Of Special Interest for Long-Term Care Facilities
MedSun: Newsletter #5, June 2006
Long-term care facilities, whose elderly and often frail residents on average are prescribed more than six concurrent drug therapies, are especially vulnerable to serious adverse drug events. The Canadian Medical Association Journal (CMAJ) has highlighted a software application that is being used with success in acute care facilities to improve drug safety and that may have particular importance in long-term care. Computerized physician order entry (CPOE) with clinical decision support (CDS) is a system in which physicians enter patient prescriptions directly into a computer and receive immediate feedback about clinically important information that may improve their prescribing decisions. Specifically, an automated interface links the newly ordered drug therapy to clinical, drug, and laboratory information in a way that guides prescription decisions in the direction of increased safety and ultimately reduces the medication errors that lead to adverse events.
Most prescribing errors are made at the ordering and monitoring phases of the process of pharmacotherapeutic care. The staffing structure at long-term care facilities—limited access to physician time and relatively few registered nurses on staff—may contribute to the problem. CPOE-CDS implementation in these settings appears to be a logical next step. The fact that the number of long-term care beds exceeds those in acute care facilities underscores the importance of accessing CPOE systems to reduce adverse drug events among the long-term patient population.
The CMAJ authors are aware of two long-term care facilities, in Toronto and Connecticut, that have CPOE-CDS systems in place and could serve as models for other long-term care settings as they develop their systems. CPOE systems will need to build on the limited technological infrastructure that exists in many long-term care facilities, starting with finding ways to link the provider, pharmacy, and laboratory systems. Smaller long-term care providers are often part of larger organizations that work with a defined group of pharmacies and laboratories, which would allow the creation of CPOE-CDS systems across entire organizations.
The complete CMAJ article can be read at