1. Improving Medication Prescribing Through Computerized Physician Order Entry Team Membership: Loyola University Physician Foundation, Department of Nursing, Medical Center Information Systems, Electronic Health Record Systems, Pharmacy, and the Center for Clinical Effectiveness

2. Opportunity Statement and Desired Outcome Goal: Reduce the number of times a pharmacist must intervene to modify or correct an issue related to the handwriting of a medication order. There is evidence that Computerized Physician Order Entry (CPOE) significantly reduces adverse drug events related to prescribing and transcribing. This leads to improved quality of care and significant savings in pharmacist time.

3. Identification of Most Likely Causes for Pharmacist Interventions More than 90% of pharmacy interventions relate to prescribing and transcribing issues. Approximately 92% of medication issues identified by pharmacists have the potential for significant clinical consequences. MEDICATION ORDER ISSUES REQUIRING PHARMACIST INTERVENTION (CY00) 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2,000 PrescribingPrescribing/ Transcribing Total Pharmacy Interventions 0 CLINICAL SIGNIFICANCE OF PHARMACY INTERVENTIONS (CY00) 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2,000 MEDIUM MAJOR MINOR Total Pharmacy Interventions 0

4. Solutions Implemented EDUCATION/TRAINING/WORKFLOW: Educate physicians, nurses and students regarding impact of CPOE on patient care Train physicians and students to use CPOE for medications Redesign nursing and ward secretary workflow and educate staff Develop process for stat/verbal orders Develop LUMC policy for CPOE Develop backup plan for when LUCI is down

5. Solutions Implemented TECHNOLOGY ISSUES: Obtain feedback from residents regarding organization of LUCI screens Modify LUCI screens to facilitate physician order entry Develop a LUCI screen of most commonly ordered medications Install sufficient PC’s and printers in all patient care areas Create a solution to route orders printed at nursing stations IMPLEMENTATION: POE had previously been implemented in NICU and the Burn Unit Feb-Nov 2001: - Implement progressively in all ICUs - Nov 2001: Pilot on 7W medical-surgical floor Hospital-wide implementation on March 4, 2002

6. Results Pharmacy interventions related to transcribed medication orders have decreased from 50-100 per month to approximately 3 per month following house-wide implementation of computerized physician order entry. Computerized Physician Order Entry reduced the number of medication issues related to transcribing of medication orders by 98%. Prescribing-related medication issues also appear to have declined significantly.

8. Prescription Related Medication Issues Pharmacy Interventions Prescription Related Medication Events 01/01/200003/01/200005/01/200007/01/200009/01/200011/01/200001/01/200103/01/200105/01/200107/01/200109/01/200111/01/200101/01/200203/01/200205/01/200207/01/200209/01/200211/01/200201/01/200303/01/200305/03/200307/01/200309/01/200311/01/200312/01/2003 0 50 100 150 200 250 300 Mean = 150.5 Mean = 184.2 Mean = 85 Before Implementation Pilot Unit Implementation LUMC-wide Implementation

9. Computerized Physician Order Entry was successfully implemented for all hospitalized patients at LUMC, and has significantly reduced the number of medication issues related to transcribing of medication orders. Issues related to prescribing have also decreased as a result of standardizing LUCI medication order screens. Conclusions

10. Continued training of physicians, students, nurses, and service associates regarding computerized order entry Identify areas with sub-optimal compliance and provide education and support Plan for new enterprise clinical information system from EPIC to improve medication issues related to prescribing Ensure that all pharmacist interventions are being documented. Next Steps