Evaluating Incorporation of Drug Restrictions into Computerized Drug Order Entries after Transition to an Electronic Health Record

Abstract

Background

Incorporation of drug restriction policy into electronic drug order entries (DOEs) can promote responsible medication use and resource utilization when implemented systematically.

Objective

To identify drugs that require further incorporation of formulary restriction policy into their DOEs after migration to an electronic health record with computerized prescriber order entry (CPOE).

Methods

After transition to CPOE, test orders for formulary restricted drugs were entered in the CPOE environment. Data were collected about rationale for drug restriction, type of formulary restriction, presence of incorporation of restriction policy into the DOE, and whether incorporation was consistent with a recommended method. Restricted drugs requiring revision of policy incorporation into their DOEs were analyzed to create a prioritized task list based on rationale for the restriction.

Results

Of all restricted drugs, 63.6% (287/451) did not have restriction policy incorporated into their DOEs consistent with the recommended method and therefore required revision. Eighteen percent (81/451) of restricted drugs had no incorporation of restriction policy in their DOEs. Safety was the rationale for restriction in 21% (17/81) of these, which received highest priority for revision. When drugs were orderable but restricted, 61.9% (78/126) lacked optimal incorporation of policy in DOEs to promote adherence. When drugs were not orderable, 64% (206/322) did not provide guidance to formulary alternatives in DOEs when they should have.

Conclusion

After transition to CPOE, almost two-thirds of all analyzed restricted drugs lacked optimal incorporation of formulary restriction policies in their DOEs. DOEs with restrictions related to safety reasons were among those most frequently requiring revision. Some DOEs can better promote adherence and provide guidance to prescribers through revision. Predefined, systematic implementation strategies should be used during changes in computerized drug use processes.

Keywords

American Recovery and Reinvestment Act computerized physician order entry electronic medication alerts hospital formularies informatics medical order policy

Get full access to this article

View all access options for this article.

References

Public Law: Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, Pub. L. No. 111–5, Division A, Title XIII, Subtitle D (February 17, 2009).

Centers for Medicare and Medicaid Services. CMS EHR meaningful use overview. https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp#TopOfPage. Accessed December 12, 2011.

Westphal

Jehl

Javelot

Nonnenmacher

Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting. Pharmacoepidemiol Drug Saf. 2011;20(2):162–168.

Traugott

Maxwell

Green

Frei

Lewis

2nd . Effects of therapeutic drug monitoring criteria in a computerized prescriber-order-entry system on the appropriateness of vancomycin level orders. Am J Health Syst Pharm. 2011;68:347–352.

Bobb

Boehne

Ethridge

. ASHP guidelines on pharmacy planning for implementation of computerized provider-order-entry systems in hospitals and health systems. Am J Health Syst Pharm. 2011;68(6):e9–31.