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Is it Possible to Change Prescribing Habits?

In the US more than 770,000 people are injured or die each year in hospitals from adverse drug events (ADEs), which can cost a hospital, depending on its size, about US$5.6 million every year, excluding ADE-associated costs for malpractice and litigation and the personal costs of injuries to patients.

Nationally, hospital expenses to treat patients who have ADEs during hospital admission are enormous: between $1.6 billion and $5.6 billion annually. The cost to patients is also high and not just monetary: those who have an ADE spend on average 8?2 days longer in the hospital than patients who do not have an ADE, and their admission costs $16,000 to $24,000 more.

One way for hospitals to tackle the problem of medication errors is to install computerized monitoring systems, which can reduce ADEs by 28%?5%. Apart from the obvious benefits to patients, these systems can save hospitals as much as $500,000 annually in direct costs. However, despite the potential, fewer than 10% of hospitals have implemented such systems.

Less is known about the value of such systems in an outpatient setting. Now, Andrew Steele and colleagues from Denver have tested a computerized physician order entry (CPOE) system in a US hospital's outpatient clinic. The main purpose of the study was to determine the impact of using computerized alerts to improve the prescribing of medications in the outpatient setting. Studies have shown that 18%?5% of patients might have an ADE in the outpatient environment. This study evaluated a CPOE system alongside an integrated computer-based clinical-decision support system.

It focused on a very specific type of clinical-decision support system: the use of a rules technology to prevent drug–laboratory ADEs. The way the system worked was that providers ordered medications on a computer and an alert was displayed if a relevant drug–laboratory interaction existed.

Comparisons were made between baseline and post-intervention per
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Source:PLoS Medecine


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