Introduction on FiCiSiEn system in IKN

1. Computerized Physician Order
Entry (CPOE) and Medication
Safety
Azmi Nor Mohd Farez bin Ahmat
B. Pharm (UKM), M. Clinical Pharmacy (UKM), BCPS.

2. CPOE?
……Is the process of a medical
professional entering medication
orders or other physician
instructions electronically
instead of on paper charts.
Institute of Medicine (IOM)
……E-prescribing is a subset of
full CPOE, with order entry
limited to prescribing.

3. HIS
Fisicien
Fisicien-
LIS
InfinittNMIS
Mosaiq
CPOE in IKN

4. CPOE….
where did they came
from?

6. To Err is Human:
Building a Safer Health System
 Human beings, in all lines of work, make
errors.
 Errors can be prevented by designing systems
that make it hard for people to do the wrong
things and easy for people to do the right
thing.
 In health care, building a safer system means
designing processes of care to ensure that
patient are safe from accidental injury.IOM, National Academy of Sciences, 2000.

7. To Err is Human..

8. Errors!
..approximately 200k people die every year in
the US as a result of preventable medical errors.
..Medication errors are estimated to account for
at least 7,000 deaths in the United States alone
every year.
..Medication error is one of the most common
causes of unintentional harm in Australia which
results in an estimated 80,000 hospital
admissions every year
Kohn et al. 1999. Institute of Medicine;
Federal Minister for Health and Ageing Australia, 9 September
2003

10. .. a 2013 Meta-analysis found that the likelihood of a
prescribing error was reduced by 48%
when using CPOE compared with paper-based
orders.
..estimated 17.4million medication errors
averted in the USA in one year.
Why CPOE?
Radley et al. 2013. J. Am Med Inform Assoc.

11. .. A study done at a pediatrics hospital in Canada
showed a decrease by 40% in medication
error rates.
..identify 62% of potential
medication errors including drug-allergy
interactions, dosing limits and inappropriate
routes of administration.
Why CPOE?
Chaparro et al. 2016. J. Am Med Inform Assoc.
King et al. 2003. Pediatrics.

12. .. A study done at a pediatrics hospital in Canada
showed a decrease by 40% in
medication error rates.
…Mortality and LOS decreased in medical and
surgical ward.
Why CPOE?
Lyons et al. 2016. J. Am Med Inform Assoc.
King et al. 2003. Pediatrics.

13. .. A study done at a pediatrics hospital in Canada
showed a decrease by 40% in
medication error rates.
…Mortality and LOS decreased in medical and
surgical ward.
Why CPOE?
Lyons et al. 2016. J. Am Med Inform Assoc.
King et al. 2003. Pediatrics.

14. Improving both efficiency
and accuracy of orders…
 Reduce errors from poor handwriting.
 Reduced Incorrect transcription
 Reduced incomplete prescription
 Allow direct transmittal of prescription to
pharmacies.

15. ..The majority of medical
mistakes happen when the
physician orders
services and
prescriptions for the
patients.
..Physicians using a paper
prescription pad often do
not have legible
handwriting, and
prescriptions often not able
to be read by the individuals
who process and prepare
them for the patient.Charles et al, 2014. Perspectives in health information
management

16. …If the pharmacist is not able to read a
prescription handwritten by the physician, the
patient is at risk of ADEs.
…A CPOE may be the solution to decrease the
number of ADEs in a hospital, enhanced patient
safety and decrease preventable medical errors.
Charles et al, 2014. Perspectives in health information
management

17. Process In Which The Error Occur
2387
3568 3290 4017
5229
13056
1…
421 1131
1433
2645
3301
44
84 407
416
398
326
2
5 41
37
31
32
0
42 134
108
119
182
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
Combination
Others
Administration
Dispensing
Prescribing
2009 2010 2011 2012 2013 2014

19. E-prescribing
..Remove abbreviations and acronyms and
increasing order speed through the used of E-
prescribing.
..Remove the need of transcribing.
..Remove in-complete prescription.
..Increased accessibility of patients medical
records.

20. E-prescribing
..Warning and alert system.
..Improved formulary adherence.
..Increased patient convenience by reducing
waiting time.
..Provider mobility – can approved medication
from any desktop.

21. …….Who want to try???

23. Electronic prescription..

24. Incomplete prescription..

25. Which one look batter??

26. PRN dosing..

27. Warning and alert
systems
DUR- Patient current
drugs
- Interaction
- Drug allergy
- Diagnosis
- Body weight
- Age
- Drug
appropriateness
- Correct dosing
- Contraindications
- Duplicate orders

28. Overlapping medication..
Reduced
duplicate orders

29. Overlapping investigation..

30. Dosage
support
Adverse
interaction
alerts
Clinical
decision
support

31. Dosage Support

32. Allergy alert..

33. Allergy alert..
But this only
can happen if
allergy history
are UPDATED!

34. Interaction alert…
..Alert system managed to prevent a large
number of inappropriate medication orders for
the older patient.
Massachusetts Medical Centre. 2004

35. Clinical decision support..

36. Drug infusion
For Infusion Therapy

37. Drug infusion
For Infusion Therapy

40. THANK YOU…
Pusat Maklumat Ubat: 3434/3435

41. AE..
…The number of ADR/ADE decreased by
84%.
…If the pharmacist is not able to read a
prescription handwritten by the physician, the
patient is at risk of ADEs.
…A CPOE may be the solution to decrease the
number of ADEs in a hospital, enhanced patient
safety and decrease preventable medical errors.
Charles et al, 2014. Perspectives in health information