Friday Brain Fry! 29 May 2015

Patient Safety: A Computer Beats A Pen For Getting Prescriptions Right

Drug errors inside hospitals remain a big problem. By one estimate, 1 in 7 hospitalized patients suffers some form of error in care. Nearly a third of those mistakes are related to drugs. And those mix-ups can lead to longer hospital stays, unnecessary suffering, permanent damage or death.

Cancer Care Ontario did a systematic review in 2012, which indicated that only small percentage of hospitals in the US use CPOE for complex chemotherapy regimens.  The error rate pre-CPOE was 15%, and the error rate post- CPOE was 5%. Interestingly, 92% of the post-CPOE errors were found in prescriptions that were still being handwritten, because the prescribing module was not yet available for all prescriptions.

 

Risk Management: Every change or improvement may have its own risks!

The design of the software can introduce errors "that would never occur on paper," like picking the wrong option from a drop-down menu.

Leadership Development: Who should be taking leadership for CPOE implementation?

In healthcare, its often unclear who is suppose to lead! In public health system, healthregions are very dependent on government funding. If an initiative such as CPOE is not funded by the MOH, its very difficult to get Hospitals leadership  excited about it. In general health regions are reluctant to install the CPOE systems, because they're seen as expensive and painful to implement. Having a unified front with the administration and physician leaders is key to move CPOE forward in a collaborative environment. The reason  why some organizations are successful [implementing CPOE] is due to the leadership and vision from their CEO and board of directors.

Lean Thinking: Mistake-proofing CPOE

Leapfrog for example, requires that hospitals test their CPOE systems to see if the pre-programmed rules actually catch harmful mistakes. They feed in fake patients and fake prescription orders — some of which contain fatal errors. Across the board, about one-third of them slip through.

Want to Read More: http://n.pr/AFiPzFl,   http://bit.ly/1cp6HFR and http://bit.ly/1BvY5Ui 

Video of the week!: Benefits of CPOE 

http://youtu.be/sTp7NgETuvg