Computerized System to Dramatically Reduce Errors
CINCINNATI -- Cincinnati Children's Hospital Medical Center has implemented a computer-based system throughout the hospital in which all medical orders are entered and documented electronically. The system, believed to be the most comprehensive in any pediatric hospital in the United States, is expected to reduce medical errors significantly – an estimated 30 percent.
"The primary focus of this clinical informatics system is patient safety, particularly the reduction of medical errors," says Brian Jacobs, MD, a critical care physician at Cincinnati Children's and director of the clinical order entry (COE) part of the project. "This system provides complete, unambiguous, safe and legible orders. And, it brings to clinicians' fingertips information that allows them to make informed decisions during the ordering process."
The informatics system has two main parts – COE and clinical documentation. The system uses fixed workstations and portable computers with a wireless infrastructure so that orders can be entered at any time and place throughout the hospital. Orders can be generated during patient round, allowing direct patient care can begin much earlier in the day, sometimes as much as two hours earlier, according to Dr. Jacobs.
The COE system includes all patient orders, including medications, special diets, laboratory studies, radiology studies, tests and consultations. Clinicians, including physicians, nurse practitioners and other nurses, simply log onto the COE system, select a patient, and begin the ordering process. Built-in decision support tools include policies and procedures, Internet search capability, help screens, medication formularies and clinical pathways. The system also has built-in safety checks to eliminate the possibility of errors due to improper dosage, drug allergies, drug interactions, duplicated orders and a patient's age or weight. Orders are instantly routed to pagers, printers or electronic interfaces throughout the hospital so that care can be initiated immediately.
"In addition to increasing patient safety, the COE system results in overall process efficiency, clinician satisfaction, and more time for clinicians to spend with their patients," says Dr. Jacobs. "Most important for the patient is that the overall process of care delivery is improved."
The COE system makes illegible physician handwriting a thing of the past. It also is seamlessly integrated with a clinical documentation system. This system documents things nurses used to document on multiple paper forms, such as vital signs, allergies, heights and weights. And, it includes an electronic medication administration record, formerly transcribed onto a piece of paper by a nurse but now seamlessly integrated into the informatics system. The electronic medication administration record indicates medication administered, frequency of administration, dosage and route of administration (IV, suspension, etc.).
Clinical documentation is essentially electronic charting and supports the COE system by providing patient data such as vital signs, weights and patient assessment information for use in the ordering process. It eliminates safety issues, such as misinterpretation of orders and transcription errors, and it gets rid of redundant charting, which is an inefficient use of a nurse's time.
"Supporting patient safety and increasing efficiency in care delivery is the goal of clinical documentation," says Terri Price, RN, a director in the department of Patient Services who has led the implementation of the clinical documentation project with the nursing staff. "Studies have demonstrated that as much as 40 minutes per shift can be gained by using electronic charting systems. That's 40 minutes more per shift that a nurse can spend with a patient and family.
Overall, clinical documentation facilitates a family centered approach to care by improving efficiency in care delivery, improving outcomes and reducing length of stay."
A Harvard Medical Practice study estimated that nearly 4 percent of hospitalized adult patients experienced adverse events related to medical errors and that two-thirds were preventable. Other studies estimate that between 44,000 and 98,000 people die each year in the United States due, in part, to medical errors.
Treating children is even more complicated than treating adults. Data suggest that adverse drug event rates are three times higher in children than adults and that more than two-thirds of these errors occur during the ordering process.
Cincinnati Children's expects to expand the clinical informatics system to outpatient clinics and satellite facilities in 2003.
Contact Information
Jim Feuer,
jim.feuer@chmcc.org, 513-636-4656
