to our CPOE system, but be sensitive to "alert fatigue" that might prompt caregivers to ignore the alerts altogether. The Relevant Data To assess our implementation of CPOE, we used the Leapfrog CPOE Evaluation Tool. We achieved a "fully implemented" score on the assessment. To achieve this score, hospitals must demonstrate that its system can alert physicians of at least 50% of common, serious prescribing errors. We also studied our experience with medication alerts in the ambulatory electronic heath record. We evaluated what was working in that setting, and then applied those lessons to the inpatient arena. Getting It Right Based on our analysis, we concluded that we would activate drug-drug interaction checking at the severe and contraindicated settings and geriatric precautions at the contraindicated setting. We felt these settings would provide the desired level of alerting. In the first month after activation, the system generated an average of 115 alerts per day. We felt it was important to suppress some of the alerts to avoid becoming a nuisance for physicians, which would affect adoption. A medical staff committee of physicians and pharmacists reviewed and validated the alerts process and recommendations to suppress additional alerts. By suppressing alerts for drug-drug interactions for two additional medications, aspirin and atrovent, the total number of CPOE alerts was decreased by nearly 50%, to 64-68 per day. These alerts are still presented to the pharmacist through a medication management system, however. With this level of alerting in place, we are confident that we can maintain physician use of the system and, at the same time, reduce errors. Medication prescribing errors decreased from an average of 0.62 per 1000 orders between January and August 2009 to 0.50 per 1000 orders between September and December 2009. We also found that 10% to 20% of alerts resulted in cancellation of prescription orders, helping avoid potential adverse drug events and improving safety for the patient. Overall, medication error rates have decreased with the implementation of CPOE alerts as well as other McKesson solutions, such as our pharmacy robot and bedside bar-code administration of medications. Our success proves that CPOE systems can enhance patient safety efforts. We will continue to collect data that demonstrates those efforts are helping to improve quality of care and patient outcomes. By making continuing gains in patient safety, we will be able to promote our facility as a preferred care provider to an increasingly astute consumer population. Jonathan Sykes, MD, is chief medical informatics officer and director of Clinical Information Systems at Allegiance Health. Dr. Sykes has been actively involved in health information technology for more than 10 years. He provides oversight for coordinating and directing implementation of a variety of systems, including computerized provider order entry, bar-code medication administration and the ambulatory EHR. He also serves as an independent urologist and is an active user of an EHR system.   |
|
|
|||||||||||||||||||||||||||||||||||||||
       |
||
  
|
||
