Effectiveness of an integrated CPOE decision-supporting system with clinical pharmacist monitoring practice in preventing antibiotic dosing errors

Hue Yu Wang, Chin Li Lu, Ming Ping Wu, Meng Hsun Huang, Yaw Bin Huang

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: Computer-prescriber order entry (CPOE) systems that lack clinical decision components actually increase errors and cause harm rather than the opposite. Recent studies have also demonstrated that dosing errors, typing errors, or miscommunication with other systems are the most common CPOE errors. Our objective was to develop an antibiotic dosing calculator and implement it in the CPOE system while integrating the role of the clinical pharmacist in the CPOE in order to minimize dosing errors in the prescription of antibiotics. Methods: A database was prepared using dosage information for 13 renal function-related antibiotics. The dosages in the database ranged from the standard to the maximum dosage based on various creatinine clearance (CL cr) levels. The antibiotic dosage monitoring system was developed to screen the entire inpatient database for inappropriate antibiotic dosage regimens and record the results as an Excel document. Main outcome measure: We tracked the frequency of calculator utilization by physicians, the acceptance rate of recommendations from the calculator and pharmacists, the inappropriate antibiotic dosage regimen prescriptions, and the antibiotic-related renal function deterioration. The relative risk (RR) with 95% confidence intervals (CI) was used to calculate the risk of inappropriate antibiotic dosage prescription, the deterioration in renal function when antibiotics were used. Results: From 2005 to 2008, 38,647 antibiotic prescriptions were recorded in the CPOE system. The instances of inappropriate antibiotic dosage prescriptions were decreased by ∼ 80% after the calculator was implemented (RR, 0.18 - 0.23; p <0.001), and the incidence rates of renal function deterioration were lowered from 12.39% to 9.47%. The frequency of antibiotic calculator utilization by physicians (from 239 times/year in 2005 to 3,480 times/year in 2008) and the acceptance rate of the calculator's dosage recommendations (from 68.2% in 2005 to 94.7% in 2008) both increased during the study period. The average acceptance rates of pharmacist recommendations by physicians were 97.65%. Conclusions: Integration of the CPOE decision-supporting system and the clinical pharmacist monitoring practice can help physicians provide appropriate antibiotic dosage regimens and decrease the incidence of dosing errors that could be decreased concerned patients with impaired renal function.

Original languageEnglish
Pages (from-to)375-382
Number of pages8
JournalInternational Journal of Clinical Pharmacology and Therapeutics
Volume50
Issue number6
DOIs
Publication statusPublished - Jun 2012

Fingerprint

Pharmacists
Anti-Bacterial Agents
Prescriptions
Kidney
Physicians
Databases
Incidence
Inpatients
Creatinine
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • Adverse drug events
  • Antibiotic
  • Clinical pharmacist
  • CPOE
  • Decision-supporting system
  • Dosing error

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Effectiveness of an integrated CPOE decision-supporting system with clinical pharmacist monitoring practice in preventing antibiotic dosing errors. / Wang, Hue Yu; Lu, Chin Li; Wu, Ming Ping; Huang, Meng Hsun; Huang, Yaw Bin.

In: International Journal of Clinical Pharmacology and Therapeutics, Vol. 50, No. 6, 06.2012, p. 375-382.

Research output: Contribution to journalArticle

@article{4c1c0ac094f841eb84adf98d1601a761,
title = "Effectiveness of an integrated CPOE decision-supporting system with clinical pharmacist monitoring practice in preventing antibiotic dosing errors",
abstract = "Objective: Computer-prescriber order entry (CPOE) systems that lack clinical decision components actually increase errors and cause harm rather than the opposite. Recent studies have also demonstrated that dosing errors, typing errors, or miscommunication with other systems are the most common CPOE errors. Our objective was to develop an antibiotic dosing calculator and implement it in the CPOE system while integrating the role of the clinical pharmacist in the CPOE in order to minimize dosing errors in the prescription of antibiotics. Methods: A database was prepared using dosage information for 13 renal function-related antibiotics. The dosages in the database ranged from the standard to the maximum dosage based on various creatinine clearance (CL cr) levels. The antibiotic dosage monitoring system was developed to screen the entire inpatient database for inappropriate antibiotic dosage regimens and record the results as an Excel document. Main outcome measure: We tracked the frequency of calculator utilization by physicians, the acceptance rate of recommendations from the calculator and pharmacists, the inappropriate antibiotic dosage regimen prescriptions, and the antibiotic-related renal function deterioration. The relative risk (RR) with 95{\%} confidence intervals (CI) was used to calculate the risk of inappropriate antibiotic dosage prescription, the deterioration in renal function when antibiotics were used. Results: From 2005 to 2008, 38,647 antibiotic prescriptions were recorded in the CPOE system. The instances of inappropriate antibiotic dosage prescriptions were decreased by ∼ 80{\%} after the calculator was implemented (RR, 0.18 - 0.23; p <0.001), and the incidence rates of renal function deterioration were lowered from 12.39{\%} to 9.47{\%}. The frequency of antibiotic calculator utilization by physicians (from 239 times/year in 2005 to 3,480 times/year in 2008) and the acceptance rate of the calculator's dosage recommendations (from 68.2{\%} in 2005 to 94.7{\%} in 2008) both increased during the study period. The average acceptance rates of pharmacist recommendations by physicians were 97.65{\%}. Conclusions: Integration of the CPOE decision-supporting system and the clinical pharmacist monitoring practice can help physicians provide appropriate antibiotic dosage regimens and decrease the incidence of dosing errors that could be decreased concerned patients with impaired renal function.",
keywords = "Adverse drug events, Antibiotic, Clinical pharmacist, CPOE, Decision-supporting system, Dosing error",
author = "Wang, {Hue Yu} and Lu, {Chin Li} and Wu, {Ming Ping} and Huang, {Meng Hsun} and Huang, {Yaw Bin}",
year = "2012",
month = "6",
doi = "10.5414/CP201678",
language = "English",
volume = "50",
pages = "375--382",
journal = "International Journal of Clinical Pharmacology and Therapeutics",
issn = "0946-1965",
publisher = "Dustri-Verlag Dr. Karl Feistle",
number = "6",

}

TY - JOUR

T1 - Effectiveness of an integrated CPOE decision-supporting system with clinical pharmacist monitoring practice in preventing antibiotic dosing errors

AU - Wang, Hue Yu

AU - Lu, Chin Li

AU - Wu, Ming Ping

AU - Huang, Meng Hsun

AU - Huang, Yaw Bin

PY - 2012/6

Y1 - 2012/6

N2 - Objective: Computer-prescriber order entry (CPOE) systems that lack clinical decision components actually increase errors and cause harm rather than the opposite. Recent studies have also demonstrated that dosing errors, typing errors, or miscommunication with other systems are the most common CPOE errors. Our objective was to develop an antibiotic dosing calculator and implement it in the CPOE system while integrating the role of the clinical pharmacist in the CPOE in order to minimize dosing errors in the prescription of antibiotics. Methods: A database was prepared using dosage information for 13 renal function-related antibiotics. The dosages in the database ranged from the standard to the maximum dosage based on various creatinine clearance (CL cr) levels. The antibiotic dosage monitoring system was developed to screen the entire inpatient database for inappropriate antibiotic dosage regimens and record the results as an Excel document. Main outcome measure: We tracked the frequency of calculator utilization by physicians, the acceptance rate of recommendations from the calculator and pharmacists, the inappropriate antibiotic dosage regimen prescriptions, and the antibiotic-related renal function deterioration. The relative risk (RR) with 95% confidence intervals (CI) was used to calculate the risk of inappropriate antibiotic dosage prescription, the deterioration in renal function when antibiotics were used. Results: From 2005 to 2008, 38,647 antibiotic prescriptions were recorded in the CPOE system. The instances of inappropriate antibiotic dosage prescriptions were decreased by ∼ 80% after the calculator was implemented (RR, 0.18 - 0.23; p <0.001), and the incidence rates of renal function deterioration were lowered from 12.39% to 9.47%. The frequency of antibiotic calculator utilization by physicians (from 239 times/year in 2005 to 3,480 times/year in 2008) and the acceptance rate of the calculator's dosage recommendations (from 68.2% in 2005 to 94.7% in 2008) both increased during the study period. The average acceptance rates of pharmacist recommendations by physicians were 97.65%. Conclusions: Integration of the CPOE decision-supporting system and the clinical pharmacist monitoring practice can help physicians provide appropriate antibiotic dosage regimens and decrease the incidence of dosing errors that could be decreased concerned patients with impaired renal function.

AB - Objective: Computer-prescriber order entry (CPOE) systems that lack clinical decision components actually increase errors and cause harm rather than the opposite. Recent studies have also demonstrated that dosing errors, typing errors, or miscommunication with other systems are the most common CPOE errors. Our objective was to develop an antibiotic dosing calculator and implement it in the CPOE system while integrating the role of the clinical pharmacist in the CPOE in order to minimize dosing errors in the prescription of antibiotics. Methods: A database was prepared using dosage information for 13 renal function-related antibiotics. The dosages in the database ranged from the standard to the maximum dosage based on various creatinine clearance (CL cr) levels. The antibiotic dosage monitoring system was developed to screen the entire inpatient database for inappropriate antibiotic dosage regimens and record the results as an Excel document. Main outcome measure: We tracked the frequency of calculator utilization by physicians, the acceptance rate of recommendations from the calculator and pharmacists, the inappropriate antibiotic dosage regimen prescriptions, and the antibiotic-related renal function deterioration. The relative risk (RR) with 95% confidence intervals (CI) was used to calculate the risk of inappropriate antibiotic dosage prescription, the deterioration in renal function when antibiotics were used. Results: From 2005 to 2008, 38,647 antibiotic prescriptions were recorded in the CPOE system. The instances of inappropriate antibiotic dosage prescriptions were decreased by ∼ 80% after the calculator was implemented (RR, 0.18 - 0.23; p <0.001), and the incidence rates of renal function deterioration were lowered from 12.39% to 9.47%. The frequency of antibiotic calculator utilization by physicians (from 239 times/year in 2005 to 3,480 times/year in 2008) and the acceptance rate of the calculator's dosage recommendations (from 68.2% in 2005 to 94.7% in 2008) both increased during the study period. The average acceptance rates of pharmacist recommendations by physicians were 97.65%. Conclusions: Integration of the CPOE decision-supporting system and the clinical pharmacist monitoring practice can help physicians provide appropriate antibiotic dosage regimens and decrease the incidence of dosing errors that could be decreased concerned patients with impaired renal function.

KW - Adverse drug events

KW - Antibiotic

KW - Clinical pharmacist

KW - CPOE

KW - Decision-supporting system

KW - Dosing error

UR - http://www.scopus.com/inward/record.url?scp=84861823659&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861823659&partnerID=8YFLogxK

U2 - 10.5414/CP201678

DO - 10.5414/CP201678

M3 - Article

C2 - 22541749

AN - SCOPUS:84861823659

VL - 50

SP - 375

EP - 382

JO - International Journal of Clinical Pharmacology and Therapeutics

JF - International Journal of Clinical Pharmacology and Therapeutics

SN - 0946-1965

IS - 6

ER -