Computerized prescriber order-entry systems: evaluation, selection, and implementation

Design and development of EMR supporting medical process management

Current EMR system benefits physicians by facilitating order entry and reducing errors. It can improve the safety and effectiveness of medical services, but cannot manage the whole medical process and the quality of medical services. In addition to physicians, EMR should be designed for all medical professionals because medical services cannot be accomplished by physicians alone, but also requires the involvement of other medical professionals. Therefore, we applied PDCA, the famous quality management cycle to design a comprehensive and coherent EMR system which can be used throughout the entire treatment process. EMR with the PDCA Cycle can record every order state and every treatment procedure in order to monitor the whole medical process. This extends the safety from planning the treatment to fulfilling it. By analyzing the records, doctors and hospital managers can perfect the medical process and improve healthcare quality. The EMR we designed with the PDCA Cycle provides a record entry interface for physicians and a worksheet interface for nurses and other professionals. Every treatment procedure and every change of orders or tasks will be fed back to medical professionals. So information generated from the beginning to the end of treatment will link with each other to avoid any information islands. Furthermore, the EMR can display the additional information intuitively and real-timely without increasing the burden of medical professionals' work.

Lessons learned from implementation of a perinatal documentation system

Implementation of an electronic medical record (EMR) system is a complex process with broad implications. In a Midwestern hospital perinatal setting, EMR implementation involved several critical steps: strategic planning and project goal setting; project structure and governance; system requirements analysis; vendor selection and contract negotiation; and EMR training. No difference in patient care activities and communications among clinicians was found between pre- and post-EMR implementation; however, nurses' perceptions of EMR were more negative afterward. Lessons learned and implications are provided.

Creating content modules for Chinese EHR documents and their trial implementation in Wuwei City

Numerous and diverse paper-based health record documents are currently used in China, which are not only different from each other but are also inconsistent with national regulations. If these documents are made to be structured and electronically available, the health records information can be processed by computers to promote a shareable electronic health record (EHR) across organizations. As such, this work was intended to develop a set of content modules to be employed as reusable building blocks for converting the paper-based health records to structured EHR documents. Therefore, in this study, we developed 77 content modules based on the documents of national specifications and implemented them to Wuwei City as a trial. According to the EHR requirements of Wuwei, we added two new content modules in addition to the 77 existing content modules. We then successfully established an EHR system based on the new content modules in combination with the original content modules. This paper could contribute to the construction of structured Chinese EHR documents and provide some experiences as a reference for building EHR systems.

Implementing a pharmacy system: facilitators and barriers

To describe facilitators and barriers to the implementation of an inpatient pharmacy system at two pediatric hospitals. Interviews, pre- and post-implementation, were conducted with pharmacy and clinical managers. Key findings from the pre-implementation survey were included in the post-implementation survey to further assess facilitators and barriers to the adoption of a pharmacy system. The majority of pharmacy participants and all clinical leaders believed that project goals were being met. Pharmacist's described staff readiness-to-change as the most significant facilitator to adoption and concerns with the usability of information in the pediatric drug file as the most significant barrier. Clinical managers described system training and education as the most significant facilitator to adoption and adjustment to new work processes as the most significant barrier. We described major facilitators and barriers to the adoption of an inpatient pharmacy system at two pediatric hospitals. Strategies identified by our informants to overcome barriers may promote successful pharmacy implementations at other pediatric facilities.

A pharmacoepidemiologic study of drug interactions in a Brazilian teaching hospital

PURPOSE

Although drug-drug interactions constitute only a small proportion of adverse drug reactions, they are often predictable and therefore avoidable or manageable. There are few studies on drug-drug interactions from Brazil. This study aimed to assess the frequency of drug-drug interactions in prescriptions and their potential clinical significance in patients of a Brazilian teaching hospital.

METHODS

From January to April 2004, a sample of 1785 drug prescriptions was drawn from a total of 11,250. Drug-drug interactions were identified by using Micromedex DrugReax System. Patients'records with major drug-drug interactions were reviewed by a pharmacist and a medical doctor looking for signs, symptoms, and lab tests that could indicate adverse drug reactions due to such interactions.

RESULTS

From the 1785 prescriptions examined, 1089 (61%) were from the male adult ward. Patients' average age was 52.7 years (SD = 18.9; range, 12-98). The median number of drugs in each prescription was 7 (range, 2-26). At least 1 drug-drug interactions was present in 887 (49.7%) prescriptions. Regarding the severity of the clinical result, the interactions were classified as minor (20; 2.3%), moderate (184; 20.7%), major (30; 3.4%), and undetermined because of an incidence of more than 1 interaction in a single patient (653; 73.6%). From the 30 patients with major interactions, 17 (56.7%) presented adverse drug reactions induced by exposure to a major drug-drug interaction.

CONCLUSIONS

Patients did suffer adverse drug reactions from major drug-drug interactions. Many physicians may be unaware of drug-drug interactions. Education, computerized prescribing systems and drug information, collaborative drug selection, and pharmaceutical care are strongly encouraged for physicians and pharmacists.

Ten simple strategies to prevent chemotherapy errors

Safety experts currently recommend using technology to prevent medication errors. Computerized prescriber order entry, automated medication-dispensing machines, and bar coding are a few of the technologies being advocated to promote safety. Simple, easily implemented safety strategies to prevent chemotherapy errors should not be overlooked and include consistent use of a reliable method to verify patient identity, metric measurement, and workplace illumination and organization. Other strategies are elimination of abbreviations and acronyms, provision of up-to-date information at the point of care, and partnering with patients for safety. These strategies can be customized for use in a variety of practice settings. Oncology nurses are at the forefront of chemotherapy error-prevention initiatives and play a key role in implementing safety measures.