• Quality Improvement in Health Care
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• v.21 no.2
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• pp.12-24
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• 2015

Purpose: The need for the rapid evaluation and treatment of emergency department patients with major trauma is essential. A computerized physician order entry (CPOE) system can improve communication and provide immediate access to information with the goal of reducing ED time delays. The aim of this study was to report on the operation of a trauma CPOE program and demonstrate its usefulness by comparing time intervals from ED arrival to various evaluation steps before and after implementation of the program. Methods: This was a before-and-after observational study from a single emergency department at an academic center. The CPOE program was implemented for 6 months and compared with the data collected from the pre-CPOE implementation period. The efficacy of the program was assessed by comparing the time difference before and after CPOE implementation based on the following factors: total boarding time in ED, door-to-disposition decision time, door-to-blood-test report time, door-to-X-ray time, door-to-CT time, and door-to-transfusion time. Results: Over a period of 6 months, the CPOE was activated for a total of 17 patients. Total boarding time was reduced significantly after implementation [median, 641.5 minutes (IQR, 367.3-859.3) versus289.0 minutes (IQR, 140.0-508.0) for pre-CPOE vs. post-CPOE, respectively, p< 0.05). Time intervals for all evaluation steps were reduced after implementation of the program. The improvements in the door-to-blood-test and door-to-CT times were both statistically significant. Conclusion: This study demonstrated that a standard CPOE system can be successfully implemented and can reduce ED time delays in managing trauma patients.

• Korean Journal of Clinical Pharmacy
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• v.19 no.2
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• pp.105-109
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• 2009

In July 2008, The National Police Hospital has developed the CPOE system(Computerized Physician Order Entry system) which links the medicine master and introduced the new program for the injectable antimicrobial agents. After introducing new system, we wanted to check the management of oral antimicrobial agents. Because new system has limitation that new system control only the use of the injectable antimicrobial agents. So we tried to evaluate the use of oral levofloxacin, which was chosen by a medical specialist of the infection. We retrospectively analyzed the appropriateness of oral levofloxacin through EMR(Electric Medical Record) of 72 inpatients who received oral levofloxacin in National Police Hospital in December 2008. We applied the modified ASHP(American Society of Health- System Pharmacists) DUE(Drug Use Evaluation) criteria, which is composed of justification of drug use, critical indicators, complications and outcome measures. Acceptable cases of use of levofloxacin were 67(93.01%) and 57cases(79.2%) showed good outcome. However critical indicators were not performed very well. We want to suggest the new system for the management of the medical therapeutics by the pharmacist in charge.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.2329-2336
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• 2016

Background: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. Initial Assessment: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. Choice of solution: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. Implementation: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. Evaluation: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. Lessons Learned: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.