Rush-Presbyterian-St. Luke's Medical Center a Leader by Implementing Physician Order Entry System
According to the Institute of Medicine (IOM) report "To Err is Human: Building a Better Health System," medication errors account for 7,000 deaths annually in the United States. The November 1999 report recommends that automated drug-ordering systems can effectively reduce the number of medication errors and deaths.
One hospital in Chicago, Rush-Presbyterian-St. Luke's Medical Center, has been methodically implementing such a system since 1993. Most of Rush's medical center will be using it by the end of the year.
"It's great that the IOM recommends automation for drug ordering," said Dr. John H. Brill, medical director of information services at Rush. "But if a hospital were to begin installing an automated system after the IOM report was released, it would still take years to complete."
The Institute of Medicine, a part of the National Academy of Science, is considered the nation's top scientific advisory group.
Rush's physician order entry (POE) system (also known as provider order entry, since nurses and other clinicians also enter orders) is a computer-based program that replaces written and verbal instructions, including drug orders (prescriptions), with keystrokes into a networked system. Physicians log onto a PC, either in their office or the units where patients are being treated, including post-operative recovery rooms and intensive care units. The screens prompt the physicians through a series of questions about how the patient is to be cared for including what medications the patient should be receiving, what tests are required and even the nutrition requirements.
"POE can all but eliminate one of the most common mistakes made by physicians: errors caused by bad or illegible handwriting," he said. Besides creating a legible, date- and time-stamped order that the pharmacy and pathology can clearly read, there are other advantages to the POE:
1) Speed of order delivery. Old methods of communicating physician orders required several hours for a clerk to pick up and transcribe the physician's orders and route them to radiology or the pharmacy, for instance. Now, with a push of a button, orders are sent immediately to the pharmacy and other departments. Brill said that in tests done on Rush's POE system, radiology orders took less than one minute, on average, to arrive in the radiology department.
2) Accessibility. Physicians can access the POE anywhere in the medical center, including their offices, making it easier to transmit orders if they get paged. "Eventually, we hope to make this available at remote locations so care givers can use POE at home, too," Brill said. "The system markedly reduces the need for telephone orders from the doctor to the nurse, which saves time and improves documentation."
3) Education. POE provides special reminders to physicians about do not resuscitate orders, advance directives and other patient mandates hospitals must comply with. The POE system reminds physicians about these key items, facilitating important conversations with patients, Brill stressed. Physicians are also reminded about procedural issues, streamlining patient care.
4) Drug Interactions. POE will soon warn the physician of a potential drug interaction or food-drug interaction and will then suggest an alternative. It also will help physicians determine the proper dose of a medication for a specific patient. "A good example of this is the drug heparin, which is a blood thinner," Brill said. Dosage is critical with heparin and the guidelines for determining the dose is being built into the Rush system now, replacing the calculations that physicians had to make on their own in the past.
LDS Hospital in Salt Lake City (now part of the Intermountain Health Care system) developed one of the first POE systems almost 30 years ago. While today's systems are far more sophisticated than those put in place in the 1960s, the concept remains similar: providing physicians and residents with an automated prescription system that seeks to prevent errors while also creating better record keeping and enabling cost savings. While the medical literature suggests that there are major cost savings to be obtained, Rush is implementing POE to improve patient care.
Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about three million people through its outpatient facilities and eight member hospitals.