From Rush Presbyterian St. Luke's Medical Center
Computerized prescription system reduces turnaround time for medications and lowers resistance to antibiotics Rush-Presbyterian-St. Luke's Medical Center one of few hospitals in Chicago offering physician order entry
A hospital-wide computerized system that allows physicians and nurses to order prescriptions and tests reduces the time it takes to get medications to patients and cuts resistance to one common antibiotic used to treat infections.
Rush-Presbyterian-St. Luke's Medical Center began installing a computerized physician order entry system (POE) in 1995 and recently completed installing the system throughout the inpatient areas of the hospital.
Rush's POE system (also known as provider order entry, since nurses and other clinicians also enter orders) is a computer-based program that replaces written and verbal instructions, including drug orders, with keystrokes into a networked system. Authorized physicians and nurses log onto a computer using a special password for security, either in their offices or the units where patients are being treated, including post-operative recovery rooms and intensive care units. The screens prompt the physicians through a series of questions about how the patient is to be cared for including what medications the patient should be receiving, what tests are required and even the nutrition requirements.
According to John H. Brill, MD, internist and medical director of information services at Rush, the POE system has demonstrated its effectiveness and netted positive results. "On two measures - turnaround time for medications for patients in the hospital and cutting resistance to antibiotics - POE has shown that it can make a significant difference," he said.
Rush examined POE's effectiveness at reducing the amount of time it takes from the time a physician orders a medication, until the time the patient receives it. Of the 100 samples collected in the neurosurgery and transplant units before POE was put in place, 76 had the complete information relevant to the study and of these 76, the average turn around time was 3 hours and 43 minutes.
After implementing POE, turnaround time for 147 prescriptions was reduced to an average of two hours and 12 minutes, an average reduction of 1 hour and 31 minutes for each medication order, Dr. Brill said.
Dr. Brill said that Rush also used POE to place an alert when physicians ordered imipenem to treat patients with Pseudomonas aeruginosa infections. Imipenem is an antibiotic that is normally effective against this bacteria, but because the drug is over-prescribed, the bacteria was becoming resistant to the antibiotic.
When doctors attempt to order imipenem, a message appears warning them to prescribe the drug only if they are certain the patient's bacteria will respond to it.
"If you give imipenem and it doesn't kill the bacteria, the organism develops resistance which can be passed from organism to organism," Dr. Brill noted.
Thus far, POE has been remarkably effective at reducing imipenem resistance. The number of doses of imipenem prescribed per month fell from 199 to 128 during a six-month study and resistance to imipenem declined from 50% to 15%.
Computerized physician order entry was cited by an Institute of Medicine report that recommended POE as one method to reduce prescription errors. The 1999 report found that more than 7,000 deaths occur annually due to medication errors in hospitals. The Leapfrog Group (www.leapfroggroup.org), a consortium of Fortune 500 companies and other purchasers of healthcare, wants to do business only with hospitals that meet three goals, one of which is to use a CPOE system for all orders.
"POE provides legible, time and date stamped orders that are delivered quickly to departments throughout the hospital, allowing for clear communication," said Dr. Brill. "We hope that this system will, over time, speed efficiency and reduce medical errors significantly so that our patients receive the best care possible."
Rush-Presbyterian-St. Luke's Medical Center includes the 824-bed Presbyterian-St. Luke's Hospital; 110-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about two