Appl Clin Inform - Conversion of a single-facility pediatric antimicrobial stewardship program to multi-facility application with computerized provider order entry and clinical decision support.

Tópicos

{ medic(1828) order(1363) alert(1069) }
{ implement(1333) system(1263) develop(1122) }
{ data(3963) clinic(1234) research(1004) }
{ ehr(2073) health(1662) electron(1139) }
{ time(1939) patient(1703) rate(768) }
{ health(1844) social(1437) communiti(874) }
{ take(945) account(800) differ(722) }
{ error(1145) method(1030) estim(1020) }
{ use(976) code(926) identifi(902) }
{ clinic(1479) use(1117) guidelin(835) }
{ perform(1367) use(1326) method(1137) }
{ spatial(1525) area(1432) region(1030) }
{ record(1888) medic(1808) patient(1693) }
{ patient(2837) hospit(1953) medic(668) }
{ first(2504) two(1366) second(1323) }
{ use(2086) technolog(871) perceiv(783) }
{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
{ imag(1057) registr(996) error(939) }
{ design(1359) user(1324) use(1319) }
{ general(901) number(790) one(736) }
{ risk(3053) factor(974) diseas(938) }
{ drug(1928) target(777) effect(648) }
{ imag(1947) propos(1133) code(1026) }
{ network(2748) neural(1063) input(814) }
{ assess(1506) score(1403) qualiti(1306) }
{ treatment(1704) effect(941) patient(846) }
{ chang(1828) time(1643) increas(1301) }
{ concept(1167) ontolog(924) domain(897) }
{ health(3367) inform(1360) care(1135) }
{ data(2317) use(1299) case(1017) }
{ sampl(1606) size(1419) use(1276) }
{ data(3008) multipl(1320) sourc(1022) }
{ structur(1116) can(940) graph(676) }
{ activ(1452) weight(1219) physic(1104) }
{ model(3404) distribut(989) bayesian(671) }
{ can(774) often(719) complex(702) }
{ data(1737) use(1416) pattern(1282) }
{ inform(2794) health(2639) internet(1427) }
{ system(1976) rule(880) can(841) }
{ measur(2081) correl(1212) valu(896) }
{ bind(1733) structur(1185) ligand(1036) }
{ sequenc(1873) structur(1644) protein(1328) }
{ method(1219) similar(1157) match(930) }
{ featur(3375) classif(2383) classifi(1994) }
{ imag(2830) propos(1344) filter(1198) }
{ imag(2675) segment(2577) method(1081) }
{ patient(2315) diseas(1263) diabet(1191) }
{ studi(2440) review(1878) systemat(933) }
{ motion(1329) object(1292) video(1091) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ framework(1458) process(801) describ(734) }
{ problem(2511) optim(1539) algorithm(950) }
{ learn(2355) train(1041) set(1003) }
{ algorithm(1844) comput(1787) effici(935) }
{ extract(1171) text(1153) clinic(932) }
{ method(1557) propos(1049) approach(1037) }
{ data(1714) softwar(1251) tool(1186) }
{ control(1307) perform(991) simul(935) }
{ model(2220) cell(1177) simul(1124) }
{ care(1570) inform(1187) nurs(1089) }
{ method(984) reconstruct(947) comput(926) }
{ search(2224) databas(1162) retriev(909) }
{ featur(1941) imag(1645) propos(1176) }
{ case(1353) use(1143) diagnosi(1136) }
{ howev(809) still(633) remain(590) }
{ studi(1410) differ(1259) use(1210) }
{ perform(999) metric(946) measur(919) }
{ research(1085) discuss(1038) issu(1018) }
{ system(1050) medic(1026) inform(1018) }
{ import(1318) role(1303) understand(862) }
{ model(2341) predict(2261) use(1141) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ studi(1119) effect(1106) posit(819) }
{ blood(1257) pressur(1144) flow(957) }
{ model(3480) simul(1196) paramet(876) }
{ monitor(1329) mobil(1314) devic(1160) }
{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ model(2656) set(1616) predict(1553) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
{ cost(1906) reduc(1198) effect(832) }
{ group(2977) signific(1463) compar(1072) }
{ gene(2352) biolog(1181) express(1162) }
{ intervent(3218) particip(2042) group(1664) }
{ activ(1138) subject(705) human(624) }
{ patient(1821) servic(1111) care(1106) }
{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ use(1733) differ(960) four(931) }
{ result(1111) use(1088) new(759) }
{ survey(1388) particip(1329) question(1065) }
{ estim(2440) model(1874) function(577) }
{ decis(3086) make(1611) patient(1517) }
{ process(1125) use(805) approach(778) }
{ method(1969) cluster(1462) data(1082) }
{ method(2212) result(1239) propos(1039) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

JECTIVE: Antimicrobial stewardship programs (ASPs) help meet quality and safety goals with regard to antimicrobial use. Prior to CPOE implementation, the ASP at our pediatric tertiary hospital developed a paper-based order set containing recommendations for optimization of dosing. In adapting our ASP for CPOE, we aimed to preserve consistency in our ASP recommendations and expand ASP expertise to other hospitals in our health system.METHODS: Nine hospitals in our health system adopted pediatric CPOE and share a common domain (Cerner Millenium). ASP clinicians developed sixty individual electronic order sets (vendor reference PowerPlans) to be used independently or as part of larger electronic order sets. Analysis of incidents reported during CPOE implementation and medication variances reports was used to determine the effectiveness of the ASP adaptation.RESULTS: 769 unique PowerPlans were used 15,889 times in the first 30 days after CPOE implementation. Of these, 43 were PowerPlans included in the ASP design and were used a total of 1149 times (7.2% of all orders). During CPOE implementation, 437 incidents were documented, 1.1% of which were associated with ASP content or workflow. Additionally, analysis of medication variance following CPOE implementation showed that ASP errors accounted for 2.9% of total medication variances.DISCUSSION: ASP content and workflow accounted for proportionally fewer incidents than expected as compared to equally complex and frequently used CPOE content.CONCLUSION: Well-defined ASP recommendations and modular design strengthened successful CPOE implementation, as well as the adoption of specialized pediatric ASP expertise with other facilities.

Resumo Limpo

jectiv antimicrobi stewardship program asp help meet qualiti safeti goal regard antimicrobi use prior cpoe implement asp pediatr tertiari hospit develop paperbas order set contain recommend optim dose adapt asp cpoe aim preserv consist asp recommend expand asp expertis hospit health systemmethod nine hospit health system adopt pediatr cpoe share common domain cerner millenium asp clinician develop sixti individu electron order set vendor refer powerplan use independ part larger electron order set analysi incid report cpoe implement medic varianc report use determin effect asp adaptationresult uniqu powerplan use time first day cpoe implement powerplan includ asp design use total time order cpoe implement incid document associ asp content workflow addit analysi medic varianc follow cpoe implement show asp error account total medic variancesdiscuss asp content workflow account proport fewer incid expect compar equal complex frequent use cpoe contentconclus welldefin asp recommend modular design strengthen success cpoe implement well adopt special pediatr asp expertis facil

Resumos Similares

J Am Med Inform Assoc - A nationwide medication incidents reporting system in The Netherlands. ( 0,71248987334348 )
Comput Methods Programs Biomed - A guideline-based decision support for pharmacological treatment can improve the quality of hyperlipidemia management. ( 0,699898297677576 )
J Med Syst - A data-mining framework for transnational healthcare system. ( 0,673128360277757 )
J Am Med Inform Assoc - An analysis of electronic health record-related patient safety concerns. ( 0,671119802759904 )
Appl Clin Inform - A review of medication reconciliation issues and experiences with clinical staff and information systems. ( 0,662249424106013 )
AMIA Annu Symp Proc - How many medication orders are entered through free-text in EHRs?--a study on hypoglycemic agents. ( 0,660439242777841 )
Appl Clin Inform - Electronic medical record prompts for lab orders in patients initiating statins. ( 0,656578994140339 )
Health Informatics J - Implementation of smart pump technology in a paediatric intensive care unit. ( 0,64515283653111 )
J Am Med Inform Assoc - Informatics and data quality at collaborative multicenter Breast and Colon Cancer Family Registries. ( 0,643542498641148 )
J Am Med Inform Assoc - Failure to utilize functions of an electronic prescribing system and the subsequent generation of 'technically preventable' computerized alerts. ( 0,639135085790395 )
J Am Med Inform Assoc - Integrating pharmacogenetic information and clinical decision support into the electronic health record. ( 0,635943486593892 )
Methods Inf Med - Attitude of physicians towards automatic alerting in computerized physician order entry systems. A comparative international survey. ( 0,635737086490283 )
BMC Med Inform Decis Mak - The Intego database: background, methods and basic results of a Flemish general practice-based continuous morbidity registration project. ( 0,630746204260269 )
Int J Med Inform - A comprehensive RFID solution to enhance inpatient medication safety. ( 0,629399666329761 )
J Biomed Inform - Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions. ( 0,619424432102849 )
AMIA Annu Symp Proc - Implementing a Real-time Complex Event Stream Processing System to Help Identify Potential Participants in Clinical and Translational Research Studies. ( 0,618685673715574 )
AMIA Annu Symp Proc - An interface terminology for medical imaging ordering purposes. ( 0,618240817660425 )
Int J Med Inform - Operational rules for the implementation of INN prescribing. ( 0,616622420066248 )
Int J Med Inform - What, if all alerts were specific - estimating the potential impact on drug interaction alert burden. ( 0,613476120700513 )
J Am Med Inform Assoc - Factors contributing to an increase in duplicate medication order errors after CPOE implementation. ( 0,611201498245858 )
BMC Med Inform Decis Mak - Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents. ( 0,610594736421438 )
J Clin Monit Comput - Connecting the dots: rule-based decision support systems in the modern EMR era. ( 0,608344893315233 )
J Am Med Inform Assoc - Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system. ( 0,603395631065916 )
J Am Med Inform Assoc - Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey. ( 0,602980796662356 )
BMC Med Inform Decis Mak - Development of a context model to prioritize drug safety alerts in CPOE systems. ( 0,6019108195759 )
Int J Med Inform - Impact of electronic order management on the timeliness of antibiotic administration in critical care patients. ( 0,600586243497765 )
Appl Clin Inform - JADE: a tool for medical researchers to explore adverse drug events using health claims data. ( 0,593590503322583 )
J Am Med Inform Assoc - Optimization of drug-drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard. ( 0,593172370669001 )
J Am Med Inform Assoc - Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE). ( 0,590970656785031 )
Telemed J E Health - Electronic prescriptions are slowly spreading in the European Union. ( 0,590620908705342 )
J Am Med Inform Assoc - Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. ( 0,58957968139718 )
Appl Clin Inform - Analysis of electronic medication orders with large overdoses: opportunities for mitigating dosing errors. ( 0,589098934790742 )
Appl Clin Inform - Reducing risk with clinical decision support: a study of closed malpractice claims. ( 0,586455303298283 )
Comput. Biol. Med. - NeuPAT: an intranet database supporting translational research in neuroblastic tumors. ( 0,58626202323799 )
AMIA Annu Symp Proc - Evaluation of RxNorm for Medication Clinical Decision Support. ( 0,585083125990781 )
J Med Syst - A proposed approach for safety management in medical software design. ( 0,583722375012836 )
J Am Med Inform Assoc - Prescribers' expectations and barriers to electronic prescribing of controlled substances. ( 0,58363512212404 )
J Am Med Inform Assoc - Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period. ( 0,583430833957199 )
J Am Med Inform Assoc - Early cost and safety benefits of an inpatient electronic health record. ( 0,582763205430231 )
J Am Med Inform Assoc - Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool. ( 0,582636846423538 )
BMC Med Inform Decis Mak - A cross-sectional pilot study assessing needs and attitudes to implementation of Information and Communication Technology for rational use of medicines among healthcare staff in rural Tanzania. ( 0,581356075059695 )
J Am Med Inform Assoc - Development and use of active clinical decision support for preemptive pharmacogenomics. ( 0,579623943516851 )
Comput Methods Programs Biomed - Potential drug-drug interactions in pediatric outpatient prescriptions for newborns and infants. ( 0,578727938857848 )
AMIA Annu Symp Proc - Reducing free-text communication orders placed by providers using association rule mining. ( 0,578436273661563 )
J Am Med Inform Assoc - A framework for evaluating the appropriateness of clinical decision support alerts and responses. ( 0,577631503822239 )
Appl Clin Inform - Associations between the concurrent use of clinical decision support and computerized provider order entry and the rates of appropriate prescribing at discharge. ( 0,577526248121367 )
J Am Med Inform Assoc - Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. ( 0,577126639742483 )
AMIA Annu Symp Proc - Reducing wrong patient selection errors: exploring the design space of user interface techniques. ( 0,576112764413543 )
Comput Methods Programs Biomed - A smart medication recommendation model for the electronic prescription. ( 0,573289178201081 )
Comput Methods Programs Biomed - A simple versatile solution for collecting multidimensional clinical data based on the CakePHP web application framework. ( 0,572724018496796 )
J Am Med Inform Assoc - N-CANDA data integration: anatomy of an asynchronous infrastructure for multi-site, multi-instrument longitudinal data capture. ( 0,571847190603079 )
Med Biol Eng Comput - Strategy for NSAID administration to aspirin-intolerant asthmatics in combination with PGE2 analogue: a theoretical approach. ( 0,571403731328081 )
AMIA Annu Symp Proc - Developing national eHealth infrastructures--results and lessons from Europe. ( 0,570082377545456 )
Telemed J E Health - Rural inpatient telepharmacy consultation demonstration for after-hours medication review. ( 0,566740066229893 )
J Am Med Inform Assoc - Don't fuel the fire: decreasing intravenous haloperidol use in high risk patients via a customized electronic alert. ( 0,566590208437242 )
Appl Clin Inform - Medication safety improves after implementation of positive patient identification. ( 0,566520107920499 )
J Am Med Inform Assoc - Classification of medication incidents associated with information technology. ( 0,566206224100327 )
J Am Med Inform Assoc - How to improve the delivery of medication alerts within computerized physician order entry systems: an international Delphi study. ( 0,565585994264622 )
J Am Med Inform Assoc - Errors associated with outpatient computerized prescribing systems. ( 0,565518706435656 )
J. Med. Internet Res. - Ethical principles for physician rating sites. ( 0,564929176031724 )
BMC Med Inform Decis Mak - Physicians' perceptions on the usefulness of contextual information for prioritizing and presenting alerts in Computerized Physician Order Entry systems. ( 0,564927936592256 )
AMIA Annu Symp Proc - Ontological approach for safe and effective polypharmacy prescription. ( 0,564151137103043 )
Perspect Health Inf Manag - A journey through meaningful use at a large academic medical center: lessons of leadership, administration, and technical implementation. ( 0,563943229910318 )
J Med Syst - Development of a point-of-care HIV/AIDS medication dosing support system using the Android mobile platform. ( 0,563625990669248 )
Appl Clin Inform - Drug interaction alert override rates in the Meaningful Use era: no evidence of progress. ( 0,562056502449455 )
BMC Med Inform Decis Mak - Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model. ( 0,559925530944899 )
Perspect Health Inf Manag - Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting. ( 0,559447544061371 )
Int J Med Inform - Misspellings in drug information system queries: characteristics of drug name spelling errors and strategies for their prevention. ( 0,559190291269604 )
Appl Clin Inform - Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System: A systematic approach to decrease alerts. ( 0,559109575447026 )
Int J Med Inform - Evaluating the medication process in the context of CPOE use: the significance of working around the system. ( 0,558524192449219 )
J Am Med Inform Assoc - Impact of clinical decision support preventing the use of QT-prolonging medications for patients at risk for torsade de pointes. ( 0,557671011429271 )
Methods Inf Med - From adverse drug event detection to prevention. A novel clinical decision support framework for medication safety. ( 0,55737494329535 )
Int J Med Inform - Medication errors in residential aged care facilities: a distributed cognition analysis of the information exchange process. ( 0,556306910882081 )
J Am Med Inform Assoc - Using EHRs to integrate research with patient care: promises and challenges. ( 0,556133700486029 )
AMIA Annu Symp Proc - Evaluating the effectiveness of clinical alerts: a signal detection approach. ( 0,555906744447207 )
J Am Med Inform Assoc - Overrides of medication-related clinical decision support alerts in outpatients. ( 0,555798795613348 )
Int J Med Inform - Evaluation of medication dose alerts in pediatric inpatients. ( 0,55474478660927 )
J Am Med Inform Assoc - The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. ( 0,55368298081022 )
Artif Intell Med - Safety and usability evaluation of a web-based insulin self-titration system for patients with type 2 diabetes mellitus. ( 0,552888860870224 )
BMC Med Inform Decis Mak - Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence. ( 0,552887377719944 )
Int J Med Inform - Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. ( 0,552307357212461 )
Perspect Health Inf Manag - Enhance the accuracy of medication histories for the elderly by using an electronic medication checklist. ( 0,552092740853356 )
J Am Med Inform Assoc - Improving the utilization of admission order sets in a computerized physician order entry system by integrating modular disease specific order subsets into a general medicine admission order set. ( 0,55200205117093 )
Perspect Health Inf Manag - Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events? ( 0,550768777446034 )
Appl Clin Inform - Use of clinical decision support to improve the quality of care provided to older hospitalized patients. ( 0,55071179206322 )
J. Med. Internet Res. - Physician order entry or nurse order entry? Comparison of two implementation strategies for a computerized order entry system aimed at reducing dosing medication errors. ( 0,55025164529067 )
Artif Intell Med - Evaluation of rule effectiveness and positive predictive value of clinical rules in a Dutch clinical decision support system in daily hospital pharmacy practice. ( 0,549379624402623 )
J Med Syst - Two RFID-based solutions for secure inpatient medication administration. ( 0,549275089228162 )
AMIA Annu Symp Proc - Improving Patient Safety through Medical Alert Management: An Automated Decision Tool to Reduce Alert Fatigue. ( 0,549207410216661 )
J Am Med Inform Assoc - Prevalence of medication administration errors in two medical units with automated prescription and dispensing. ( 0,548463823634674 )
J Am Med Inform Assoc - The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals. ( 0,548407055443778 )
J Am Med Inform Assoc - Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system. ( 0,548061205898942 )
J Am Med Inform Assoc - Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM. ( 0,546218855704625 )
J Am Med Inform Assoc - Early experience with electronic prescribing of controlled substances in a community setting. ( 0,546089993968427 )
J Am Med Inform Assoc - Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors. ( 0,546049572981887 )
Int J Med Inform - Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. ( 0,54582374164402 )
Int J Med Inform - Technology-related medication errors in a tertiary hospital: a 5-year analysis of reported medication incidents. ( 0,545312196617802 )
Telemed J E Health - E-health implementation challenges in Iranian medical centers: a qualitative study in Iran. ( 0,544747509379681 )
Appl Clin Inform - Implementing Black Box Warnings (BBWs) in Health Information Systems: An Organizing Taxonomy Identifying Opportunities and Challenges. ( 0,544625676812073 )
AMIA Annu Symp Proc - I meant that med for Baylee not Bailey!: a mixed method study to identify incidence and risk factors for CPOE patient misidentification. ( 0,543362058161353 )