FOCUSFOCUS. CPOE at Cedars-Sinai What Worked, What Didn’t Cedars-Sinai Medical Center Los Angeles,...
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Transcript of FOCUSFOCUS. CPOE at Cedars-Sinai What Worked, What Didn’t Cedars-Sinai Medical Center Los Angeles,...
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CPOE at Cedars-SinaiCPOE at Cedars-SinaiWhat Worked, What Didn’tWhat Worked, What Didn’t
Cedars-Sinai Medical CenterCedars-Sinai Medical CenterLos Angeles, CaliforniaLos Angeles, California
C SS
Paul Hackmeyer, M.D.Paul Hackmeyer, M.D.Chief of Staff 2000-2001Chief of Staff 2000-2001
PBH 04/03
Patient Care Expert (PCX) System
• Physician Order Entry: Automated physician’s entry of orders. Med orders automatically checked for allergies, drug interactions & dose range (October 2002)
• Patient Management: Admission, discharge, transfer, bed management & preregistration (May 2003)
• Patient Accounting: Bills patients & insurance providers with enhanced accuracy for capturing charges (July 2003)
• Contract Management: Database of contract terms to verify payment ability during preregistration & proper billing of patient accounts
PBH 04/03
Patient Care Expert (PCX) System
• Physician Order Entry: Automated physician’s entry of orders. Med orders automatically checked for allergies, drug interactions & dose range (October 2002)
• Patient Management: Admission, discharge, transfer, bed management & preregistration (March 2003)
• Patient Accounting: Bills patients & insurance providers with enhanced accuracy for capturing charges (July 2003)
• Contract Management: Database of contract terms to verify payment ability during preregistration & proper billing of patient accounts
Temporarily suspended January 23, 2003
PBH 04/03
PCX In the News
PBH 04/03
PCX in the News
PBH 04/03
What Worked
CPOE
PBH 04/03
The system itself
What Worked
• No crashes or unscheduled downtime
• No lost or mistransmitted orders
PBH 04/03
Oct 24, 2002 – Jan 23, 2003
What Worked
• 700,000 orders placed & transmitted
• 8,000+ patients
• 10,000 orders per day
PBH 04/03
Medical Records Components (still running)
What Worked
• Coding & abstraction
• Charge entry
PBH 04/03
Education about value of CPOE re: Medication Errors
What Worked
PBH 04/03
Medication Alerts
What Worked
PBH 04/03
PCX CPOE Alert Statistics
Oct 24, 2002 – Jan 23, 2003
PBH 04/03
Live Interface to ICU System MAR
What Worked
PBH 04/03
PreliminaryOutcomes
What Worked
• Decreased length of stay
• Decreased mortality rate
• Decreased SAEs
PBH 04/03
What Didn’t Work
CPOE
PBH 04/03
What Didn’t WorkPhysician Issues & Change
Management
• Very difficult to get physicians to test system during development
• After go-live, much angst over added time for order entry
• Negative perception for ease of use
• Insufficient education for optimal use
PBH 04/03
What Didn’t Work
Work Flow Change Management
• CPOE affects all caregivers
• Incompletely understood complex hospital procedures that affected order management
• Much more operational workflow analysis required
PBH 04/03
What Didn’t Work
Need for System Enhancement
• Hundreds of suggestions post “go-live” to be prioritized for action
• By its nature, CPOE is difficult to bring down even transiently
• Difficult to significantly enhance system while it is running
PBH 04/03
CPOE
• Complexity of human change management may be easily underestimated
• For physicians, speed, ease of use and intuitiveness of the system are critical
• Complex workflow issues affecting orders must be completely understood and incorporated in the system. Example: Patient transfers to and from procedure areas.
Lessons Learned
PBH 04/03
CPOE Reimplementation Plan
• Other parts of the PCX system will go-live as scheduled: Patient Management (March), Patient Accounting (July)
• Workflow issues will be carefully analyzed
• CPOE portion of the system will be enhanced to improve speed & ease of use
• Significant medical staff input will be obtained to test enhancements
• Reimplementation schedule not yet set
PBH 04/03
CPOE Reimplementation Plan
• PCX Advisory Task Force to the MEC
• Safety Council evaluation and monitoring
• Advisory Task Force and the Safety Council will advise the MEC on a monthly basis.
• Reimplementation schedule not yet set, but will be fully vetted and approved by the MEC
Questions?
PBH 04/03
Formulary, purchasing decisions
Inventory management
Dispense/distribute
medication
Medication Management ProcessWhere the Adverse Drug Events originate
Obtain Medication-related
History
Document Medication History
Diagnostic/ Therapeutic
Decisions Made
Medication Ordered
Evaluate order Select medication
Educate patientregarding
medication
Order verified and submitted
Prepare medication
Educate staff regarding
medications
History-Taking
Ordering
Pharmacy Management
Education
Select thecorrect drug for
the correctpatient
Administeraccording toorder and
standards fordrug
Documentadministrationand associated
information
Assess and document
patient responseto medicationaccording to
defined parameters
Intervene asindicated for
adversereaction/error
Administer MedicationMonitor/Evaluate Response Document
Medication Inventory Management
Administration Management
Incident/adverse event surveillance
and reporting
Surveillance49%
11%
14%
26% (Mostly IV)
Bates et al.; JAMA 1995;274:29-34
PBH 04/03
Formulary, purchasing decisions
Inventory management
Dispense/distribute
medication
Medication Management ProcessWhere the Adverse Drug Events originate
Obtain Medication-related
History
Document Medication History
Diagnostic/ Therapeutic
Decisions Made
Medication Ordered
Evaluate order Select medication
Educate patientregarding
medication
Order verified and submitted
Prepare medication
Educate staff regarding
medications
History-Taking
Ordering
Pharmacy Management
Education
Select thecorrect drug for
the correctpatient
Administeraccording toorder and
standards fordrug
Documentadministrationand associated
information
Assess and document
patient responseto medicationaccording to
defined parameters
Intervene asindicated for
adversereaction/error
Administer MedicationMonitor/Evaluate Response Document
Medication Inventory Management
Administration Management
Incident/adverse event surveillance
and reporting
Surveillance49%
11%
14%
26% (Mostly IV)
Bates et al.; JAMA 1995;274:29-34
PBH 04/03
Formulary, purchasing decisions
Inventory management
Dispense/distribute
medication
Medication Management Processwith specific technologies to
reduce errorsObtain
Medication-related History
Document Medication History
Diagnostic/ Therapeutic
Decisions Made
Medication Ordered
Evaluate order Select medication
Educate patientregarding
medication
Order verified and submitted
Prepare medication
Educate staff regarding
medications
History-Taking
Ordering
Pharmacy Management
Education
Select thecorrect drug for
the correctpatient
Administeraccording toorder and
standards fordrug
Documentadministrationand associated
information
Assess and document
patient responseto medicationaccording to
defined parameters
Intervene asindicated for
adversereaction/error
Administer MedicationMonitor/Evaluate Response Document
Medication Inventory Management
Administration Management
Incident/adverse event surveillance
and reporting
Surveillance
•Wireless devices for medication
history capture,
etc.
•PhysicianOrder Entry (PCX)
•Pharmacy Information
Systems
•Robotic dispensin
gsystems
•Bar coding administration, smart
infusion pumps
•AutomatedSurveillanc
e
ElectronicOrder
Transfer(PCX)
PBH 04/03
PCX--”First Pass Stats”
