Patient safety/medication safety: The impact of computerized physician order entry on medication error prevention in hospitalized patients
Projectomschrijving
Bij het handmatig voorschrijven van medicijnen kunnen fouten ontstaan die soms leiden tot schade bij patiënten. Door bij het voorschrijven van medicijnen gebruik te maken van een elektronisch systeem dat de voorschrijver tevens ondersteunt bij het kiezen van het juiste medicijn, neemt het aantal medicatiefouten af. De Groningse onderzoekers gingen na of dit ook leidt tot minder schade bij patiënten. Een test in twee grote ziekenhuizen bij 1195 patiënten wijst uit dat dit inderdaad zo is. Het aantal medicatiefouten nam met 40 procent af, de schade halveerde. De kosten per uitgeschreven recept stegen door het in gebruik nemen van het elektronische systeem met minder dan 3 euro per recept. De extra kosten om één fout (vermijdbare) medicatiefout te voorkomen lijken daarom acceptabel. Helemaal als hierdoor extra opnamedagen in het ziekenhuis voorkomen kunnen worden. De gebruikers van het elektronisch voorschrijfsysteem (artsen, verpleegkundigen) zijn tevreden over de nieuwe manier van werken.
Verslagen
Eindverslag
Samenvatting van de aanvraag
Summary: Patient safety is a relevant problem in health care, in terms of quality as well as efficiency. An important aspect concerns medication, where safety is threatened because of medication errors and (preventable) Adverse Drug Events (ADEs). For adults, the reported incidence of errors in treatment with medications ranges in the US from 1% to 30% of all hospital admissions, or 5% of all written medication orders. In the Netherlands the prevalence has recently been estimated as 10% of all prescriptions. Several strategies may reduce medication errors and ADEs with success, as shown in the ?Breakthrough Programme? of the CBO. Medication errors are not only of interest from a patient safety point of view but also from an economic point of view. They have been estimated to increase the costs with $ 4700 per hospital admission in the US. In the Netherlands it is estimated that reducing the medication errors and preventable ADEs by half will lead to substantial cost reduction in hospitals. For a hospital with the size of a University Hospital (28.000 admissions per year) the reduction can be up to € 588.000,- hospital wide. For a General Hospital like The Twee Steden Hospital Tilburg (18.000 admissions per year), the reduction can be up to € 380.000 hospital wide. The aim of this study is to evaluate the effects of Computerised Physician Order Entry (CPOE) in combination with a Clinical Decision Support System (CDSS), on the incidence of medication errors, (preventable) ADEs length of hospital stay and costs. The design of the study will be interrupted time series with one intervention (CPOE/CDSS) and will be performed at four medical units of the University Hospital Groningen respectively Twee Steden Hospital Tilburg. The power-data analysis is based on 80 beds; 25-30 medication orders per admission; 6-8 medication orders per patient-day. Assuming an average medication error frequency of 10% (medication order based), alpha=0.05 and a power of 80% we should be able to identify relative difference between de baseline period and the period after CPOE/CDSS intervention of approximately 50%. The economic evaluation is based on the comparison of the costs and effects of a traditional hand-written medication order system and the use of Computerised Physician Order Entry in combination with a Clinical Decision Support System (CPOE/CDSS) and will be conducted from a hospital perspective. Because the main focus of this study is patient safety and the proposed intervention aims at a reduction of medication errors and Adverse Drug Events this is also reflected in the outcome measures of the cost effectiveness analysis and so no quality of life analysis is performed. The project will be over a period of 24 months with a preparatory period of 3 months followed by a period of 4-6 months for datacollection and analysis of the baseline period; 3 month period for CPOE/CDSS introduction followed by a 6 month period for datacollection and outcome analysis and finally a 6 month period for datahandling, interpretation, publication and dissemination of knowledge. Samenvatting: Zie bijlage