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Hospitals Lag in CPOE Implementation, Errors Persist

CPOE helps prevent adverse drug events but still falls short of completely ensuring patient safety.

By Kyle Murphy, PhD

Despite the reported benefits of computerized physician order entry in reducing adverse drug events, many hospitals have yet to move forward with CPOE implementation, according to a new report published by The Leapfrog Group. CPOE use, however, is not a panacea as the survey of hospitals revealed that these systems failed to flag 39 percent of potentially harmful and 13 percent of potentially fatal orders.

"Hospitals’ continued reporting of this data will help to monitor progress and allow patients to choose hospitals based on their medication safety practices," the report states.

Using a proprietary CPOE tool, Leapfrog evaluated the CPOE systems of 1750 hospitals across the country, which in turn revealed these missed in spotting adverse drug events. Additionally, the report includes a list of most common unflagged errors related to medications and dosing:

•  Diagnosis (e.g., prescribing a beta blocker to a  patient with asthma),

•  Kidney function (e.g., a drug that must be processed by the kidneys given to a patient with impaired kidney function without reducing the dose accordingly), and

• Monitoring (e.g., the failure to display a reminder to test drug levels after issuing a medication, when such follow-up is clinically indicated).

Year over year evaluation of hospitals and their ability to spot potential errors saw only slight improvement — one percent — between 2014 and 2015.

According to the report, Leapfrog's standard for CPOE use requires that hospitals show that the system alerts physicians  to at least 50% of common, serious prescribing errors and whose physician order at least 75% of inpatient medication orders through a CPOE system.

"Using these combined criteria, nearly two-thirds of hospitals (64%) fully met the standard, showing a considerable improvement compared to 14% in 2010," reads the report. "However, some hospitals (4%) still reported that they did not have an inpatient CPOE system at all."

Variations emerged between states as well:

State-by-state comparisons also show where use and effectiveness of CPOE is lacking. Among the states with the lowest percentage of hospitals meeting Leapfrog’s standard were Indiana (25%) and Nevada (35%). Five other states also had fewer than 50% of hospitals meeting the standard (Figure 2). Among the states with the most hospitals meeting the standard were Maine (85%), Georgia (83%), and New York (81%). In addition, there were eight other states that had 75% or more hospitals meeting the standard.

As best practice for CPOE use, Leapfrog recommends the use of manual checks to supplement the computerized flagging of errors.

"Medication reconciliation is the process of identifying the most accurate list of all medications a patient is taking — including name, dosage, frequency, and route — and using this list to provide correct medications for patients," the group writes. "This process can reduce medication errors and adverse drug events."

The majority of hospitals (62%) reported performing medication reconciliation activities. Significantly more (98%) indicated that they have implemented processes for documentation patient medications at the time of admission. A similarly high number (99%) provided patients and their caregivers with update medication lists at the time of discharge.

But many hospitals failed to perform a follow-up.

"Only 84% of hospitals held their senior administrative leadership accountable for these processes through their performance review of compensation, and only 88% of hospitals had staff time or a budget allocated to developing best practices," the report reveals.

A troubling finding from the report was the revelation that some hospitals were unwilling to report their data to Leapfrog and thus prevented other participating hospitals from being able to test their medication safety tools to identify areas for improvement. "Further, the publicly reported information by hospital can also empower patients to use the results to make more informed decisions when choosing a hospital for care," Leapfrog claims.

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