Duplicate Orders: An Unintended Consequence of Computerized provider/physician order entry (CPOE) Implementation Analysis and Mitigation Strategies
Duplicate Orders: An Unintended Consequence of Computerized provider/physician order entry (CPOE) Implementation Analysis and Mitigation Strategies
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DOI：
10.4338/aci-2012-01-ra-0002
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发表时间：
2012-01-01
影响因子：
2.9
通讯作者：
Shaha, S.
中科院分区：
文献类型：
--
作者：
Magid, S.;Forrer, C.;Shaha, S.
目的：带有临床决策支持 (CDS) 的计算机化提供者/医生医嘱输入 (CPOE) 旨在提高患者安全。然而，已经报告了一些意想不到的后果，包括重复订购。这项时间序列研究的目的是描述重复订单的特征，并制定尽量减少重复订单的策略。方法：时间序列设计，每周系统抽样，持续 84 周。每周我们都会查询 CPOE 数据库，将所有有效订单下载到电子表格中，并突出显示重复订单。我们记录了每个重复订单的以下详细信息：时间、订单详细信息（例如药物、剂量、途径和频率）、订购处方者（包括职位和角色）以及订单是否源自单个订单或订单集（以及订单集的名称）。该分析导致了许多干预措施，包括以下方面的变化：医嘱集、工作流程、处方者培训、药房程序和重复警报。结果：重复的处方更有可能来自不同的处方者，而不是相同的处方者；与来自订单集相比，来自单个订单。干预后，从第 1 周到第 84 周，重复率下降了 84.8%，从最高周（1 周）到最低周（75 周），重复率下降了 94.6%。目前，我们的重复订单可以忽略不计。结论：重复订单可能是 CPOE 的一个重大意外后果。通过分析这些订单，我们能够设计并实施可大幅减少订单的通用策略。 CPOE 实施之前重复订单的发生率未知，我们的数据源自每周活跃订单快照，作为活跃订单总数的样本。因此，应该指出的是，这种方法可能会低估重复订单。
Objective: Computerized provider/physician order entry (CPOE) with clinical decision support (CDS) is designed to improve patient safety. However, a number of unintended consequences which include duplicate ordering have been reported. The objective of this time-series study was to characterize duplicate orders and devise strategies to minimize them.Methods: Time series design with systematic weekly sampling for 84 weeks. Each week we queried the CPOE database, downloaded all active orders onto a spreadsheet, and highlighted duplicate orders. We noted the following details for each duplicate order: time, order details (e. g. drug, dose, route and frequency), ordering prescriber, including position and role, and whether the orders originated from a single order or from an order set (and the name of the order set). This analysis led to a number of interventions, including changes in: order sets, workflow, prescriber training, pharmacy procedures, and duplicate alerts.Results: Duplicates were more likely to originate from different prescribers than from same prescribers; and from order sets than from single orders. After interventions, there was an 84.8% decrease in the duplication rate from weeks 1 to 84 and a 94.6% decrease from the highest (1) to the lowest week (75). Currently, we have negligible duplicate orders.Conclusions: Duplicate orders can be a significant unintended consequence of CPOE. By analyzing these orders, we were able to devise and implement generalizable strategies that significantly reduced them. The incidence of duplicate orders before CPOE implementation is unknown, and our data originate from a weekly snapshot of active orders, which serves as a sample of total active orders. Thus, it should be noted that this methodology likely under-reports duplicate orders.