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General and Risk Management, Patient Safety (including: medication errors, quality control)
Evaluation of a computerised physician order entry system
  1. C. Hofer-Dückelmann,
  2. E. Prinz,
  3. W. Beindl,
  4. K. Berger,
  5. G. Fellhofer,
  6. J.S. Mutzenbach,
  7. J. Schuler
  1. 1Landesapotheke am St. Johanns Spital, Drug information, Salzburg, Austria
  2. 2Salzburger Landeskliniken Private Paracelsus Medical University, Cardiology, Salzburg, Austria
  3. 3Landesapotheke am St. Johanns Spital, Management, Salzburg, Austria
  4. 4Christian-Doppler-Klinik Private Paracelsus Medical University, Neurology, Salzburg, Austria

Abstract

Background In a study evaluating polypharmacy in a cohort of older internal-medicine patients in Austria, inappropriate prescribing and adverse drug events (ADEs) were highly prevalent. According to the literature, computerised physician order entry systems (CPOESs) improve medication safety.

Purpose To implement a CPOES and to evaluate its benefit and acceptance.

Materials and methods A study group of 3 clinical pharmacists, 2 cardiologists and a study nurse implemented and evaluated the Rp-Doc CPOES on two surgical, two internal and one neurological ward from November 2009 to April 2010. Depending on the ward, the support given by the study group in entering data into the system was organised differently. The acceptance of Rp-Doc by its users was evaluated by a questionnaire.

Results During the study period, 1259 patients were admitted. The medication of 560 patients (44%) was documented and analysed by Rp-Doc. Depending on the support that was given, Rp-Doc was used more or less (28-65%). Rp-Doc identified potential drug-drug interactions, wrong doses, duplicated medicines, contraindications and inappropriate medicines. In a questionnaire returned by 18 users, the time that was needed to document the data was considered too long, the alert overkill concerning potential drug-drug interactions and the lack of recommendation of alternatives in case a drug was considered inappropriate were criticised. The information regarding dosing, contraindications and drug adjustment in renal failure was appreciated. The majority felt that the system increased their vigilance regarding drug-drug interactions (69%), ADEs (58%), prescribing in the older (50%) and awareness of cost (27%). There was a lack of personal computers, staff and time to really use the advantages of the CPOES.

Conclusions To implement a CPOES successfully, sufficient professional support and adequate infrastructure are necessary. Once implemented, it would improve medication safety and help to identify those patients who are in greatest need of pharmaceutical care.

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