Computerized physician order entry (cpoe) and

Introduction on FiCiSiEn system in IKN

1. Computerized Physician Order Entry (CPOE) and Medication Safety Azmi Nor Mohd Farez bin Ahmat B. Pharm (UKM), M. Clinical Pharmacy (UKM), BCPS.

2. CPOE? ……Is the process of a medical professional entering medication orders or other physician instructions electronically instead of on paper charts. Institute of Medicine (IOM) ……E-prescribing is a subset of full CPOE, with order entry limited to prescribing.

3. CPOE in IKN

4. CPOE…. where did they came from?

5. To Err is Human: Building a Safer Health System Human beings, in all lines of work, make errors. Errors can be prevented by designing systems that make it hard for people to do the wrong things and easy for people to do the right thing. In health care, building a safer system means designing processes of care to ensure that patient are safe from accidental injury. IOM, National Academy of Sciences, 2000.

6. To Err is Human..

7. Errors! ..approximately 200k people die every year in the US as a result of preventable medical errors. ..Medication errors are estimated to account for at least 7,000 deaths in the United States alone every year. ..Medication error is one of the most common causes of unintentional harm in Australia which results in an estimated 80,000 hospital admissions every year Kohn et al. 1999. Institute of Medicine; Federal Minister for Health and Ageing Australia, 9 September 2003

8. .. a 2013 Meta-analysis found that the likelihood of a prescribing error was reduced by 48% when using CPOE compared with paper-based orders . ..estimated 17.4million medication errors averted in the USA in one year. Why CPOE? Radley et al. 2013. J. Am Med Inform Assoc.

9. .. A study done at a pediatrics hospital in Canada showed a decrease by 40% in medication error rates. ..identify 62% of potential medication errors including drug-allergy interactions, dosing limits and inappropriate routes of administration. Why CPOE? Chaparro et al. 2016. J. Am Med Inform Assoc. King et al. 2003. Pediatrics.

10. .. A study done at a pediatrics hospital in Canada showed a decrease by 40% in medication error rates. …Mortality and LOS decreased in medical and surgical ward. Why CPOE? Lyons et al. 2016. J. Am Med Inform Assoc. King et al. 2003. Pediatrics.

11. .. A study done at a pediatrics hospital in Canada showed a decrease by 40% in medication error rates. …Mortality and LOS decreased in medical and surgical ward. Why CPOE? Lyons et al. 2016. J. Am Med Inform Assoc. King et al. 2003. Pediatrics.

12. Improving both efficiency and accuracy of orders… Reduce errors from poor handwriting. Reduced Incorrect transcription Reduced incomplete prescription Allow direct transmittal of prescription to pharmacies.

13. ..The majority of medical mistakes happen when the physician orders services and prescriptions for the patients. ..Physicians using a paper prescription pad often do not have legible handwriting , and prescriptions often not able to be read by the individuals who process and prepare them for the patient. Charles et al, 2014. Perspectives in health information management

14. …If the pharmacist is not able to read a prescription handwritten by the physician, the patient is at risk of ADEs. …A CPOE may be the solution to decrease the number of ADEs in a hospital, enhanced patient safety and decrease preventable medical errors. Charles et al, 2014. Perspectives in health information management

15. Process In Which The Error Occur 2009 2010 2011 2012 2013 2014

16. E-prescribing .. Remove abbreviations and acronyms and increasing order speed through the used of E-prescribing. ..Remove the need of transcribing . ..Remove in-complete prescription . ..Increased accessibility of patients medical records.

17. E-prescribing .. Warning and alert system . ..Improved formulary adherence . ..Increased patient convenience by reducing waiting time . .. Provider mobility – can approved medication from any desktop.

18. …….Who want to try???

19. Electronic prescription..

20. Incomplete prescription..

21. Which one look batter??

22. PRN dosing..

23. DUR Patient current drugs Interaction Drug allergy Diagnosis Body weight Age Drug appropriateness Correct dosing Contraindications Duplicate orders

24. Overlapping medication.. Reduced duplicate orders

25. Overlapping investigation..

26. Dosage Support

27. Allergy alert..

28. Allergy alert.. But this only can happen if allergy history are UPDATED!

29. Interaction alert… ..Alert system managed to prevent a large number of inappropriate medication orders for the older patient. Massachusetts Medical Centre. 2004

30. Clinical decision support..

31. Drug infusion For Infusion Therapy

32. Drug infusion For Infusion Therapy

33. Thank you… Pusat Maklumat Ubat : 3434/3435

34. AE.. …The number of ADR/ADE decreased by 84%. …If the pharmacist is not able to read a prescription handwritten by the physician, the patient is at risk of ADEs. …A CPOE may be the solution to decrease the number of ADEs in a hospital, enhanced patient safety and decrease preventable medical errors. Charles et al, 2014. Perspectives in health information management