Evaluating Prescribing Errors pre- and post- CPOE in the Ambulatory Setting

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Evaluating Prescribing Errors pre- and post- CPOE
in the Ambulatory Setting

• The University of Washington, Seattle, WA
• and
• The Everett Clinic, Everett, WA
• AHRQ HIT Grant 1 UC1 HS15319-01
• Beth Devine, PharmD, MBA
• Research Assistant Professor
• Department of Pharmacy, University of Washington

AHRQ Patient Safety and Health IT Conference
June 6-10, 2005
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The Everett Clinic

• Physician owned and managed multi-specialty
  integrated health-system with a 79-year history
• 13 locations 60 clinics
• Ancillary services
• 200 Physicians/1,250 Employees
• 200,000 patients
• 600,000 ambulatory visits annually
• Core values
• We do what is right for each patient
• We provide an enriching and supportive workplace
• Our team focuses on value service, quality and
  cost

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The Everett ClinicsACPOE Software

• EMR development began in 1995 chart notes, labs
  and imaging reports
• Utilizes subscription to commercial drug database
  as back end (Multum?)
• Features of ACPOE system
• Ability to write new prescriptions (output
  fax/print)
• Ability to refill prescriptions
• Optimizes ideal choice of medication
• Automatically generates medication list as
  prescriptions are written
• Pediatric antibiotic dosing by weight
• Builds patient drug database, improving disease
  management

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AHRQ HIT GrantSpecific Aims

• Evaluate pre- post-implementation medication
  errors and adverse drug events (ADEs)
• Measure pre- post- workload processes
• Process metrics (chart pulls, prescriptions
  written)
• Time-motion study
• Evaluate the impact of the ACPOE system on human
  factors
• Focus groups
• Survey assessing readiness to adopt IT

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Aims of Medication Error Study

• Evaluate the incidence of medication errors,
  comparing errors pre- to post-ACPOE
  implementation
• Characterize the epidemiology of these errors

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Methods

• Retrospective cohort study
• Review of 1,500 prescriptions in each of the two
  time frames (pre- post-)
• New prescriptions written for patients between
  18-88 years in one internal medicine clinic
  filled at the onsite pharmacy
• Adopted the definition and severity index of the
  NCC MERP1
• Other characteristics defined a priori
• Data sources prescriptions, EMR, laboratory
  values
• Primary outcome error yes/no
• Secondary outcomes characteristics and severity

1National Coordinating Council for Medication
Error Reporting and Prevention.
http//www.nccmerp.org/aboutMedErrors.html
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Results (1) Incidence of Potential and
Medication Errors
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Results (2) Severity of Potential and Medication
Errors
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Results (3)Characteristics of Errors (1)
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Results (4)Characteristics of Errors (2)
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Results(5) Patient Safety

• ACPOE reduces medication errors
• ACPOE eliminates types of errors (illegibility,
  abbreviations)
• ACPOE introduces new types of errors (picking
  errors)
• ACPOE causes different types of errors than CPOE
• ACPOE standardizes care of patients and reduce
  unnecessary variation
• Data available to help optimize quality and cost
  of prescribing

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Current Status of ACPOE

• Roll-out faster than planned!
• High adoption 150 MDs, DOs, ARNPs, and PAs are
  electronically prescribing
• gt250 staff supporting electronic prescribing
• gt320,000 electronic prescriptions sent
• Roll out to more providers underway
• Undertaking clinical decision support programming
  to address medication errors beginning with
  drug-lab ordering

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AHRQ Grant Team Members

• The Everett Clinic
• Al Fisk, MD, MMM (Co-PI)
• Jennifer Wilson-Norton, RPh, MBA
• Nathan Lawless, RPh
• Dick Rafoth, MD
• IT members, hospital members
• University of Washington
• Sean Sullivan, PhD (Co-PI)
• Beth Devine, PharmD, MBA
• Will Hollingworth, PhD
• Tom Payne, MD
• Ryan Hansen, PharmD
• Kathleen Tharp