Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study
IntroductionIn 2021, a computerized physician order entry (CPOE) system with an integrated clinical decision support system (CDSS) was implemented at a tertiary care center for the treatment of mental health conditions in Lübeck, Germany. To date, no study has been reported on the types and prevalen...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1304844/full |
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| author | Katharina Wien Julia Thern Anika Neubert Britta-Lena Matthiessen Stefan Borgwardt Stefan Borgwardt |
| author_facet | Katharina Wien Julia Thern Anika Neubert Britta-Lena Matthiessen Stefan Borgwardt Stefan Borgwardt |
| author_sort | Katharina Wien |
| collection | DOAJ |
| description | IntroductionIn 2021, a computerized physician order entry (CPOE) system with an integrated clinical decision support system (CDSS) was implemented at a tertiary care center for the treatment of mental health conditions in Lübeck, Germany. To date, no study has been reported on the types and prevalence of drug-related problems (DRPs) before and after CPOE implementation in a psychiatric inpatient setting. The aim of this retrospective before-and-after cohort study was to investigate whether the implementation of a CPOE system with CDSS accompanied by the introduction of regular medication plausibility checks by a pharmacist led to a decrease of DRPs during hospitalization and unsolved DRPs at discharge in psychiatric inpatients.MethodsMedication charts and electronic patient records of 54 patients before (cohort I) and 65 patients after (cohort II) CPOE implementation were reviewed retrospectively by a clinical pharmacist. All identified DRPs were collected and classified based on ‘The PCNE Classification V9.1’, the German database DokuPIK, and the ‘NCC MERP Taxonomy of Medication Errors’.Results325 DRPs were identified in 54 patients with a mean of 6 DRPs per patient and 151.9 DRPs per 1000 patient days in cohort I. In cohort II, 214 DRPs were identified in 65 patients with a mean of 3.3 DRPs per patient and 81.3 DRPs per 1000 patient days. The odds of having a DRP were significantly lower in cohort II (OR=0.545, 95% CI 0.412-0.721, p<0.001). The most frequent DRP in cohort I was an erroneous prescription (n=113, 34.8%), which was significantly reduced in cohort II (n=12, 5.6%, p<0.001). During the retrospective in-depth review, more DRPs were identified than during the daily plausibility analyses. At hospital discharge, patients had significantly less unsolved DRPs in cohort II than in cohort I.DiscussionThe implementation of a CPOE system with an integrated CDSS reduced the overall prevalence of DRPs, especially of prescription errors, and led to a smaller rate of unsolved DRPs in psychiatric inpatients at hospital discharge. Not all DRPs were found by plausibility analyses based on the medication charts. A more interactive and interdisciplinary patient-oriented approach might result in the resolution of more DRPs. |
| first_indexed | 2024-04-24T11:56:04Z |
| format | Article |
| id | doaj.art-fe7cff71654f46c38dc1a9640fc84c91 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-04-24T11:56:04Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Psychiatry |
| spelling | doaj.art-fe7cff71654f46c38dc1a9640fc84c912024-04-09T04:25:52ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402024-04-011510.3389/fpsyt.2024.13048441304844Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort studyKatharina Wien0Julia Thern1Anika Neubert2Britta-Lena Matthiessen3Stefan Borgwardt4Stefan Borgwardt5Department of Hospital Pharmacy, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyDepartment of Hospital Pharmacy, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyDepartment of Hospital Pharmacy, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyDepartment of Psychiatry and Psychotherapy, Center for Integrative Psychiatry, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyDepartment of Psychiatry and Psychotherapy, Center for Integrative Psychiatry, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyDepartment of Psychiatry and Psychotherapy, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Lübeck, GermanyIntroductionIn 2021, a computerized physician order entry (CPOE) system with an integrated clinical decision support system (CDSS) was implemented at a tertiary care center for the treatment of mental health conditions in Lübeck, Germany. To date, no study has been reported on the types and prevalence of drug-related problems (DRPs) before and after CPOE implementation in a psychiatric inpatient setting. The aim of this retrospective before-and-after cohort study was to investigate whether the implementation of a CPOE system with CDSS accompanied by the introduction of regular medication plausibility checks by a pharmacist led to a decrease of DRPs during hospitalization and unsolved DRPs at discharge in psychiatric inpatients.MethodsMedication charts and electronic patient records of 54 patients before (cohort I) and 65 patients after (cohort II) CPOE implementation were reviewed retrospectively by a clinical pharmacist. All identified DRPs were collected and classified based on ‘The PCNE Classification V9.1’, the German database DokuPIK, and the ‘NCC MERP Taxonomy of Medication Errors’.Results325 DRPs were identified in 54 patients with a mean of 6 DRPs per patient and 151.9 DRPs per 1000 patient days in cohort I. In cohort II, 214 DRPs were identified in 65 patients with a mean of 3.3 DRPs per patient and 81.3 DRPs per 1000 patient days. The odds of having a DRP were significantly lower in cohort II (OR=0.545, 95% CI 0.412-0.721, p<0.001). The most frequent DRP in cohort I was an erroneous prescription (n=113, 34.8%), which was significantly reduced in cohort II (n=12, 5.6%, p<0.001). During the retrospective in-depth review, more DRPs were identified than during the daily plausibility analyses. At hospital discharge, patients had significantly less unsolved DRPs in cohort II than in cohort I.DiscussionThe implementation of a CPOE system with an integrated CDSS reduced the overall prevalence of DRPs, especially of prescription errors, and led to a smaller rate of unsolved DRPs in psychiatric inpatients at hospital discharge. Not all DRPs were found by plausibility analyses based on the medication charts. A more interactive and interdisciplinary patient-oriented approach might result in the resolution of more DRPs.https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1304844/fullcomputerized physician order entry systemclinical decision support systemmedication reviewmedication prescriptiondrug-related problemsmental health |
| spellingShingle | Katharina Wien Julia Thern Anika Neubert Britta-Lena Matthiessen Stefan Borgwardt Stefan Borgwardt Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study Frontiers in Psychiatry computerized physician order entry system clinical decision support system medication review medication prescription drug-related problems mental health |
| title | Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study |
| title_full | Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study |
| title_fullStr | Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study |
| title_full_unstemmed | Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study |
| title_short | Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study |
| title_sort | reduced prevalence of drug related problems in psychiatric inpatients after implementation of a pharmacist supported computerized physician order entry system a retrospective cohort study |
| topic | computerized physician order entry system clinical decision support system medication review medication prescription drug-related problems mental health |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1304844/full |
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