subject: Medication Safety Results Present An Iron-clad Case For Mckesson Cpoe [print this page] When we started rolling out a computerized physician order entry (CPOE) system from McKesson at Peninsula Regional Medical Center in 2005, I felt that I had a solid argument for adoption.
As the chief medical information officer, I told physicians and other caregivers that the CPOE system would help us to minimize errors and provide safer care to our patients. Plain and simple, I thought playing the patient safety card would be more than enough to persuade clinicians of the need for change.
One physician, however, said he would not use the system until I could unequivocally prove to him that CPOE could, in fact, improve medical care at Peninsula Regional. In essence, he demanded a well-rounded Aristotelian argument that included not only emotional and logical appeals but concrete data as well.
As a result, I took a methodical approach to decision supportstarting with the orthopedic department. I reasoned that these physicians would be most amenable to CPOE because they practice medicine in an evidence-based manner. A "peer-to-peer" training program also helped get physicians, nurses and pharmacists up to speed quickly.
Most important, we leveraged key interdisciplinary teamsone focusing on anticoagulants and the other on narcotic medications. Focusing our CPOE efforts on use of these medications would help the hospital achieve some significant patient safety wins and reduce some of the dangers associated with high-risk medications.
By using CPOE with high-risk medications, we've been able to:
1. Eliminate concurrent orders of heparin and lovenox, a combination that results in potentially
dangerous complications. The two medications were ordered concurrently three times
between January and June of 2009, but were prevented when a CPOE order that stops
concurrent orders was put into play.
2. Reduce the number of patients with elevated INR (international normalized ratio) for blood
clotting time from greater than 20% to about 10% in a one-year period.
3. Increase compliance with an accepted heparin protocol by 60%, greatly improving
anticoagulation management.
4. Achieve a 19% reduction in adverse drug reactions with dilaudid, a highly overused and
potentially dangerous narcotic medication.
These results have made it possible to convince the naysayerssuch as the physician who resisted our initial effortsthat CPOE is worth it. We now operate with 85% CPOE adoption. Instead of spending time trying to persuade clinicians to adopt CPOE, I am working to keep up with the demand for CPOE-driven decision support.
For a complete version of this article, or to learn more about medication safety or CPOE, visit McKesson online.
