Computerized Physician Order Entry with Clinical Decision Support in the Long‐Term Care Setting: Insights from the Baycrest Centre for Geriatric Care

Although computerized physician order entry (CPOE) has been successfully implemented in many acute care hospitals, few descriptions of its use in the long‐term care (LTC) setting are available. This report describes the experiences of one LTC facility in developing and implementing a CPOE system with clinical decision support (CDS). Even when a facility has the necessary resources and “institutional will,” many challenges are associated with the implementation of this application. The system was designed to meet the needs of healthcare providers in the LTC setting, in particular by informing prescribing decisions, reducing the frequency of prescribing and monitoring errors, and reducing adverse drug event rates. Based on experience adopting this technology early, 10 insights are offered that it is hoped will assist others who are considering the implementation of CPOE systems with CDS in the LTC setting.

[1]  D. Bates,et al.  Guided medication dosing for inpatients with renal insufficiency. , 2001, JAMA.

[2]  Hagop S. Mekhjian,et al.  Implementation Brief: Key Attributes of a Successful Physician Order Entry System Implementation in a Multi-hospital Environment , 2002, J. Am. Medical Informatics Assoc..

[3]  J. Hanley,et al.  The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[4]  R. Raschke,et al.  A computer alert system to prevent injury from adverse drug events: development and evaluation in a community teaching hospital. , 1998, JAMA.

[5]  D W Bates,et al.  Incidence and preventability of adverse drug events in nursing homes. , 2000, The American journal of medicine.

[6]  G. Kuperman,et al.  Computer Physician Order Entry: Benefits, Costs, and Issues , 2003, Annals of Internal Medicine.

[7]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[8]  M S Fischbach,et al.  Pill-splitting in a long-term care facility. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[9]  H. Mcdonald,et al.  Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. , 2005, JAMA.

[10]  R E Ferner,et al.  Computer aided prescribing leaves holes in the safety net , 2004, BMJ : British Medical Journal.

[11]  D. Bates,et al.  Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. , 2003, Archives of internal medicine.

[12]  Melissa M. Honour,et al.  Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. , 2004, Health affairs.

[13]  P. Rochon,et al.  Subcutaneous Fluid Infusion in a Long‐Term Care Setting , 2000, Journal of the American Geriatrics Society.

[14]  Linda Gavendo,et al.  The incidence of adverse drug events in two large academic long-term care facilities. , 2005, The American journal of medicine.

[15]  Rainu Kaushal,et al.  Computerized Physician Order Entry ( CPOE ) with Clinical Decision Support Systems ( CDSSs ) , 2001 .

[16]  Michael Weiner,et al.  Using Information Technology To Improve the Health Care of Older Adults , 2003, Annals of Internal Medicine.

[17]  T. Clemmer,et al.  A computer-assisted management program for antibiotics and other antiinfective agents. , 1998, The New England journal of medicine.

[18]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005, JAMA.

[19]  D. Bates,et al.  Improving safety with information technology. , 2003, The New England journal of medicine.

[20]  E. Etchells,et al.  Unintended medication discrepancies at the time of hospital admission. , 2005, Archives of internal medicine.

[21]  Bill Briggs,et al.  CPOE order from chaos. , 2003, Health data management.

[22]  D. Bates,et al.  Risk factors for adverse drug events among nursing home residents. , 2001, Archives of internal medicine.

[23]  C. McDonald.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[24]  Marilyn D Paterno,et al.  Electronic alerts to prevent venous thromboembolism among hospitalized patients. , 2005, The New England journal of medicine.