Order Set to Improve the Care of Patients Hospitalized for COPD Exacerbations.

Link to article at PubMed

Order Set to Improve the Care of Patients Hospitalized for COPD Exacerbations.

Ann Am Thorac Soc. 2016 Apr 8;

Authors: Brown KE, Johnson KJ, Deronne BM, Parenti CM, Rice KL

RATIONALE: Physician adherence to prescribing evidence-based inpatient and outpatient therapies for chronic obstructive pulmonary disease (COPD) is low, and there is a paucity of information about the utility of admission order sets for patients with COPD exacerbation.
OBJECTIVES: To determine if implementation of a locally-designed, evidence-based, multidisciplinary computer physician order entry (CPOE) set in the electronic health record (EHR) improves the quality of physician pharmacologic prescribing for patients hospitalized for COPD exacerbations.
METHODS: This study was performed before and after implementation of a computerized order set for patients hospitalized for COPD exacerbations. The primary outcome was the rate of zero prescribing errors by physicians for inpatient and discharge drugs for COPD for a 1 year period prior to implementation and for 6 months after implementation. Errors were defined as no therapy or inappropriate therapy in the following categories: antibiotic, systemic corticosteroid, short-acting bronchodilator, long-acting bronchodilator, and inhaled corticosteroid. Secondary outcomes included mean pharmacy prescribing error rate, types of errors, hospital length of stay, and unscheduled physician visits, emergency department visits, re-hospitalization and death within 30 days from discharge.
MEASUREMENTS AND MAIN RESULTS: There were 194 COPD exacerbation admissions during the 1 year pre-implementation period, and 81 admissions during the 6 month post-implementation period. Compared to the pre-implementation period, the percentage of patients receiving all recommended pharmacologic therapies for the 6 months after implementation increased from 18.6% to 54.3% (p<0.001). The mean number of errors decreased from 1.76 to 0.65 (p<0.001). Antibiotic and systemic corticosteroid errors decreased from 39% to 16% (p<0.001) and 58% to 28% (p<0.001), respectively. Fewer patients were discharged without a short-acting bronchodilator (13.9% vs. 2.5%, p=0.005), a long-acting bronchodilator (16.5% vs. 7.4%, p=0.047), or inhaled corticosteroid (18% vs. 9.9%, p=0.089). Improvements were sustained over the 6 month post-implementation period. Hospital length of stay decreased from 4 (±3) days pre-implementation to 2.9 (± 1.9) days post-implementation (p=0.002). There were no significant differences in 30-day clinical outcomes including the rates of unscheduled physician or emergency department visits, re-hospitalizations, or deaths.
CONCLUSION: Computerized multidisciplinary admission order set implementation for patients hospitalized for a COPD exacerbation improved physicians' adherence to evidence-based pharmacologic treatment, and were associated with reductions in length of hospital stay.

PMID: 27058777 [PubMed - as supplied by publisher]

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