National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (3)
- Adverse Events (4)
- Ambulatory Care and Surgery (1)
- Blood Pressure (1)
- Clinical Decision Support (CDS) (1)
- Communication (1)
- Community-Based Practice (1)
- Electronic Health Records (EHRs) (3)
- (-) Electronic Prescribing (E-Prescribing) (11)
- Evidence-Based Practice (1)
- Health Information Technology (HIT) (10)
- Intensive Care Unit (ICU) (1)
- Medical Errors (3)
- Medication (10)
- Medication: Safety (5)
- Newborns/Infants (1)
- Patient Adherence/Compliance (1)
- Patient Safety (6)
- Provider (1)
- Provider: Clinician (1)
- Risk (2)
- Surgery (1)
- Vulnerable Populations (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedIqbal AR, Parau CA, Kazi S
Identifying electronic medication administration record (eMAR) usability issues from patient safety event reports.
This study investigated the contribution of usability challenges associated with the electronic medication administration record (eMAR) to medication errors using patient safety event reports (PSEs). The authors analyzed free-text descriptions of 849 medication-related PSEs selected from 2.3 million reports. Specific health IT components, usability challenge categories, and nuanced usability themes that contributed to each PSE were identified by coders. Usability challenges included workflow support, alerting, and display/visual clutter.
AHRQ-funded; HS025136.
Citation: Iqbal AR, Parau CA, Kazi S .
Identifying electronic medication administration record (eMAR) usability issues from patient safety event reports.
Jt Comm J Qual Patient Saf 2021 Dec;47(12):793-801. doi: 10.1016/j.jcjq.2021.09.004..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Medication, Medical Errors, Patient Safety
King CR, Abraham J, Fritz BA
Predicting self-intercepted medication ordering errors using machine learning.
Current approaches to understanding medication ordering errors rely on relatively small manually captured error samples. These approaches are resource-intensive, do not scale for computerized provider order entry (CPOE) systems, and are likely to miss important risk factors associated with medication ordering errors. Previously, the investigators described a dataset of CPOE-based medication voiding accompanied by univariable and multivariable regression analyses. In this paper, they updated the analysis using machine learning (ML) models to predict erroneous medication orders and identify its contributing factors.
AHRQ-funded; HS025443.
Citation: King CR, Abraham J, Fritz BA .
Predicting self-intercepted medication ordering errors using machine learning.
PLoS One 2021 Jul 14;16(7):e0254358. doi: 10.1371/journal.pone.0254358..
Keywords: Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Kandaswamy S, Pruitt Z, Kazi S
Clinician perceptions on the use of free-text communication orders.
The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. The investigators concluded that clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks.
AHRQ-funded; HS025136; HS024755.
Citation: Kandaswamy S, Pruitt Z, Kazi S .
Clinician perceptions on the use of free-text communication orders.
Appl Clin Inform 2021 May;12(3):484-94. doi: 10.1055/s-0041-1731002..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Electronic Health Records (EHRs), Medication: Safety, Medication, Patient Safety, Communication, Provider: Clinician, Provider, Risk
Abraham J, Galanter WL, Touchette D
Risk factors associated with medication ordering errors.
This study’s goal was to collect data on “voided” orders in computerized order entry systems for medication to 1) identify the nature and characteristics of medication ordering errors; 2) investigate the risk factors associated with these errors and; 3) explore potential strategies to mitigate these risk factors. Data was collected using clinician interviews and surveys within 24 hours of the voided order and using chart reviews. During the 16-month study period 1074 medication orders were voided, with 842 being true medication errors. A total of 22% reached the patient, with at least a single administration, but without causing patient harm. Interviews were conducted on 355 voided orders (33%). Errors were associated with multiple factors not just a single risk factor. The causal contributors included a combination of technological-, cognitive-, environment-, social-, and organization-level factors.
AHRQ-funded; HS025443.
Citation: Abraham J, Galanter WL, Touchette D .
Risk factors associated with medication ordering errors.
J Am Med Inform Assoc 2021 Jan 15;28(1):86-94. doi: 10.1093/jamia/ocaa264..
Keywords: Medication: Safety, Electronic Prescribing (E-Prescribing), Medication: Safety, Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Risk, Health Information Technology (HIT), Patient Safety
Adelman JS, Applebaum JR, Southern WN
Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units of 2 integrated health care systems.
Researchers assessed the risk of wrong-patient orders among multiple-birth infants and singletons receiving care in the NICU and examined the proportion of wrong-patient orders between multiple-birth infants and siblings (intrafamilial errors) and between multiple-birth infants and nonsiblings (extrafamilial errors). They found that multiple-birth status in the NICU is associated with significantly increased risk of wrong-patient orders compared with singleton-birth status. Strategies to reduce this risk include using given names at birth, changing from temporary to given names when available, and encouraging parents to select names for multiple births before they are born when acceptable to families.
AHRQ-funded; HS024538.
Citation: Adelman JS, Applebaum JR, Southern WN .
Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units of 2 integrated health care systems.
JAMA Pediatr 2019 Oct 10;173(10):979-85. doi: 10.1001/jamapediatrics.2019.2733..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Bucher BT, Ferraro JP, Finlayson SRG
Use of computerized provider order entry events for postoperative complication surveillance.
The purpose of this study was to determine if a surveillance system using computerized provider order entry (CPOE) events for selected medications as well as laboratory, microbiologic, and radiologic orders can decrease the manual medical record review burden for surveillance of postoperative complications. Results showed that a CPOE-based surveillance of postoperative complications has high negative predictive value, demonstrating that this approach can augment the currently used, resource-intensive manual medical record review process.
AHRQ-funded; HS025776.
Citation: Bucher BT, Ferraro JP, Finlayson SRG .
Use of computerized provider order entry events for postoperative complication surveillance.
JAMA Surg 2019 Apr;154(4):311-18. doi: 10.1001/jamasurg.2018.4874..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Adverse Events, Surgery, Patient Safety
Lindau ST
CommunityRx, an e-prescribing system connecting people to community resources.
CommunityRx is an e-prescribing system that make it easier for patients in communities to connect with health resources. NowPow, LLC is an information technology enterprise that is part of CommunityRx. NowPow participated in AHRQ’s EvidenceNow grants program and worked with hundreds of small Midwestern primary care practices in the Healthy Hearts in the Heartland study. By 2018, over 1600 youths had been employed (many for the first-time) and generated annual asset census for Chicago, New York, and two rural areas of North Carolina. CommunityRx has been successful in providing health resource information to lower-income communities such as Chicago’s South Side. They also found that half of people who received a HealtheRx e-prescription use the information to help others.
AHRQ-funded; HS023921.
Citation: Lindau ST .
CommunityRx, an e-prescribing system connecting people to community resources.
Am J Public Health 2019 Apr;109(4):546-47. doi: 10.2105/ajph.2019.304986..
Keywords: Access to Care, Community-Based Practice, Electronic Prescribing (E-Prescribing), Evidence-Based Practice, Health Information Technology (HIT), Medication, Vulnerable Populations
Garabedian PM, Wright A, Newbury I
Comparison of a prototype for indications-based prescribing with 2 commercial prescribing systems.
The objective of this study was to evaluate, in comparison with the prescribing modules of 2 leading electronic health record prescribing systems, the efficiency, error rate, and satisfaction with a new computerized provider order entry prototype for the outpatient setting that allows clinicians to initiate prescribing using the indication. The investigators found that reengineering prescribing to start with the drug indication allowed indications to be captured in an easy and useful way, which may be associated with saved time and effort, reduced medication errors, and increased clinician satisfaction.
AHRQ-funded; HS023694.
Citation: Garabedian PM, Wright A, Newbury I .
Comparison of a prototype for indications-based prescribing with 2 commercial prescribing systems.
JAMA Netw Open 2019 Mar;2(3):e191514. doi: 10.1001/jamanetworkopen.2019.1514..
Keywords: Electronic Health Records (EHRs), Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Medication
Bergeron AR, Webb JR, Serper M
Impact of electronic prescribing on medication use in ambulatory care.
This study investigated differences before and after rollout of electronic prescribing (e-prescribing) in (1) patients’ primary adherence to newly prescribed medications, (2) patients' understanding of how to use their medications, and (3) multiple pharmacy use. It found an increase in abandoned prescriptions immediately following the implementation of e-prescribing. However, with time, these issues were resolved and even improved to rates lower than baseline.
AHRQ-funded; HS017220.
Citation: Bergeron AR, Webb JR, Serper M .
Impact of electronic prescribing on medication use in ambulatory care.
Am J Manag Care 2013 Dec;19(12):1012-7..
Keywords: Electronic Prescribing (E-Prescribing), Ambulatory Care and Surgery, Patient Adherence/Compliance, Medication
Abramson EL, Pfoh ER, Barron Y
The effects of electronic prescribing by community-based providers on ambulatory medication safety.
This study was conducted to assess the effect of implementing a commercial electronic health record with e-prescribing on rates and types of prescribing errors. Use of e-prescribing resulted in relatively low error rates (6.0 errors per 100 prescriptions). These rates were sustained over time but without further improvement (6.0 versus 4.5 errors per 100) prescriptions).
AHRQ-funded; HS016970.
Citation: Abramson EL, Pfoh ER, Barron Y .
The effects of electronic prescribing by community-based providers on ambulatory medication safety.
Jt Comm J Qual Patient Saf 2013 Dec;39(12):545-52..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Medication: Safety, Medication, Electronic Health Records (EHRs)
Falck S, Adimadhyam S, Meltzer DO
A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation.
The authors measured the accuracy and completeness of electronic problem list additions using indication-based prescribing of antihypertensives. They found that clinical decision support using indication-based prescribing of antihypertensives produced accurate problem placement roughly two-thirds of the time with fewer than 5% inaccurate problems placed; performance of alerts was sensitive to the number of potential indications of the medication and attendings vs. other clinicians prescribing.
AHRQ-funded; HS016967.
Citation: Falck S, Adimadhyam S, Meltzer DO .
A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation.
Int J Med Inform 2013 Oct;82(10):996-1003. doi: 10.1016/j.ijmedinf.2013.07.003.
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Keywords: Blood Pressure, Medication, Clinical Decision Support (CDS), Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)