Int J Med Inform - Conducting an efficient proactive risk assessment prior to CPOE implementation in an intensive care unit.

Tópicos

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Resumo

RPOSE: To develop, conduct, and evaluate a proactive risk assessment (PRA) of the design and implementation of CPOE in an ICU.METHODS: We developed a PRA method based on issues identified from documented experience with conventional PRA methods and the constraints of an organization about to implement CPOE in an intensive care unit. The PRA method consists of three phases: planning (three months), team (one five-hour meeting), and evaluation (short- and long-term).RESULTS: Sixteen unique relevant vulnerabilities were identified as a result of the PRA team's efforts. Negative consequences resulting from the vulnerabilities included potential patient safety and quality of care issues, non-compliance with regulatory requirements, increases in cognitive burden on CPOE users, and/or worker inconvenience or distress. Actions taken to address the vulnerabilities included redesign of the technology, process (workflow) redesign, user training, and/or ongoing monitoring. Verbal and written evaluation by the team members indicated that the PRA method was useful and that participants were willing to participate in future PRAs. Long-term evaluation was accomplished by monitoring an ongoing "issues list" of CPOE problems identified by or reported to IT staff. Vulnerabilities identified by the team were either resolved prior to CPOE implementation (n=7) or shortly thereafter (n=9). No other issues were identified beside those identified by the team.CONCLUSIONS: Generally positive results from the various evaluations including a long-term evaluation demonstrate the value of developing an efficient PRA method that meets organizational and contextual requirements and constraints.

Resumo Limpo

rpose develop conduct evalu proactiv risk assess pra design implement cpoe icumethod develop pra method base issu identifi document experi convent pra method constraint organ implement cpoe intens care unit pra method consist three phase plan three month team one fivehour meet evalu short longtermresult sixteen uniqu relev vulner identifi result pra team effort negat consequ result vulner includ potenti patient safeti qualiti care issu noncompli regulatori requir increas cognit burden cpoe user andor worker inconveni distress action taken address vulner includ redesign technolog process workflow redesign user train andor ongo monitor verbal written evalu team member indic pra method use particip will particip futur pras longterm evalu accomplish monitor ongo issu list cpoe problem identifi report staff vulner identifi team either resolv prior cpoe implement n short thereaft n issu identifi besid identifi teamconclus general posit result various evalu includ longterm evalu demonstr valu develop effici pra method meet organiz contextu requir constraint

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