Integrated Clinical Information System Collaboration Project (CPOE).

摘要

This project is Phase II in the Integrated Clinical Information System Collaboration Project. Phase I of the project included a surrogate measurement for adverse medication outcomes through the collection of data on the number of major contraindicated medication alerts. A high level alert indicates possible serious drug-drug interactions that will likely result in patient harm. Pre-CPOE only the pharmacist saw these alerts. Post-CPOE the physicians saw these alerts initially and were expected to act on them. If the physicians did not take action, the alerts would then be seen by the pharmacist. In the Post-CPOE environment, this dual monitoring system, by physician and pharmacist, is seen as a potential way of reducing potential harmful ADE s. Although Mission Hospital assessed mortality rates along with ADEs in Phase I, there was no provision for effectively measuring ADEs in relation to mortality rates. For phase II of this study Mission Hospital used a tool developed by The Institute for Health Care Improvement (IHI). This is a Trigger Tool for identifying ADEs with harm. This tool includes a list of known ADE triggers and instructions for collecting the data needed to assess the number of ADEs per 1,000 doses and the percentage of admissions with ADEs. Mission Hospital obtained permission from the Institute for Health Care Improvement (IHI) to use this tool to assess and compare patient harm due to medication errors pre and post CPOE.