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Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients

BACKGROUND: Prescribing inappropriate pill splitting is not rare in clinical practice. To reduce inappropriate pill splitting, we developed an automatic warning system linked to a computerized physician order entry (CPOE) system for special oral formulation drugs in outpatient settings. We examined...

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Autores principales: Hsu, Chia-Chen, Chou, Chia-Yu, Chou, Chia-Lin, Ho, Chin-Chin, Chen, Tzeng-Ji, Chiang, Shu-Chiung, Wu, Min-Shan, Wang, Sen-Wen, Lee, Chung-Yuan, Chou, Yueh-Ching
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257670/
https://www.ncbi.nlm.nih.gov/pubmed/25479360
http://dx.doi.org/10.1371/journal.pone.0114359
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author Hsu, Chia-Chen
Chou, Chia-Yu
Chou, Chia-Lin
Ho, Chin-Chin
Chen, Tzeng-Ji
Chiang, Shu-Chiung
Wu, Min-Shan
Wang, Sen-Wen
Lee, Chung-Yuan
Chou, Yueh-Ching
author_facet Hsu, Chia-Chen
Chou, Chia-Yu
Chou, Chia-Lin
Ho, Chin-Chin
Chen, Tzeng-Ji
Chiang, Shu-Chiung
Wu, Min-Shan
Wang, Sen-Wen
Lee, Chung-Yuan
Chou, Yueh-Ching
author_sort Hsu, Chia-Chen
collection PubMed
description BACKGROUND: Prescribing inappropriate pill splitting is not rare in clinical practice. To reduce inappropriate pill splitting, we developed an automatic warning system linked to a computerized physician order entry (CPOE) system for special oral formulation drugs in outpatient settings. We examined the impact of the warning system on inappropriate prescribing of pill splitting and assess prescribers' responses to the warnings. METHODS: Drugs with extended-release or enteric-coated formulations that were not originally intended to be split were recognized as “special oral formulations”. A hard-stop system which could examine non-integer doses of drugs with special oral formulations, provide warnings to interrupt inappropriate prescriptions was integrated in CPOE in a medical center since June 2010. We designed an intervention study to compare the inappropriate splitting before and after the implementation of the warning system (baseline period 2010 January to May vs. intervention period 2010 June to 2011 August). During the intervention period, prescription changes in response to a warning were logged and analyzed. RESULTS: A total of 470,611 prescribed drug items with 34 different drugs with special oral formulations were prescribed in the study period. During the 15-month intervention period, 909 warnings for 26 different drugs were triggered among 354,523 prescribed drug items with special oral formulations. The warning rate of inappropriate splitting in the late intervention period was lower than those in baseline period (0.16% vs. 0.61%, incidence rate ratio 0.27, 95% CI 0.23–0.31, P<0.001). In respond to warnings, physicians had to make adjustments, of which the majority was changing to an unsplit pill (72.9%). CONCLUSIONS: The interruptive warning system could avoid the prescriptions with inappropriate pill splitting. Accordingly, physicians changed their behavior of prescribing special oral formulations regarding inappropriate pill splitting. We suggest the establishment of such system to target special oral formulations with warnings to prevent inappropriate pill splitting.
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spelling pubmed-42576702014-12-15 Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients Hsu, Chia-Chen Chou, Chia-Yu Chou, Chia-Lin Ho, Chin-Chin Chen, Tzeng-Ji Chiang, Shu-Chiung Wu, Min-Shan Wang, Sen-Wen Lee, Chung-Yuan Chou, Yueh-Ching PLoS One Research Article BACKGROUND: Prescribing inappropriate pill splitting is not rare in clinical practice. To reduce inappropriate pill splitting, we developed an automatic warning system linked to a computerized physician order entry (CPOE) system for special oral formulation drugs in outpatient settings. We examined the impact of the warning system on inappropriate prescribing of pill splitting and assess prescribers' responses to the warnings. METHODS: Drugs with extended-release or enteric-coated formulations that were not originally intended to be split were recognized as “special oral formulations”. A hard-stop system which could examine non-integer doses of drugs with special oral formulations, provide warnings to interrupt inappropriate prescriptions was integrated in CPOE in a medical center since June 2010. We designed an intervention study to compare the inappropriate splitting before and after the implementation of the warning system (baseline period 2010 January to May vs. intervention period 2010 June to 2011 August). During the intervention period, prescription changes in response to a warning were logged and analyzed. RESULTS: A total of 470,611 prescribed drug items with 34 different drugs with special oral formulations were prescribed in the study period. During the 15-month intervention period, 909 warnings for 26 different drugs were triggered among 354,523 prescribed drug items with special oral formulations. The warning rate of inappropriate splitting in the late intervention period was lower than those in baseline period (0.16% vs. 0.61%, incidence rate ratio 0.27, 95% CI 0.23–0.31, P<0.001). In respond to warnings, physicians had to make adjustments, of which the majority was changing to an unsplit pill (72.9%). CONCLUSIONS: The interruptive warning system could avoid the prescriptions with inappropriate pill splitting. Accordingly, physicians changed their behavior of prescribing special oral formulations regarding inappropriate pill splitting. We suggest the establishment of such system to target special oral formulations with warnings to prevent inappropriate pill splitting. Public Library of Science 2014-12-05 /pmc/articles/PMC4257670/ /pubmed/25479360 http://dx.doi.org/10.1371/journal.pone.0114359 Text en © 2014 Hsu et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Hsu, Chia-Chen
Chou, Chia-Yu
Chou, Chia-Lin
Ho, Chin-Chin
Chen, Tzeng-Ji
Chiang, Shu-Chiung
Wu, Min-Shan
Wang, Sen-Wen
Lee, Chung-Yuan
Chou, Yueh-Ching
Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients
title Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients
title_full Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients
title_fullStr Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients
title_full_unstemmed Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients
title_short Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients
title_sort impact of a warning cpoe system on the inappropriate pill splitting of prescribed medications in outpatients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257670/
https://www.ncbi.nlm.nih.gov/pubmed/25479360
http://dx.doi.org/10.1371/journal.pone.0114359
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