Safety Issues
Conditions
Keywords
medication safety, patient safety
Brief summary
Indications-based prescribing is a medication ordering system in which a clinician selects an indication, and then the electronic health record (EHR) suggests an appropriate medication regimen. This approach was shown to significantly decrease medication ordering errors in a prototype environment. However, the effect of indications-based prescribing on preventing ordering errors has not been rigorously evaluated in a real-world healthcare setting. Antibiotics are the medication class most likely to contain ordering errors, which can lead to significant patient harm. At NewYork-Presbyterian (NYP) a robust antimicrobial indication-based order set was developed to help clinicians identify the appropriate antibiotic, dose, frequency, and duration, based on type of infection and patient-specific characteristics, but it is not widely used. The investigators propose a randomized controlled trial to assess the effectiveness of this indications-based order set for reducing antimicrobial ordering errors.
Interventions
OTHERClinical Decision Support
Upon ordering antibiotics the provider will be prompted to utilize an indication-based order set which guides the clinician to the appropriate empiric antibiotic choice.
Sponsors
New York Presbyterian Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All providers placing inpatient orders on adult patients.
Exclusion criteria
Providers placing orders on patients who were ordered for antibiotics \>24 hours in the past 72 hours and/or patients with positive cultures during that admission, and/or placing an order from the order set.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The combined rate of Wrong Drug, Wrong Duration, Wrong Dose and Wrong Frequency Retract-And-Reorder (RAR) events will be combined to create an overall rate of near-miss ordering errors in the control and intervention arm. | Up to 18 months | Novel Health IT measures which utilize provider ordering patterns to capture near-miss ordering errors. |
Outcome results
None listed