As part of a quality improvement initiative, a hospital implements a new clinical decision support tool in the electronic medical record. When a provider places a new medication order, the tool prompts the provider to confirm the order if a potentially dangerous multi-drug interaction exists, if a nonstandard dose is entered, or if the drug indication is missing. A provider is reviewing medication orders on a patient with intractable colon cancer who is about to undergo partial colectomy. The patient is currently taking oral morphine. The provider discontinues oral morphine, determines an equivalent dose of intravenous hydromorphone, and enters the order into the electronic medical record. Which of the following potential errors related to this order would the new clinical decision support tool be most likely to detect?

Question

As part of a quality improvement initiative, a hospital implements a new clinical decision support tool in the electronic medical record.  When a provider places a new medication order, the tool prompts the provider to confirm the order if a potentially dangerous multi-drug interaction exists, if a nonstandard dose is entered, or if the drug indication is missing.  A provider is reviewing medication orders on a patient with intractable colon cancer who is about to undergo partial colectomy.  The patient is currently taking oral morphine.  The provider discontinues oral morphine, determines an equivalent dose of intravenous hydromorphone, and enters the order into the electronic medical record.  Which of the following potential errors related to this order would the new clinical decision support tool be most likely to detect?

Quizplus · Accepted Answer

11ec25c8_d531_7d91_bc81_af5335e5dcc7_MD0003_00 Clinical decision support systems (CDSS) describe processes that assist providers in making evidence-based diagnostic and therapeutic decisions. Built into computerized provider order entry systems, CDSS prompt providers at the point-of-care (ie, upon entering an order) to consider specific actions based on patient data (eg, laboratory values, diagnoses). CDSS can improve reliability (ie, reducing harmful variations in care) during complex decision-making processes (eg, diagnostic workup of pulmonary embolism). CDSS can also reduce medication errors (ie, errors of drug selection, dosing, and administration). When converting between opioids (eg, from oral morphine to intravenous hydromorphone, as in this patient), mathematical errors (eg, miscalculated dose) can occur and may be life-threatening (eg, 1 mg of intravenous hydrocodone is ~4 times as strong as 1 mg of intravenous morphine). Because this CDSS is programmed to recognize nonstandard doses, it can alert providers to unusually high or low opioid doses, thereby preventing incorrect dosing related to mathematical errors. (Choice A) Drug monitoring errors occur when parameters related to high-risk medications are inadequately checked or acted upon (eg, not realizing that a patient with atrial fibrillation has a subtherapeutic INR value, which results in stroke). Certain CDSS can reduce monitoring errors by reminding providers to check drug levels or act on abnormal results; however, such actions are not within the scope of the CDSS described in this scenario. (Choices C and D) Patient identification errors result in patients receiving an intervention intended for another patient (eg, wrong-patient surgery). A mislabeling error is a type of patient identification error related to specimen labeling (eg, mislabeled patient blood resulting in transfusion reaction). Prevention includes increasing redundancy, through use of dual identifiers (eg, medical record number and date of birth), and barcode scanning of patient wristband and specimen in addition to visual inspection. This new CDSS is unlikely to prevent such errors. Educational objective: Clinical decision support systems (CDSS) assist providers in achieving reliability (minimizing harmful variations of care) and adhering to evidence-based guidelines in diagnostic and therapeutic processes. CDSS can potentially reduce medication errors (eg, mathematical errors resulting from incorrect conversion of opioid equivalents). References: An overview of clinical decision support systems: benefits, risks, and strategies for success. (http://www.ncbi.nlm.nih.gov/pubmed/32047862)

As Part of a Quality Improvement Initiative, a Hospital Implements