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Sherine Ismail, Mohamed Osman, Rayf Abulezz, Hani Alhamdan, K H Mujtaba Quadri
Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs). We present a tertiary care facility experience of pharmacists vis-a-vis interprofessional collaboration for designing and implementing CPs. We participated in the development of CPs as leading members of a collaborative team of healthcare professionals. We reviewed literature, aligning it with hospital formulary and institutional standards, and participated in weekly team meetings for six months. Several tools and services were adapted to guide prescribing and standardization of care through time-bound order sets...
March 16, 2018: Pharmacy (Basel, Switzerland)
Clement Chung, Shital Patel, Rosetta Lee, Lily Fu, Sean Reilly, Tuyet Ho, Jason Lionetti, Michael D George, Pam Taylor
PURPOSE: The development of a computerized prescriber order-entry (CPOE) system for chemotherapy in a multisite safety-net health system and the challenges to its successful implementation are described. SUMMARY: Before CPOE for chemotherapy was first implemented and embedded in the electronic medical record system of Harris Health System (HHS), pharmacy personnel relied on regimen-specific preprinted order sets. However, due to differences in practice styles and workflow logistics, the paper orders across the 3 facilities were mostly site specific, with varying clinical content...
March 15, 2018: American Journal of Health-system Pharmacy: AJHP
Matthew Rubinstein, Robert Hirsch, Kakali Bandyopadhyay, Bereneice Madison, Thomas Taylor, Anne Ranne, Millie Linville, Keri Donaldson, Felicitas Lacbawan, Nancy Cornish
Objectives: To evaluate the effectiveness of practices used to support appropriate clinical laboratory test utilization. Methods: This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practices A6 cycle method. Eligible studies assessed one of the following practices for effect on outcomes relating to over- or underutilization: computerized provider order entry (CPOE), clinical decision support systems/tools (CDSS/CDST), education, feedback, test review, reflex testing, laboratory test utilization (LTU) teams, and any combination of these practices...
February 17, 2018: American Journal of Clinical Pathology
Virginie Korb-Savoldelli, Abdelali Boussadi, Pierre Durieux, Brigitte Sabatier
OBJECTIVE: The positive impact of computerized physician order entry (CPOE) systems on prescription safety must be considered in light of the persistence of certain types of medication-prescription errors. We performed a systematic review, based on the PRISMA statement, to analyze the prevalence of prescription errors related to the use of CPOE systems. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, CENTRAL, DBLP, the International Clinical Trials Registry, the ISI Web of Science, and reference lists of relevant articles from March 1982 to August 2017...
March 2018: International Journal of Medical Informatics
Delphine Carli, Guillaume Fahrni, Pascal Bonnabry, Christian Lovis
BACKGROUND: Computerized decision support systems have raised a lot of hopes and expectations in the field of order entry. Although there are numerous studies reporting positive impacts, concerns are increasingly high about alert fatigue and effective impacts of these systems. One of the root causes of fatigue alert reported is the low clinical relevance of these alerts. OBJECTIVE: The objective of this systematic review was to assess the reported positive predictive value (PPV), as a proxy to clinical relevance, of decision support systems in computerized provider order entry (CPOE)...
January 24, 2018: JMIR Medical Informatics
Satish Munigala, Ronald R Jackups, Robert F Poirier, Stephen Y Liang, Helen Wood, S Reza Jafarzadeh, David K Warren
BACKGROUND: Urinalysis and urine culture are commonly ordered tests in the emergency department (ED). We evaluated the impact of removal of order sets from the 'frequently ordered test' in the computerised physician order entry system (CPOE) on urine testing practices. METHODS: We conducted a before (1 September to 20 October 2015) and after (21 October to 30 November 2015) study of ED patients. The intervention consisted of retaining 'urinalysis with reflex to microscopy' as the only urine test in a highly accessible list of frequently ordered tests in the CPOE system...
January 20, 2018: BMJ Quality & Safety
Cheng-Yi Yang, Yu-Sheng Lo, Ray-Jade Chen, Chien-Tsai Liu
BACKGROUND: A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients' integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients' medication records prescribed by different health care facilities across Taiwan...
January 19, 2018: JMIR Medical Informatics
Walter E Haefeli, Hanna M Seidling
Because of its inherent complexity, it is a considerable challenge to tailor drug treatment to a prevalent disease and its subgroups, which are increasingly defined by genomic variability (personalized medicine) and require consideration of context information such as co-morbidity, co-medication, patient preferences, and the specific characteristics of the healthcare sector. Thus, optimum treatment decisions might not be taken intuitively any longer, because decisions must be made both rapidly and increasingly based on analyses of complex relations of numerous variables that exceed the processing performance of a human brain...
January 16, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Nicolas Delvaux, An De Sutter, Stijn Van de Velde, Dirk Ramaekers, Steffen Fieuws, Bert Aertgeerts
BACKGROUND: Laboratory testing is an important clinical act with a valuable role in screening, diagnosis, management and monitoring of diseases or therapies. However, inappropriate laboratory test ordering is frequent, burdening health care spending and negatively influencing quality of care. Inappropriate tests may also result in false-positive results and potentially cause excessive downstream activities. Clinical decision support systems (CDSSs) have shown promising results to influence the test-ordering behaviour of physicians and to improve appropriateness...
December 6, 2017: Implementation Science: IS
Melissa T Baysari, Rae-Anne Hardie, Rebecca Lake, Lauren Richardson, Cheryl McCullagh, Alan Gardo, Johanna Westbrook
OBJECTIVE: To explore the views of nurses and doctors during the early stages of implementation of a computerized provider order entry (CPOE) system in a pediatric hospital and to examine changes in perceptions and reported behaviors as use of the CPOE system became routine. METHODS: Semi-structured interviews were undertaken at four time points following CPOE implementation: during week one, week three, week six and then six months following implementation. In total, 122 users were interviewed...
January 2018: International Journal of Medical Informatics
Gili Kadmon, Michal Pinchover, Avichai Weissbach, Shirley Kogan Hazan, Elhanan Nahum
OBJECTIVE: To assess the prolonged impact of computerized physician order entry (CPOE) on medication prescription errors in pediatric intensive care patients. STUDY DESIGN: This observational study was conducted at a pediatric intensive care unit in which a CPOE (Metavision, iMDsoft, Israel) with a limited clinical decision support system was implemented between 2004 and 2007. Since then, no changes were made to the systems. We analyzed 2500 electronic prescriptions (1250 prescriptions from 2015 and 1250 prescriptions from 2016)...
November 2017: Journal of Pediatrics
Edmondo J Robinson, Meredith R Bergey, Elizabeth Brady, Alexandra M Mapp, Jennifer C Goldsack
OBJECTIVE: The aim of this study is to describe the impact of the introduction of health information technology (HIT) on the utilization and payroll costs of nurse extenders and unit clerks in medicine and surgery units in a large regional health system. BACKGROUND: Long-term policy goals of HIT implementation are reported to include system-level reductions in labor costs, achieved through improved efficiency. METHODS: Using a retrospective cohort model, we analyzed how hours worked per patient day and staffing costs per patient day varied with the implementation of HIT over time at 2 different hospitals within a health system...
December 2017: Journal of Nursing Administration
Eileen Yilin Sim, Daryl Jian An Tan, Hairil Rizal Abdullah
BACKGROUND AND GOAL OF STUDY: Over-ordering of routine preoperative investigations is prevalent. Adherence to institutional guidelines differs among physicians. Our institution integrated a Clinical Decision Support (CDS) model into our hospital's Computerized Physician Ordering Entry (CPOE) system to guide physician orders. We investigate if the implementation of CDS into CPOE increases physician adherence to our institutional guidelines. METHODS: A retrospective cohort study in a tertiary academic hospital over 18 months...
December 2017: International Journal of Medical Informatics
Cassie Jaeger, Paul Sullivan, James Waymack, David Griffen Griffen
BACKGROUND: Amylase and lipase, pancreatic biomarkers, are measured in acute pancreatitis diagnosis. Since amylase testing does not add diagnostic value, lipase testing alone is recommended. Despite new recommendations, many physicians and staff continue to test both amylase and lipase. OBJECTIVE: To reduce unnecessary diagnostic testing in acute pancreatitis. METHODS: The pre-checked amylase test within the Emergency Department's Computerized Provider Order Entry (CPOE) abdominal pain order set was changed to an un-checked state, but kept as an option to order with a single click...
October 6, 2017: Journal of Innovation in Health Informatics
R A Jenders
Introduction: Advances in clinical decision support (CDS) continue to evolve to support the goals of clinicians, policymakers, patients and professional organizations to improve clinical practice, patient safety, and the quality of care. Objectives: Identify key thematic areas or foci in research and practice involving clinical decision support during the 2015-2016 time period. Methods: Thematic analysis consistent with a grounded theory approach was applied in a targeted review of journal publications, the proceedings of key scientific conferences as well as activities in standards development organizations in order to identify the key themes underlying work related to CDS...
August 2017: Yearbook of Medical Informatics
Chad E Tewell, Thomas R Talbot, George E Nelson, Bryan D Harris, Whitney A Jones, Narinder M Midha, David P Mulherin, Eric B Stephens, Anuj Thirwani, Patty W Wright
BACKGROUND: Diarrhea is one of the most common illnesses in the United States. Evaluation frequently does not follow established guidelines. The objective of this study was to evaluate the effectiveness of a computerized physician order entry-based test guidance algorithm with regard to the clinical, financial, and operational impacts. METHODS: Our population was patients with diarrheal illness at a tertiary academic medical center. The intervention was a computerized physician order entry-based test guidance algorithm that restricted the use of stool cultures and ova and parasites testing of diarrhea in the adult inpatient location vs nonintervention sites, which were the emergency department, pediatric inpatient and adult and pediatric outpatient locations...
February 2018: American Journal of Medicine
Mitchell Kim, Stephen J Kaplan, Steven H Mitchell, Medley Gatewood, Itay Bentov, Katherine A Bennett, Carol A Crawford, Paul R Sutton, Diane Matsuwaka, Mamatha Damodarasamy, May J Reed
BACKGROUND: Older adults are more susceptible to adverse events when administered certain medications at doses appropriate for younger adults. OBJECTIVE: The aim of this study was to investigate the effect of default geriatric dosing on computerized physician order entry (CPOE) templates on the subsequent administration of recommended starting doses of opioids, benzodiazepines (BZDs) and non-steroidal anti-inflammatory drugs (NSAIDs) to older adults in the emergency department (ED)...
October 2017: Drugs & Aging
Aubrey N Jones, Jamie L Miller, Stephen Neely, Bethany W Ibach, Tracy M Hagemann, Charles L Golding, Teresa V Lewis, Leigh A Peek, Peter N Johnson
OBJECTIVES: This study aims to determine the prevalence and factors associated with unrounded doses ordered via a computerized prescriber order entry (CPOE) system among children during a 1-week reference period. METHODS: This retrospective, cross-sectional study included children younger than 18 years admitted during a 7-day period. An unrounded dose was defined as an unrounded actual dose (eg, dose calculated to the tenths place for non-neonatal intensive care (non-NICU) patients and dose calculated to the hundredth place for NICU patients) or unrounded volume per dose [eg, <0...
July 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Melissa T Baysari, Jessica Del Gigante, Maria Moran, Indy Sandaradura, Ling Li, Katrina L Richardson, Anmol Sandhu, Elin C Lehnbom, Johanna I Westbrook, Richard O Day
OBJECTIVE: To determine the impact of the introduction of new pre-written orders for antimicrobials in a computerized provider order entry (CPOE) system on 1) accuracy of documented indications for antimicrobials in the CPOE system, 2) appropriateness of antimicrobial prescribing, and 3) compliance with the hospital's antimicrobial policy. Prescriber opinions of the new decision support were also explored to determine why the redesign was effective or ineffective in altering prescribing practices...
September 13, 2017: Applied Clinical Informatics
Putu Wuri Handayani, Achmad Nizar Hidayanto, Indra Budi
This study reviews the literature on the most important acceptance factors associated with Hospital Information Systems (HIS) and related technologies based on user groups' perspectives (medical staff, hospital management, administrative personnel, patient, medical student, and IT staff), which can assist researchers and hospital management to develop suitable acceptance models to improve the quality of HIS. We conducted searches in online databases with large repositories of academic studies, written in English and fully accessible by the authors...
August 22, 2017: Informatics for Health & Social Care
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