Assess Risk of Wrong Patient Errors in an EMR that Allows Multiple Records Open

评估允许打开多条记录的 EMR 中错误患者错误的风险

基本信息

批准号：
9320335
负责人：
Jason Stuart Adelman
金额：
$ 10万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-30 至 2018-09-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9320335
关键词：
Assess Risk Wrong Patient Errors

项目摘要

DESCRIPTION (provided by applicant): Patient safety experts worry that CPOE systems that allow multiple patient records open at once increases the risk of wrong patient errors. A recent national survey of Chief Medical Information Officers demonstrated the lack of consensus on the safest number of patient records to allow opened at once, with marked heterogeneity in the number of records currently allowed open by IT leadership. Our application will be the first study to provide IT leaders data on the risk of wrong patient errors when varying number of records are opened at once, which will help them make a more informed decision on the best configuration for their CPOE systems. We propose a large observational study to examine the relationship between the number of records open and the risk of wrong-patient error (Aim 1). It is possible, however, that clinical environments where providers are more likely to open more than one record at a time may also be the clinical settings in which wrong patient errors are more likely to occur, and the type of clinical setting or other factors may confound the observational study. To address the threat of confounding, we also propose a two-armed crossover pilot study in which the CPOE system will be configured to limit the number of records opened to one patient at a time for roughly half the inpatient beds ("restricted environment"), while the other half of the inpatient beds will be allowed to open a maximum of four records at once ("unrestricted environment"); midway through the pilot study these configurations will be reversed (Aim 2). A comparison of the wrong-patient error rates in the restricted and unrestricted cohorts will help further quantify the risk of having multiple records open at once. This study is made possible by an innovative tool for identifying wrong patient electronic orders that was developed and validated at Montefiore Medical Center. This tool, which identified an average of 14 wrong patient errors a day at Montefiore, will be used to identify the primary outcome measures for both the prospective, observational study as well as a two-armed crossover pilot study. We will pursue the following specific aims: 1) In a prospective, observational study, assess the relationship between the number of records open at the time of placing an order, and the risk of placing an order on the wrong patient. 2) In a two-armed crossover pilot study, compare the incidence of wrong-patient orders in a "restricted environment" that limits its providers to only one record open at a time to an "unrestricted environment" where users can open a maximum of four records at once. This project is a collaboration between Montefiore Medical Center and the Brigham and Women's Hospital, with Dr. David Bates leading an Expert Advisory Panel of national leaders in Informatics and Patient Safety research. This project directly addresses AHRQ's special emphasis notice, as it is a research project that will provide evidence to inform the safe use of health IT.

描述（由申请人提供）：患者安全专家担心，允许同时打开多个患者记录的 CPOE 系统会增加错误患者错误的风险。最近对首席医疗信息官进行的一项全国调查表明，对于允许一次打开的最安全的患者记录数量缺乏共识，IT 领导层目前允许打开的记录数量存在明显的异质性。我们的应用程序将是第一项为 IT 领导者提供有关同时打开不同数量的记录时出现错误患者错误风险的数据的研究，这将帮助他们就 CPOE 系统的最佳配置做出更明智的决策。我们提议进行一项大型观察性研究，以检查开放记录数量与错误患者错误风险之间的关系（目标 1）。然而，提供者更有可能一次打开多个记录的临床环境也可能是更有可能发生错误患者错误的临床环境，并且临床环境的类型或其他因素也可能是混淆了观察性研究。为了解决混淆的威胁，我们还提出了一项双臂交叉试点研究，其中 CPOE 系统将被配置为限制大约一半住院床位一次向一名患者打开的记录数量（“受限环境”），而另一半住院床位将被允许一次最多打开四个记录（“无限制环境”）；在试点研究中途，这些配置将被逆转（目标 2）。比较受限制和不受限制队列中的错误患者错误率将有助于进一步量化同时打开多个记录的风险。这项研究是通过蒙特菲奥里医疗中心开发和验证的用于识别错误患者电子医嘱的创新工具实现的。该工具在 Montefiore 每天平均识别出 14 例错误的患者错误，将用于确定前瞻性观察性研究以及双组交叉试点研究的主要结果指标。我们将追求以下具体目标： 1) 在前瞻性观察性研究中，评估下订单时打开的记录数量与向错误患者下订单的风险之间的关系。 2) 在一项双臂交叉试点研究中，将“受限环境”中错误患者订单的发生率进行比较，“受限环境”限制其提供者一次只能打开一条记录，而“非受限环境”中用户最多可以打开一条记录。一次四个记录。该项目是蒙特菲奥里医疗中心和布莱根妇女医院之间的合作项目，由 David Bates 博士领导的专家咨询小组由信息学和患者安全研究方面的国家领导人组成。该项目直接针对 AHRQ 的特别强调通知，因为它是一个研究项目，将为卫生 IT 的安全使用提供证据。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Effect of number of open charts on intercepted wrong-patient medication orders in an emergency department.

开放图表数量对急诊科截获的错误患者用药订单的影响。

DOI：
发表时间：
2018
期刊：
影响因子：
0
作者：
Kannampallil, Thomas G;Manning, John D;Chestek, David W;Adelman, Jason;Salmasian, Hojjat;Lambert, Bruce L;Galanter, William L
通讯作者：
Galanter, William L

A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites.

一项全国性调查，评估医院和流动场所允许开放电子健康记录的记录数量。

DOI：
发表时间：
2017-09-01
期刊：
影响因子：
0
作者：
Adelman, Jason S;Berger, Matthew A;Rai, Amisha;Galanter, William L;Lambert, Bruce L;Schiff, Gordon D;Vawdrey, David K;Green, Robert A;Salmasian, Hojjat;Koppel, Ross;Schechter, Clyde B;Applebaum, Jo R;Southern, William N
通讯作者：
Southern, William N

Limiting the Number of Open Records in an Electronic Health Record-Reply.

限制电子健康记录回复中的开放记录数量。