| - Estimated one adverse drug event occurs per | | | | Clinical decision support systems provide care |
| patient per day | | | | guidelines to clinicians and promotes resident safety, |
| - Treating avoidable events conservatively cost | | | | education and communication. Diagnosis specific |
| $billions annually | | | | treatment guidelines (e.g., myocardial infarction plus |
| - Information technology plays a key role in improving | | | | aspirin or atrial fibrillation plus warfarin) support optimal |
| resident medication safety Nursing home residents | | | | health through proactive disease management. |
| take an average of eight medications per month. | | | | Automated resident-specific reminders for drug |
| One-third of them take nine or more. Despite the | | | | allergies, interactions, dosing adjustments and |
| excellent care provided to these residents, one | | | | evidence-based interventions prevent errors of |
| avoidable adverse drug related event is estimated to | | | | omission. The reminders become a reliably consistent |
| occur per resident per day at an annual healthcare | | | | surrogate for resources inefficiently spent in |
| cost of billions. Many events are caused by inefficient | | | | retrospective, individual chart reviews. When combined |
| information systems offering incomplete or inaccurate | | | | with clinical decision support systems CPOE reduce |
| information to the clinician. Increasing access to | | | | medication errors by 80 percent. Benefits of CPOE |
| accurate resident specific information empowers | | | | and CDSS include: |
| physicians in perhaps their most important role in | | | | - Better documentation for drug usage indications, |
| long-term care facilities; that of monitoring for inevitable | | | | allergies and interactions |
| drug interactions between diseases, symptoms and | | | | - Warning messages triggered by incomplete, incorrect |
| other drugs in the medication use process. Three | | | | or excessive dosing orders |
| emerging technologies (EMRs, CPOE and CDSS) | | | | - Improvements in therapeutic drug dosing adjustments |
| actively enlist clinician participation in this ongoing | | | | - Avoidance of preventable pharmacotherapeutic |
| process. | | | | organ toxicity |
| Information Technology (IT) Opportunities | | | | - Improved clinician adherence to guideline-based care |
| Electronic medical records (EMRs) store resident | | | | - Positive influence on provider prescribing behavior |
| specific information electronically thus centralizing | | | | - Increased adherence to corollary orders |
| information and enhancing operational efficiencies for | | | | Cultural Changes |
| clinicians and the interdisciplinary team. Other benefits | | | | Residents and families, institutional partners and third |
| include: | | | | party payers now expect system approaches to |
| - Increased accessibility to and sharing of information | | | | ensure policies and procedures follow evolving |
| - Ongoing clinician maintenance and review of the | | | | standards of care. Cost related quicker and sicker |
| resident specific medication list | | | | hospital discharges into nursing facilities and lawsuits |
| - Legible clinician documentation consistently compliant | | | | involving adverse drug events are a few of the |
| with regulatory language | | | | change drivers for using these integrated information |
| - Enhanced systematic surveillance of disease | | | | systems to improve communication efficiency and |
| symptom/drug monitoring | | | | quality of care. Despite demonstrated improvements |
| - Updated drug information resources | | | | using an EMR, CPOE and CDSS, the long term care |
| Computerized Physician Order Entry (CPOE) | | | | industry has been slow to voluntarily adopt these |
| CPOE enables electronic entry of clinician orders. | | | | technologies. The government is considering mandating |
| Prescribing medications electronically with an EMR is | | | | e-prescribing as requisite for physician Medicare |
| safer and more reliable than paper based prescribing | | | | participation with all prescriptions being written |
| and reduces medication error rates. | | | | electronically by 2010. |
| Clinical Decision Support Systems (CDSS) | | | | |