Enhancing Medication CPOE Safety & Quality by Indications Based Prescribing

提高药物 CPOE 安全性

• 批准号: 8827917
• 负责人: Gordon David Schiff
• 金额: $ 24.95万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2017-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8827917
• 关键词: Enhancing; Medication; CPOE; Safety; Quality

DESCRIPTION (provided by applicant): Medication CPOE (Computerized Prescriber Order Entry), currently lacks an essential safety feature-the indication for the prescription. Re-engineering CPOE to incorporate drug indications is vital and likely to markedly improve quality and safety in 6 key areas: medication error prevention and mitigation, facilitating patient education, promoting prescribing drugs-of-choice, enhanced team communication, organizing med lists for medication reconciliation, enabling more meaningful comparative outcomes research. We will bring together key stakeholders with experts in HIT, patient safety, pharmacy practice, HIT knowledge and EMR vendors, and user-centered design to achieve consensus on key issues related to the rationale, feasibility, features, barriers, and risks related to indicatins-based prescribing (I-CPOE). We will create 6 panels to: 1) delineate the construct and experience with I-CPOE, 2) indentify role and approaches of I-CPOE in preventing and recognizing med errors, 3) spell out role and practical logistics for I-CPOE related to pharmacists and pharmacies, 4) develop ways I-CPOE can impact patient education, 5) understand ways to implement drugs-of-choice recommendations into CPOE, and 6) develop strategies for overcoming technical challenges and interface with knowledge and EMR vendors. Using a modified Delphi approach we will achieve consensus on these key strategic and design issues. Based on the findings from this consensus development phase, along with formally collected user requirements, we will build and test a working prototype for an I-CPOE ordering system. This will be accomplished in four phases: creation of user requirements document, participatory design sessions, contextual inquiry sessions, and usability testing with iterative completion of a final high fidelity prototype. We will proceed to test the safety, speed, and satisfaction of this working prototype compared to two well established EMRs (LMR, and Epic). We will also compare the usability and safety of the prescriptions generated from these 3 systems (2 standard vs I-CPOE prototype) from the perspective of pharmacists and patients, examining their assessments of indications-enabled prescriptions and medication lists. Overall, these tests will test the hypothesis that I-CPOE prescribing, prescriptions, and medication lists are safer and superior in key measures of HIT safety, efficiency and satisfaction. Finally we will work with our partnering stakeholders to disseminate our tools, prototype and findings to advance the agenda and development of indications-based prescribing thereby facilitating progress toward this stalled patient safety recommendation and goal. ,

描述（由申请人提供）：药物CPOE（计算机处方单录入），目前缺乏基本的安全特征-处方的适应症。重新设计CPOE以纳入药物适应症至关重要，并可能显著提高6个关键领域的质量和安全性：预防和减轻用药错误，促进患者教育，促进处方选择，加强团队沟通，组织药物调和的医疗清单，实现更有意义的比较结果研究。我们将召集关键利益相关者与HIT、患者安全、药房实践、HIT知识和EMR供应商以及以用户为中心的设计方面的专家，就与基于适应症的处方（I-CPOE）相关的基本原理、可行性、特征、障碍和风险等关键问题达成共识。我们将创建6个小组：1)描述I-CPOE的构建和经验，2)确定I-CPOE在预防和识别医疗错误方面的作用和方法，3)阐明与药剂师和药房相关的I-CPOE的作用和实际物流，4)开发I-CPOE影响患者教育的方法，5)了解在CPOE中实施药物选择建议的方法，以及6)制定克服技术挑战的策略，并与知识和EMR供应商进行接口。使用改进的德尔菲方法，我们将在这些关键的战略和设计问题上达成共识。基于这个共识开发阶段的发现，以及正式收集的用户需求，我们将构建和测试I-CPOE订购系统的工作原型。这将在四个阶段完成：创建用户需求文档，参与设计会议，上下文查询会议，以及迭代完成最终高保真原型的可用性测试。我们将继续测试这个工作原型的安全性、速度和满意度，并将其与两个完善的emr （LMR和Epic）进行比较。我们还将从药剂师和患者的角度比较这3种系统（2种标准与I-CPOE原型）生成的处方的可用性和安全性，检查他们对具有适应症的处方和药物清单的评估。总的来说，这些测试将验证I-CPOE处方、处方和药物清单在HIT安全性、效率和满意度的关键指标上更安全、更优越的假设。最后，我们将与我们的伙伴利益相关者合作，传播我们的工具、原型和研究结果，以推进基于适应症的处方的议程和发展，从而促进这一停滞不前的患者安全建议和目标的进展。，