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]