Physician Order Research Articles

The Digital Hospital: A Scoping Review of How Technology Is Transforming Cardiopulmonary Care.

Innovative models of health care that involve advanced technology in the form of a digital hospital are emerging globally. Models include technology such as machine learning and smart wearables, that can be used to integrate patient data and improve continuity of care. This model may have benefits in situations where patient deterioration must be detected quickly so that a rapid response can occur such as cardiopulmonary settings. The purpose of this scoping review was to examine the evidence for a digital hospital model of care, in the context of cardiac and pulmonary settings. Scoping review. Databases searched were using PsycInfo, Ovid MEDLINE, and CINAHL. Studies written in English and containing key terms related to digital hospital and cardiopulmonary care were included. The Joanna Briggs Institute methodology for systematic reviews was used to assess the risk of bias. Thirteen (13) studies fulfilled the inclusion criteria. For cardiac conditions, a deep-learning-based rapid response system warning system for predicting patient deterioration leading to cardiac arrest had up to 257% higher sensitivity than conventional methods. There was also a reduction in the number of patients who needed to be examined by a physician. Using continuous telemonitoring with a wireless real-time electrocardiogram compared with non-monitoring, there was improved initial resuscitation and 24-hour post-event survival for high-risk patients. However, there were no benefits for survival to discharge. For pulmonary conditions, a natural language processing algorithm reduced the time to asthma diagnosis, demonstrating high predictive values. Virtual inhaler education was found to be as effective as in-person education, and prescription error was reduced following the implementation of computer-based physician order entry electronic medical records and a clinical decision support tool. While we currently have only a brief glimpse at the impact of technology care delivery for cardiac and respiratory conditions, technology presents an opportunity to improve quality and safety in care, but only with the support of adequate infrastructure and processes. Open Science Framework (OSF: DOI 10.17605/OSF.IO/PS6ZU).

Do junior doctors make more prescribing errors than experienced doctors when prescribing electronically using a computerised physician order entry system combined with a clinical decision support system? A cross-sectional study

ObjectivesPrescribing errors can lead to inconvenience, morbidity and mortality. It is therefore crucial to educate doctors to prescribe safely, efficiently and effectively. To create an effective educational programme, it is...

Artificial intelligence in the pre-analytical phase: State-of-the art and future perspectives.

The use of artificial intelligence (AI) has become widespread in many areas of science and medicine, including laboratory medicine. Although it seems obvious that the analytical and post-analytical phases could be the most important fields of application in laboratory medicine, a kaleidoscope of new opportunities has emerged to extend the benefits of AI to many manual labor-intensive activities belonging to the pre-analytical phase, which are inherently characterized by enhanced vulnerability and higher risk of errors. These potential applications involve increasing the appropriateness of test prescription (with computerized physician order entry or demand management tools), improved specimen collection (using active patient recognition, automated specimen labeling, vein recognition and blood collection assistance, along with automated blood drawing), more efficient sample transportation (facilitated by the use of pneumatic transport systems or drones, and monitored with smart blood tubes or data loggers), systematic evaluation of sample quality (by measuring serum indices, fill volume or for detecting sample clotting), as well as error detection and analysis. Therefore, this opinion paper aims to discuss the state-of-the-art and some future possibilities of AI in the preanalytical phase.

Primary care pediatricians and job satisfaction: a cross sectional study in the Lazio region

BackgroundThe Order of Physicians and Dentists of the Province of Rome aims at focusing on the satisfaction of healthcare personnel as an essential factor for the quality of medical care in the health sector. The aim of this study is to assess and prioritize the factors that can be linked to a higher or lower degree of job satisfaction in Primary Care Pediatricians (PCPs).MethodsThis study is a cross sectional survey. A questionnaire was administered to all primary care pediatricians registered to the Order, exploring in particular the work activity organization, the level of satisfaction in their professional life, and the level of perceived health. A pilot activity was conducted to validate the questionnaire. Fisher exact test and ordinal logistic regression (ologit) models were used for the univariate and multivariate analysis.ResultsThe highest level of job dissatisfaction, in both men and women, was found to be in the practice type without any form of association; among women, it reached an even higher level for those who had their own practice at a distance of 20–40 km from their home. Women, compared to men, maintained a lower level of job satisfaction also while working in Pediatric Primary Care Units (PPCUs). In PPCUs, for the same distance, females showed a more similar pattern to males. Men working in PPCUs, regardless of distance, declared a higher degree of job satisfaction. Both men and women, working as a group pediatrician or in PPCUs, did not show a significant difference in the level of job satisfaction.ConclusionsThe study contributes to a deeper understanding of the factors that may influence levels of career satisfaction in female and male PCPs. Therefore, research and interventions regarding job satisfaction should foster an organizational network connection among PCPs for their job and individual well-being, from a perspective of enhancing patient care. A major effort to improve work-life balance and career satisfaction among women is important, suggesting that interventions for improving job satisfaction could benefit from a gender-specific approach.

Antibiotics use patterns in end-of-life cancer patients and medical staff's perception of antimicrobial stewardship programs.

While most cancer patients with end-of-life (EOL) care receive antibiotic treatments, antibiotic use should be decided appropriately considering the benefits, side effects, resistance, and cost effects. Antimicrobial stewardship programs (ASP) are important for patients with EOL care, but there is limited study analyzing actual antibiotic use in EOL care and the perceptions of Korean medical staff. Electronic medical records of 149 deceased cancer patients hospitalized in the medical hospitalist units at Asan Medical Center in Seoul from May 2019 to September 2021 were reviewed. Basic information, antibiotic use, duration, and changes were investigated. We surveyed medical staff's perceptions of antibiotics in cancer patients with EOL. Of the 149 cancer patients with EOL care, 146 (98.0%) agreed with physician orders for life-sustaining treatment (POLST). In total, 143 (95.9%) received antibiotics, 110 (76.9%) received combination antibiotic treatment, and 116 (81.1%) were given antibiotics until the day of death. In a survey of 60 medical staff, 42 (70.0%) did not know about ASP, and 24 (40.0%) thought ASP was important in EOL care. Nineteen doctors (31.7%) discussed the use or discontinuation of antibiotics with patients or caregivers when writing POLST, but only 8 patients (5.6%) stopped antibiotics after POLST. Most cancer patients with EOL care continue to receive antibiotics until just before their death. A careful approach is needed, considering the benefits and side effects of antibiotic use, and the patient's right to self-decision. It is necessary to actively improve awareness of ASP and its importance for medical staff.

Assessing Health Care Providers' Knowledge and Practices of Nutrition during Pregnancy in Lebanon: A Cross-Sectional Study.

Background and objectives: Health care professionals (HCPs) are well-positioned to discuss healthy behaviors during pregnancy, but the published research of prenatal healthcare providers' knowledge about the significance of nutrition during pregnancy in Lebanon is scarce. The purpose of this study was to explore the knowledge, attitudes, and practices of Lebanese prenatal healthcare providers towards nutrition during pregnancy. Materials and Methods: A cross-sectional study using an online questionnaire was conducted. Health care providers were contacted by phone and email to participate in the online survey. A list of all clinics providing antenatal health services was obtained from the Order of Physicians and the Order of Midwives. A multistage random sample was selected. In the first stage, it was stratified per region (Beirut center or suburbs, and the southern region). In the second phase, it was stratified per clinic type (private, primary healthcare center, or hospital). Gynecologists and midwives who are members of the Order of Physicians and the Order of Midwives (n = 1333), were included. Results: Two-hundred and six responses (55% males) were obtained. Approximately 44% of the HCP were aged 50 and older, and 68.4% had more than 10 years of work experience. HCPs from Beirut represented 41.3% of the respondents. Eighty-eight percent of the HCPs were physicians, and 11% were midwives. The majority of the participants considered nutrition during pregnancy to be very important. Furthermore, half of these participants considered their position in delivering nutrition information as very significant. Most of the respondents reported that they provide nutrition advice to pregnant women, and they also received nutrition education during their profession. However, they perceived their nutrition knowledge as inadequate. Conclusion: Health care providers' attitude towards the importance of maternal nutrition and their confidence in talking about nutrition-related topics with pregnant women were positive despite the lack of knowledge in several areas related to nutrition during pregnancy. Therefore, there is a need for continuing nutrition education for health care providers and the implementation of nutrition education programs to achieve better health outcomes.

Assessment of medical knowledge toward genetic testing for individuals with hereditary breast and ovarian cancer syndrome in Brazil

Genetic testing has become increasingly used in medical practice to enable genetic cancer risk assessment. In Hereditary Breast and Ovarian Cancer syndrome (HBOC), it can be used to screen pathogenic germline variants. The access to early diagnosis, from the request until the proper interpretation of genetic tests depends on medical knowledge. The aim of this study was to evaluate the knowledge of family physicians, oncologists, geneticists and gynecologists regarding genetic testing for patients with suspected HBOC in Brazil. A cross-sectional survey of physicians was performed using a self-administered questionnaire. One hundred and ninety-two physicians answered the questionnaire (23 were geneticists, 38 gynecologists, 39 family physicians, and 92 oncologists). Only 15.4% of family physicians and 26% of gynecologists feel prepared to order genetic testing for patients with personal and/or family history of breast and/or ovarian cancer. Even though 87% of the oncologists have genetic testing available in their clinical practice, only 51.1% consider they have sufficient knowledge to manage patients after detecting a pathogenic germline variant and 17.4% do not feel comfortable interpreting them. Most oncologists and geneticists are very knowledgeable about recommendations for genetic testing order and management of HBOC patients. On the other hand, gynecologists and family physicians order genetic testing less frequently (28.9% and 7.7%, respectively) and have difficulties interpreting (26.3% and 2.3%, respectively) and managing these patients. These observations raise important issues regarding the implementation of genetic testing in Brazil, including the development of training programs for physicians from different specialties.

Trends in computerized provider order entry: 20-year bibliometric overview.

Drug-related problems (DRPs) can lead to serious health issues and have significant economic impacts on healthcare systems. One solution to address this issue is the use of computerized physician order entry systems (CPOE), which can help prevent DRPs by reducing the risk of medication errors. The purpose of this study is to provide an analysis on scientific production of the past 20 years in order to describe trends in academic publishing on CPOE and to identify the major topics as well as the predominant actors (journals, countries) involved in this field. A PubMed search was carried out to extract articles related to computerized provider order entry during the period January 1st 2003- December 31st 2022 using a specific query. Data were downloaded from PubMed in Extensible Markup Language (XML) and were processed through a dedicated parser. A total of 2,946 articles were retrieved among 623 journals. One third of these articles were published in eight journals. Publications grew strongly from 2002 to 2006, with a dip in 2008 followed by an increase again in 2009. After 2009, there follows a decreasing until 2022.The most producing countries are the USA with 51.39% of the publication over the period by France (3.80%), and Canada (3.77%). About disciplines, the top 3 is: "medical informatics" (21.62% of articles), "pharmacy" (19.04%), and "pediatrics" (6.56%). This study provides an overview of publication trends related to CPOE, which exhibited a significant increase in the first decade of the 21st century followed by a decline after 2009. Possible reasons for this decline include the emergence of digital health tools beyond CPOE, as well as healthcare professionals experiencing alert fatigue of the current system. Future research should focus on analyzing publication trends in the field of medical informatics and decision-making tools to identify other areas of interest that may have surpassed the development of CPOE.

Using alert dwell time to filter universal clinical alerts: A machine learning approach

BackgroundAlerts in computerized physician order entry (CPOE) systems can improve patient safety. However, alerts in rule-based systems cannot be customized based on individual patient or user characteristics. This limitation can lead to the presentation of irrelevant alerts and subsequent alert fatigue. ObjectiveWe used machine learning approaches with alert dwell time to filter out irrelevant alerts for physicians based on contextual factors. MethodsWe utilized five machine learning algorithms and a total of 1,120 features grouped into six categories: alert, demographic, environment, diagnosis, prescription, and laboratory results. The output of the models was the alert dwell time within a specified time window to determine the optimal range by the sensitivity analysis. ResultsWe used 813,026 records (19 categories) from the hospital's outpatient clinic data from 2020 to 2021. The sensitivity analysis showed that a time window with a range of 0.3–4.0 s had the best performance, with an area under the receiver operating characteristic (AUROC) curve of 0.73 and an area under the precision–recall curve (AUPRC) of 0.97. The model built with alert and demographic feature groups showed the best performance, with an AUROC of 0.73. The most significant individual feature groups were alert and demographic, with AUROCs of 0.66 and 0.62, respectively. ConclusionOur study found that alerts and user and patient demographic features are more crucial than clinical features when constructing universal context-aware alerts. Using alert dwell time in combination with a time window is an effective way to determine the trigger status of an alert. The findings of this study can provide useful insights for researchers working on specific and universal context-aware alerts.

Traduction et adaptation au contexte hospitalier français d’un outil de codification des erreurs de prescription liées aux logiciels

Prescribing errors related to computerized physician order entry are current and may have serious consequences for patients. They can be detected by pharmacists during prescriptions analysis and lead to pharmacist's interventions. In France, few monocentric studies have studied Pharmacist Interventions triggered by prescribing errors identified as System-Related Errors (PISREs) in French hospitals. However, their respective analysis method prevent any comparison between computerized physician order entry systems in order to identify the safest and rule out the most dangerous. A computerized physician prescribing error related to the software is characterized by its causes, consequences and mechanism of occurrence. US researchers have developed and validated a tool to classify and illustrate these three characteristics. The objectives of this article are to present this tool, to propose a French adaptation and to describe the perspectives analyze and understand prescription errors related to computerized physician order entry based on data of Act-IP©. The adaptation was performed using PISREs extracted from the Act-IP© observatory of the French Society of Clinical Pharmacy. Each item of the codification is illustrated with an example of PI. We are considering a training plan in order to allow wide use of this tool. Once adopted this tool, the next step will be to organize a prospective multicenter study including as many computerized prescription order entry systems as possible. The aim of this study will be identifying the safest systems. Consequently, it will then be possible to have arguments to qualify the most dangerous and thus propose their withdrawal from the market.

Impact of automated dispensing cabinets on dispensing errors, interruptions and pillbox preparation time

AimThis work aimed to evaluate the impact of automated dispensing cabinets on the dispensing error rate, the number of interruptions, and pillbox preparation times.MethodsA prospective observational study was conducted across...

#4621 TREATMENT PREFERENCES TO SERIOUS ILLNESS IN PATIENTS RECEIVING PERITONEAL DIALYSIS

Abstract Background and Aims People with end-stage kidney disease receiving maintenance dialysis are more likely to receive intensive pattern of end-of-life care than those with other severe illness. It's important to understand the preferences to cardiopulmonary resuscitation (CPR) and other end-of-life care. However, no prior studies have investigated patients receiving peritoneal dialysis. This study aimed to explore the preference to CPR and patterns of end-of-life care in patient receiving peritoneal dialysis (PD), which had not been specifically investigated in the literature. Method This cross-sectional study of patients receiving PD was conducted in the National Taiwan University Hospital between Dec. 2021, and Mar. 2022. Patients were enrolled if they were 20 years or older, sufficiently fluent to complete surveys and cognitively able to provide written informed consent and had received maintenance peritoneal dialysis for at least 3 months. Enrollee were asked to the Chinese version of Physician Orders for Life-Sustaining Treatment questionnaire. Results Among 400 eligible patients, 364 (91%) responded to the questionnaire. The average age was 55.5 years; 50.3% were men. Among the 364 responders, 73.6% selected do not attempt resuscitation (DNR) and 26.4% preferred CPR. Multivariate logistic analysis revealed that age (OR = 0.96, 95% CI 0.94-0.98), male (OR = 2.44, 95% CI 1.45-4.1) and residual kidney Kt/V (OR = 2.45 95% CI 1.24-4.82) were associated with CPR. If they are facing on serious illness, 47.5% of participants prefer to “Focus on comfort”, 28.6% choose “try treatments, but do not suffer” and 23.9% request “live as long as possible”. Furthermore, 51.4% of participants selected “No artificial nutrient support” in the end of life and 87.1% select “comfort care” as their first priority. Paradoxically, only 13.5% of the patients who preferred CPR took “staying alive” as their first priority, while 71.9% focused on “comfort care”. Conclusion Around 75% of PD patients selected DNR when cardiopulmonary arrest. Age, gender, residual Kt/V were important factors associated with CPR preference. Most patients preferred supportive pattern of end-of-life care. Integrating patients' treatment preference to serious illness and values and goals of end-of-life care in shared decision making is important for patients receiving dialysis.

Current Practice and Barriers to the Implementation of Mobilization in ICUs in Japan: A Multicenter Prospective Cohort Study.

Background: Limited information is currently available on the barriers to implementing mobilization at the bedside for critically ill patients. Therefore, we investigated the current practice of and barriers to the implementation of mobilization in intensive care units (ICU). Methods: A multicenter prospective observational study was conducted at nine hospitals between June 2019 and December 2019. Consecutive patients admitted to the ICU for more than 48 h were enrolled. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Results: The 203 patients enrolled in the present study were divided into 69 elective surgical patients and 134 unplanned admission patients. The mean periods of time until the initiation of rehabilitation programs after ICU admission were 2.9 ± 7.7 and 1.7 ± 2.0 days, respectively. Median ICU mobility scales were five (Interquartile range: three and eight) and six (Interquartile range: three and nine), respectively. The most common barriers to mobilization in the ICU were circulatory instability (29.9%) and a physician's order for postoperative bed rest (23.4%) in the unplanned admission and elective surgery groups, respectively. Conclusions: Rehabilitation programs were initiated later for unplanned admission patients and were less intense than those for elective surgical patients, irrespective of the time after ICU admission.

The NASEM Report: Are the Solutions Part of the Problem?

The NASEM Report: Are the Solutions Part of the Problem?

OVERVIEW OF MEDICATION ERROR INCIDENCE IN HOSPITALS IN VARIOUS COUNTRIES: LITERATURE REVIEW

Background: Medication error is one of the most common types of errors contributing to patient safety incidents in hospitals. In addition to their numerous cases and high costs, medication errors also contribute to deaths in various countries. Aims: This study describes the incidence of medication errors in hospitals in various countries, determines the phase of errors that occurred the most, and describes preventive strategies for medication errors in hospitals. Methods: This study was conducted between April 2021-July 2021 using the literature review method. Data were retrieved from ProQuest, ScienceDirect, PubMed, Google Scholar, and Garuda RistekBRIN. The data are generalized and extracted in a table based on the incidence of medication errors and preventive strategies. Results: Of the eleven included studies, the incidence of medication errors in one study conducted in Nigeria was the highest (80%). Four of the eleven studies were conducted in India with varying incidence rates. Most errors occurred during the prescribing stage. The number of reports and the number of events actually have no relevance. It can be said that countries with a high number of reporting have good reporting indicators. Strategies for preventing medication errors include the implementation of an information system in the CPOE (Computerized Physician Order Entry) form and providing training for staff. Conclusion: The difference in the incidence of medication errors in developing and developed economies can be attributed to factors in the healthcare system and the lower prescribing ratio and nurse ratio in developing countries. Keywords: literature review, medication errors, patient safety

OVERVIEW OF MEDICATION ERROR INCIDENCE IN HOSPITALS IN VARIOUS COUNTRIES: LITERATURE REVIEW

Background: Medication error is one of the most common types of errors contributing to patient safety incidents in hospitals. In addition to their numerous cases and high costs, medication errors also contribute to deaths in various countries. Aims: This study describes the incidence of medication errors in hospitals in various countries, determines the phase of errors that occurred the most, and describes preventive strategies for medication errors in hospitals. Methods: This study was conducted between April 2021-July 2021 using the literature review method. Data were retrieved from ProQuest, ScienceDirect, PubMed, Google Scholar, and Garuda RistekBRIN. The data are generalized and extracted in a table based on the incidence of medication errors and preventive strategies. Results: Of the eleven included studies, the incidence of medication errors in one study conducted in Nigeria was the highest (80%). Four of the eleven studies were conducted in India with varying incidence rates. Most errors occurred during the prescribing stage. The number of reports and the number of events actually have no relevance. It can be said that countries with a high number of reporting have good reporting indicators. Strategies for preventing medication errors include the implementation of an information system in the CPOE (Computerized Physician Order Entry) form and providing training for staff. Conclusion: The difference in the incidence of medication errors in developing and developed economies can be attributed to factors in the healthcare system and the lower prescribing ratio and nurse ratio in developing countries. Keywords: literature review, medication errors, patient safety

Patient Safety of Perioperative Medication Through the Lens of Digital Health and Artificial Intelligence.

Perioperative medication has made significant contributions to enhancing patient safety. Nevertheless, administering medication during this period still poses considerable safety concerns, with many errors being detected only after causing significant physiological disturbances. The intricacy of medication administration in the perioperative setting poses specific challenges to patient safety. To address these challenges, implementing potential strategies and interventions is critical. One such strategy is raising awareness and revising educational curricula regarding drug safety in the operating room. Another crucial strategy is recognizing the importance of redundancy and multiple checks in the operating room as a hallmark of medication safety, which is not a common practice. Digital health technologies and artificial intelligence (AI) also offer the potential to improve perioperative medication safety. Computerized physician order entry systems, electronic medication administration records, and barcode medication administration systems have been proven to reduce medication errors and improve patient safety. By implementing these strategies and interventions, health care professionals can enhance the safety of perioperative medication administration and improve patient outcomes.

Impact of a computerized physician order entry system on medication safety in pediatrics-The AVOID study.

One of the most critical steps in the medication process on pediatric wards is the medical prescription. This study aims to investigate the impact of a computerized physician order entry (CPOE) system on Adverse Drug Events (ADEs) and potentially harmful ADEs (pot ADEs) in comparison with paper-based documentation in a general pediatric ward at a German University hospital. A prospective pre-post study was conducted. All patients aged 17 years or younger were observed during the study periods (5 months pre- and postimplementation). Issues Regarding Medication (IRM) were identified by intensive chart review. Events were assessed regarding causality (WHO), severity (WHO; Dean & Barber for MEs), and preventability (Shumock) and classified into (pot) ADEs, (pot) Medication errors (ME), Adverse drug Reactions (ADR), and Other incidents (OI) accordingly. Total of 333 patients with medication were included in the paper-based prescribing cohort (phase I) and 320 patients with medication in the electronic prescribing cohort (phase II). In each cohort, patients received a median number of four different drugs (IQR 5 and IQR 4). A total of 3966 IRM was observed. During the hospitalization, 2.7% (n = 9) patients in phase I and 2.8% (n = 9) in phase II experienced an ADE. Potentially harmful MEs were less often observed in the cohort with electronic prescribing (n = 228 vs. n = 562). The mean number per patient significantly decreased from 1.69 to 0.71 (p < .01). The implementation of a CPOE system resulted in a reduction of issues regarding medication, particularly MEs with the potential to harm patients decreased significantly.

Computerized physician order entry (CPOE) evaluation – what can we measure and how can we do it?

Computerized physician order entry (CPOE) evaluation – what can we measure and how can we do it?

The Connecticut MOLST: Lessons for Policy and Practice

In accordance with national directives from POLST.org, Connecticut’s Department of Public Health formed a working group to review the literature and new directives for a Medical Orders for Life-Sustaining Treatment program in the state in 2013 that was signed into law in 2017. Five years later, many barriers have kept the program from becoming well-known and accessible to medical providers and the public. These policy lessons are important for the developing programs of other states to keep in mind as they further develop their own Medical Orders for Life-Sustaining Treatment (MOLST)/Physician Orders for Life-Sustaining Treatment (POLST) programs that ensure end-of-life wishes for life-sustaining treatments are honored on a form that is transferrable between institutions. Additionally, the goals of care conversation, teaching, and advocacy for better policies affecting end-of-life care remain critical skills for the nurse practitioner.