News
Quality assurance necessary during implementation of computerised
medication systems
21 October 2008
The Leapfrog Group, a US not-for-profit advocate of hospital patient
safety and medication management, has highlighted the importance of
assuring proper implementation of computerised physician order entry (CPOE)
systems to prevent serious medication errors.
The caution comes on the heels of findings from Leapfrog's first-ever
Evaluation of CPOE that showed large variability in quality between
hospitals.
Leah Binder, CEO of The Leapfrog Group, stated, "As CPOE systems are
implemented at the clinical level in hospitals, we're seeing a broad
variance in both the degree of adoption and in the quality of outcomes.
"There is no doubt that hospitals investing in CPOE are taking
positive steps to address medication safety and a transition period
between installation and effective implementation is natural and
expected. 2008 Evaluation Tool findings indicate that collectively, US
hospitals still have a way to go in addressing the technology, workflow
and cultural challenges of CPOE implementation. We all need to recognise
that installing a system is really just the beginning."
"CPOE systems are not 'off-the-shelf' or 'plug-in' products," added
David C Stockwell, MD FAAP, Medical Director of Patient Safety,
Children's National Medical Center, and participant in Leapfrog's 2008
Hospital Survey and CPOE Evaluation Tool. "They are highly customized to
match internal workflow or they become untenable and will not be readily
adopted. That customisation inevitably introduces variability in the
effectiveness of implementations. The Leapfrog CPOE Evaluation Tool
provides the standard by which to measure if local implementations are
achieving organizational goals."
Developed by First Consulting Group (now Computer Sciences
Corporation /CSC) and the Institute for Safe Medication Practices,
Leapfrog's CPOE Evaluation Tool provides hospitals with an assessment of
the adequacy of their CPOE system alerts for common, serious prescribing
errors.
Funding for the Leapfrog CPOE Evaluation Tool resulted from a clearly
defined need for hospitals to measure the effectiveness of their CPOE
systems in meaningful terms, including the prevention of adverse events.
"The commitment of the Agency for Healthcare Research and Quality (AHRQ),
the California Healthcare Foundation and the Robert Wood Johnson
Foundation in seeing the development of this Tool through to its
completion will have a beneficial impact on the reduction of medication
errors in this country and in the cost and quality of healthcare," said
Binder.
"The biggest value in Leapfrog's CPOE Evaluation Tool is that it
gives hospitals the opportunity to gauge where they are with respect to
clinical decision support in their CPOE implementation," added David W
Bates, MD, MSc, Chief, General Medicine Division, Brigham and Women's
Hospital and Leapfrog Advisor. "While we saw considerable variability in
how hospitals scored in 2008, the process of participating gave them a
clear idea of what they now need to focus on in the absence of industry
standards in decision support."
Individual hospital score results will not be publicly released by
Leapfrog for the 2008 survey, opting to recognise organisations for the
significant merit of testing their system. "But the results were
concerning enough for Leapfrog to issue this caution," and Binder
anticipates that, "In 2009, individual hospital scores will be
identified."
Details on the 2008 findings will be the subject of a subsequent
article being written by the CPOE Evaluation Tool developers. "The
intent of this effort is to help hospitals understand where they are on
the clinical decision support journey, and where there are opportunities
for improvement, especially with respect to more decision support,"
concluded Bates.
Meanwhile, the Children's National Medical Center has already
committed the resources to revisit Leapfrog's CPOE Evaluation Tool in
2009. "The value to us is in knowing that our CPOE system implementation
is working as we think it should be and in keeping our priorities for
improvement on course with organisational goals," offered Stockwell.
"Additionally, we are able to compare and contrast our implementation
with national experts and peers across the country to raise the bar on
best practices and to engage in unprecedented conversations on
improvement."
More than 1,200 hospitals participated in the 2008 Hospital Survey.
The results are available at
http://leapfroggroup.org/
|