ABSTRACT
PURPOSE: Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration (BCMA) system were evaluated. METHODS: All patients receiving warfarin who were admitted to a university medical center between July 1, 2008, and February 6, 2009, in inpatient units with BCMA systems were candidates for inclusion in this study. Medication-error alerts displayed to the nurse administering the warfarin were reviewed to determine whether a true potential error was detected. Each alert was converted to a scenario, and its potential to require treatment or cause patient harm was rated using a validated severity scale of 0-10, where a score of 0 indicated no probable effect on the patient and 10 indicated that the error would likely result in patient death. A severity score was obtained by averaging the scores of four pharmacist reviewers. RESULTS: Of the 18,393 warfarin doses ordered during the study period for 2,404 patients, error alerts associated with only 99 warfarin doses were found to be clinically meaningful. The mean ± S.D. severity rating of these alerts was low (2.93 ± 1.42), with a standardized Cronbach's coefficient alpha of 0.845. The mean ± S.D. warfarin dose attempted when the nurse received an alert was 4.10 ± 2.48 mg. The majority of doses with alerts (70%) were for patients who had an active order for warfarin. CONCLUSION: Of the large number of medication-error alerts generated through a BCMA system, only a small proportion were considered clinically significant. This indicated that the rate of false-positive alerts was unexpectedly high, increasing the risk of alert fatigue.
Subject(s)
Electronic Data Processing , Medical Order Entry Systems , Medication Errors/prevention & control , Warfarin/adverse effects , Academic Medical Centers , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Drug Packaging , Female , Humans , Male , Medication Systems, Hospital/organization & administration , Severity of Illness Index , Warfarin/administration & dosageABSTRACT
Identifying missed opportunities for revenue requires examining front-end processes and how they might join with transactions generated during processes of care. Linking the initiation of a charge to an important process in the clinic procedures helps ensure capture of both professional and facility charges. Implementing a software program to automatically initiate correlated charges and measuring the change in charges and revenue are steps that provide a substantial revenue opportunity for healthcare organizations.
Subject(s)
Accounts Payable and Receivable , Efficiency, Organizational/economics , Hospital Information Systems , Patient Credit and Collection/organization & administration , Academic Medical Centers/economics , Fees, Medical , Organizational Case Studies , TennesseeABSTRACT
Physician order entry is difficult to implement, both in inpatient and outpatient settings. Such systems must integrate conveniently into clinical workflows, and provide sufficient benefit to offset the burden of system use. For outpatient order entry, significant advantages can accrue when systems incorporate medical necessity guidelines - improved billing and adherence to governmental policies. The authors developed and implemented an outpatient order entry system that utilizes an electronically accessible history of patient, provider, and clinic-related diagnoses in assisting providers (when possible and appropriate) to select compliant justifications for tests and procedures. The pilot implementation site, active for more than six months, has been the Vanderbilt University Page Campbell Cardiology Clinic, with 34 providers.
