Diane L. Seger

The Impact of Computerized Physician Order Entry on Medication Error Prevention

BACKGROUNDnMedication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events.nnnOBJECTIVEnTo evaluate the impact of computerized physician order entry (POE) with decision support in reducing the number of medication errors.nnnDESIGNnProspective time series analysis, with four periods.nnnSETTING AND PARTICIPANTSnAll patients admitted to three medical units were studied for seven to ten-week periods in four different years. The baseline period was before implementation of POE, and the remaining three were after. Sophistication of POE increased with each successive period.nnnINTERVENTIONnPhysician order entry with decision support features such as drug allergy and drug-drug interaction warnings.nnnMAIN OUTCOME MEASUREnMedication errors, excluding missed dose errors.nnnRESULTSnDuring the study, the non-missed-dose medication error rate fell 81 percent, from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period (P < 0.0001). Non-intercepted serious medication errors (those with the potential to cause injury) fell 86 percent from baseline to period 3, the final period (P = 0.0003). Large differences were seen for all main types of medication errors: dose errors, frequency errors, route errors, substitution errors, and allergies. For example, in the baseline period there were ten allergy errors, but only two in the following three periods combined (P < 0.0001).nnnCONCLUSIONSnComputerized POE substantially decreased the rate of non-missed-dose medication errors. A major reduction in errors was achieved with the initial version of the system, and further reductions were found with addition of decision support features.

Identifying adverse drug events: development of a computer-based monitor and comparison with chart review and stimulated voluntary report.

BACKGROUNDnAdverse drug events (ADEs) are both common and costly. Most hospitals identify ADEs using spontaneous reporting, but this approach lacks sensitivity; chart review identifies more events but is expensive. Computer-based approaches to ADE identification appear promising, but they have not been directly compared with chart review and they are not widely used.nnnOBJECTIVESnTo develop a computer-based ADE monitor, and to compare the rate and type of ADEs found with the monitor with those discovered by chart review and by stimulated voluntary report.nnnDESIGNnProspective cohort study in one tertiary-care hospital.nnnPARTICIPANTSnAll patients admitted to nine medical and surgical units in a tertiary-care hospital over an eight-month period.nnnMAIN OUTCOME MEASUREnAdverse drug events identified by the computer-based monitor, by chart review, and by stimulated voluntary report.nnnMETHODSnA computer-based monitoring program identified alerts, which were situations suggesting that an ADE might be present (e.g., an order for an antidote such as naloxone). A trained reviewer then examined patients hospital records to determine whether an ADE had occurred. The results of the computer-based monitoring strategy were compared with two other ADE detection strategies: intensive chart review and stimulated voluntary report by nurses and pharmacists. The monitor and the chart review strategies were independent, and the reviewers were blinded.nnnRESULTSnThe computer monitoring strategy identified 2,620 alerts, of which 275 were determined to be ADEs. The chart review found 398 ADEs, whereas voluntary report detected 23. Of the 617 ADEs detected by at least one method, 76 ADEs were detected by both computer monitor and chart review. The computer monitor identified 45 percent; chart review, 65 percent; and voluntary report, 4 percent. The ADEs identified by computer monitor were more likely to be classified as severe than were those identified by chart review (51 versus 42 percent, p = .04). The positive predictive value of computer-generated alerts was 16 percent during the first eight weeks of the study; rule modifications increased this to 23 percent in the final eight weeks. The computer strategy required 11 person-hours per week to execute, whereas chart review required 55 person-hours per week and voluntary report strategy required 5.nnnCONCLUSIONSnThe computer-based monitor identified fewer ADEs than did chart review but many more ADEs than did stimulated voluntary report. The overlap among the ADEs identified using different methods was small, suggesting that the incidence of ADEs may be higher than previously reported and that different detection methods capture different events. The computer-based monitoring system represents an efficient approach for measuring ADE frequency and gauging the effectiveness of ADE prevention programs.

An International Evaluation of Drug-Drug Interaction Alerts That Should be Non-Interruptive in U.K. and U.S. Settings.

s from the 37th Annual Meeting of the Society of General Internal Medicine “A ONE-STOP SHOP:” PERCEIVED BENEFITS OF DIABETES GROUP VISITS IN THE SAFETY NET CLINIC SETTING Arshiya A. Baig; Amanda Benitez; Amanda Campbell; Cynthia T. Schaefer; Loretta J. Heuer; Michael T. Quinn; Deborah L. Burnet; Marshall Chin. University of Chicago, Chicago, IL; MidWest Clinicians’ Network, Lansing, MI; University of Evansville, Evansville, IN; North Dakota State University, Fargo, ND. (Tracking ID #1934849) BACKGROUND: Diabetes group visits, shared appointments in which patients with diabetes receive self-management education in a group setting and have a medical visit, are an innovative and promising way to deliver diabetes care. The group visit model may be especially promising in safety net clinics where many patients with diabetes in underserved settings receive their care. However, little is known about safety net providers’ perceptions of diabetes group visits in the community health center setting. METHODS: The research team conducted site visits at community health centers across the Midwest to assess their experiences in providing diabetes group visits. Site visits were conducted at centers that had implemented diabetes group visits in the past or currently had them. Two members of the research team interviewed health center personnel at each site regarding their diabetes group visit program. Health center personnel included chief executive officers, medical and nursing directors, care coordinators, physicians, nurses, physician assistants, diabetes educators, mental health professionals, dietitians, medical assistants, pharmacists, and other recommended staff members who were familiar with the diabetes group visits at the site. Interviewees were asked about the benefits of having diabetes group visits at their site. All interviews were audio-recorded and transcribed. Systematic qualitative analysis techniques were used to identify the range and consistency of opinions and experiences across interviewees. RESULTS: The research team visited five health center sites across four states in the Midwest and conducted a total of 26 interviews with health center personnel. One site was rural, three were urban, and one was suburban. Health center personnel noted many benefits of group visits to the health center, providers, and patients. The benefits of group visits to the health center included an alignment of the group visit model with the mission of becoming a patient centered medical home, the ability to bill for group visits, and an efficient way to improve guideline-driven care for patients. Provider benefits from group visits included boost to provider morale, opportunities to collaborate with multidisciplinary colleagues, and having more time to focus on other medical concerns during patient’s routine follow-up visits. Patients derived many benefits, including receiving education and medical care in a single appointment, e.g. “the one-stop shop” or “best bang for your buck,” the opportunity to obtain social support and enhanced motivation through peers, and the potential to improve their clinical outcomes by attending group visits. CONCLUSIONS: Diabetes group visits can offer many unique benefits to safety net clinics by providing patient-centered care, boosting provider morale, increasing multidisciplinary collaboration, and offering patients the convenience of combining an educational session with a primary care appointment. Further studies need to assess best practices in implementing group visits in health centers and assess their impact on patient outcomes. “A PLACE AT THE TABLE:” EVALUATION OF COMMUNITY MEMBERS’ EXPERIENCES AND EXPECTATIONS FOR ACADEMIC-COMMUNITY PARTNERSHIPS IN HIV/AIDS RESEARCH Stella Safo; Chinazo Cunningham; Alice Beckman; Joanna L. Starrels. Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY. (Tracking ID #1937992) BACKGROUND: The foundation of community based participatory research (CBPR) is collaboration between academic researchers and members of a given community. Community advisory boards (CABs) are one mechanism through which academic-community partnerships are formed, but current research about CAB members’ opinions on barriers to collaborations with academics is limited. This qualitative study examined CAB members’ expectations and experiences in working with academic researchers in the field of HIV/AIDS. METHODS: We conducted 10 semi-structured one-on-one interviews with individuals serving on a CAB for HIV-related research at an urban academic medical center. Participating CAB members were leaders of HIV/AIDS community organizations in Bronx, NY and had at least 5 years of experience working in the field of HIV/AIDS. Interview questions focused on participants’ current and previous experiences with academic research and researchers, trust in these relationships, and best practices for collaboration. Interviews were professionally transcribed and data was analyzed using a grounded theory approach. Transcript data were coded by two independent researchers using NVivo 10 software and analyzed in an iterative process to identify emergent themes. RESULTS: CAB members described positive aspects of inclusion on a CAB, including improved access to information about current HIV topics and the opportunity to help shape HIV research in their communities. However, CAB members also described negative previous interactions with researchers, and a lack of trust in researchers themselves or in the process of conducting research with academic institutions. A major reason for distrust was that power was perceived as unequal, SCIENTIFIC ABSTRACTS