Order set to improve the care of patients hospitalized for an exacerbation of chronic obstructive pulmonary disease

Kirstin E. Brown, Kara J. Johnson, Beth M. DeRonne, Connie M. Parenti, Kathryn L. Rice

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Rationale: Physicians' 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 exacerbations. Objectives: To determine if implementation of a locally designed, evidence-based, multidisciplinary computer physicianorderentryset in the electronic health record 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 over a 1-year period before 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 physician pharmaceutical prescribing error rate; types of errors; hospital lengths of stay; and unscheduled physician visits, emergency department visits, rehospitalizations, and deaths within 30 days from discharge. Measurements and Main Results: There were 194 COPD exacerbation admissions during the 1-year preimplementation period and 81 admissions during the 6-month postimplementation period. Compared with the preimplementation 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 from 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 postimplementation period. Hospital length of stay decreased from 4 (±3) days preimplementation to 2.9 (±1.9) days postimplementation (P = 0.002). There were no significant differences in 30-day clinical outcomes, including the rates of unscheduled physician or emergency department visits, rehospitalizations, or deaths.

Original languageEnglish (US)
Pages (from-to)811-815
Number of pages5
JournalAnnals of the American Thoracic Society
Volume13
Issue number6
DOIs
StatePublished - Jun 2016

Bibliographical note

Publisher Copyright:
Copyright © 2016 by the American Thoracic Society.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

  • Chronic obstructive pulmonary disease
  • Computer physician order entry (CPOE)
  • Electronic health record
  • Prescribing errors
  • Quality improvement

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