The Leapfrog CPOE Evaluation Tool: One Academic Medical Center's Experience

Nov Dec Patient Safety & Quality Healthcare

By Andrea L. Long, PharmD; Monica M. Horvath, PhD; Jeanette Jansen, RN, MSN; Jeffrey Ferranti, MD, MS; Heidi Cozart, RPh
 

A large proportion of medication errors occur at the prescribing phase. Computerized provider order entry (CPOE) offers a possible means by which to avoid these potentially harmful mistakes through implementation of electronic ordering and clinical decision support software (Kuperman, et al., 2007). Prior studies have demonstrated that CPOE and decision support reduce medication errors (Kadmon, et al., 2009; Kaushal, et al., 2003; Kuperman, et al., 2003), with less evidence directly linking this technology to a reduction of adverse drug events (Peterson, et al., 2005; Wolfstadt, et al., 2008). Despite these advantages, only 17% of healthcare institutions have fully implemented CPOE, and even fewer are using CPOE with decision support (Jha, et al., 2009; Pedersen, et al., 2008). The software is not only expensive but also requires resources to integrate it into the current information technology (IT) infrastructure, train staff, and support ongoing maintenance. Some institutions favor less expensive alternatives—such as barcode medication administration—as a patient safety investment (Scanlon, et al., 2008).

Formed following publication of the highly publicized Institute of Medicine report, To Err Is Human, in 2000, the Leapfrog Group is a coalition of healthcare purchasers with a mission to help make great "leaps forward" in the patient safety and quality of healthcare (Kilbridge, et al., 2006). The group's strategy centers on a set of purchasing principles voluntarily agreed to by member purchasers that target consumer awareness and provide incentives to patients and providers based on the comparative value of healthcare delivery. Ideally, these principles would create a business case for providers and hospitals to drive advancements in safety and quality (Milstein, et al., 2000). Recognizing the need to promote CPOE adoption, the group selected CPOE as one of its four safety standards. The CPOE standard targets medication prescribing error reduction, one of several capabilities of these order entry systems. To this end, the Leapfrog CPOE evaluation tool was designed to assess the error trapping performance of implemented CPOE systems. Metzger and colleagues recently reported on the wide variability in performance of CPOE decision support across 62 U.S. hospitals using the Leapfrog tool (Metzger, et al., 2010). In this article, we describe our institution's experience with the adult and pediatric versions of the CPOE evaluation tool for inpatients.

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