The Use Of Clinical Systems To Improve Outcomes And Efficiencies
New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.
Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.
In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.
- Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
- Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
- Identify and select 5 peer-reviewed articles from your research.
The Assignment: (4-5 pages)
In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:
- Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
- Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
Patient safety is a subset of healthcare and is defined as the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of health care.1 In 1999 the Institute of Medicine’s (IOM) report “To err is human” called for developing and testing new technologies to reduce medical error,2 and the subsequent 2001 report “crossing the quality chiasm” called for using information technology as a key first step in transforming and changing the healthcare environment to achieve better and safer care.3
Healthcare information technology (HIT) has been defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making”.4
Health information technology includes various technologies that span from simple charting, to more advanced decision support and integration with medical technology. Health information technology presents numerous opportunities for improving and transforming healthcare which includes; reducing human errors, improving clinical outcomes, facilitating care coordination, improving practice efficiencies, and tracking data over time. Since the original IOM report was published, there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety.
This review is intended to summarize the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes. This review might be useful for clinicians and healthcare policy makers when making evidence based decisions on procurement and implementation of such technology to improve patient safety. This review considered studies that were conducted in the healthcare settings both inpatient and community setting, with an intervention of any of the following; electronic physician’s orders (CPOE), clinical decision support (CDS), E-prescribing, electronic sign-out and hand-off tools, bar code medication administration (BCMA), smart pumps, automated medication dispensing cabinets (ADC), electronic medication administration record (eMAR), patient data management systems (PDMS), retained surgical items detectors, patient electronic portals, telemedicine, electronic incident reporting, and electronic medical record (EMR). Our primary outcomes of interest were patient safety, medical errors, adverse events, medication errors, adverse drug events, and mortality. The priority was given to systematic reviews, meta-analysis and randomized clinical trials. If such studies were not identified then other types of experimental studies or epidemiological study designs including; non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies and case control studies.
Studies were excluded if they met any of the following criteria: high risk of bias, studies that were conducted in non-clinical settings, cointerventions with non-health information technology interventions, not evaluating patient safety outcomes, qualitative or narrative studies.
The search strategy was conducted to find both published and unpublished studies. The search strategy included Medline, Embase, Cochrane Database. Studies published until January 2017 were considered for inclusion in this review. Initial keywords used were: Electronic Medical Record (EMR), Electronic Physician’s Order entry (CPOE), Clinical Decision Support (CDS), E-prescribing, Electronic Sign-out and Hand-off, Bar Code Medication Administration (BCMA), Closed Loop Medication Administration, Patient Data Management Systems (PDMS), Retained Surgical Items Detectors, Patient Electronic Portals, Telemedicine, Electronic Incident Reporting, Intelligent Infusion Devices, Smart Pump, Programmable Pump, Automated Medication Dispensing, medication error adverse events, adverse drug events, adverse drug reactions, patient safety, medical errors. Studies were assessed for methodological validity and risk of bias using the Cochrane methodology prior to inclusion in the review.
Electronic physician’s orders and E-prescribing
Computerized physician order entry entails the use of electronic or computer support to enter physician orders including medication orders using a computer or mobile device platform.5 Computerized physician order entry systems were originally developed to improve the safety of medication orders, but more modern systems allow electronic ordering of tests, procedures, and consultations as well. Computerized physician order entry systems are usually integrated with a clinical decision support system (CDS), which acts as an error prevention tool through guiding the prescriber on the preferred drug doses, route, and frequency of administration. In addition, some CPOE systems may have the feature of prompting the prescriber to any patient allergies, drug-drug or drug-lab interactions or with sophisticated systems it might prompt the prescriber towards interventions that should be prescribed based on clinical guideline recommendation (example venous thromboembolism prophylaxis). A metaanalysis6 evaluating the effectiveness of CPOE to reduce medication errors and adverse drug events in hospitals found that the implementation of a COPE with clinical decision support resulted in significant reduction in medication errors (RR:0.46; 95% CI 0.31 to 0.71) and adverse drug reactions (RR: 0.47; 95% CI 0.35 to 0.60). Similarly, studies conducted in community based outpatient services showed comparable results in reducing medication errors.7,8 The use of hard-stops as a measure of forcing function and error prevention in CPOE systems has been studied and was found to be effective in changing prescribing errors. However, the use of hard-stops resulted in clinically important treatment delays