Leapfrog on CPOE

Leapfrog Announces New Report on the Safety of Electronic Prescribing Sysems in Hospitals (Report PDF, Press Release PDF)

Executive Summary

Using The Leapfrog Group's web‐based simulation tool, 214 hospitals tested their computerized physician order entry (CPOE) systems for their ability to detect common medication errors and errors that could lead to fatalities. The CPOE systems on average missed one half of the routine medication orders and a third of the potentially fatal orders. Nearly all of the hospitals improved their performance after adjusting their systems and protocols, and running the simulation a second time. The simulations were conducted from June 2008 to January 2010.

The Leapfrog simulation tool used to develop this report is the only one of its kind available to all hospitals through The Leapfrog Hospital Survey. Every hospital that employs a computer prescribing system should incorporate the Leapfrog simulation tool into their ongoing quality assurance and improvement processes.

For the sake of safe patient care, hospitals must test and monitor their CPOE systems on an ongoing basis to achieve true meaningful use. In addition, vendors and hospitals must collaborate more closely during the pre‐implementation and implementation phases to ensure that best practices are shared and followed.

The Leapfrog Group is calling on the federal government to ensure that any definition of meaningful use employed as a requirement for federal financial assistance to hospitals to adopt CPOE and other health care IT systems require monitoring and improvement at implementation and on a long‐term basis.

Adult & Pediatric Medication & Potentially Fatal Orders

	Medication Orders without Proper Warnings	Potentially Fatal Orders without Proper Warnings
Adult Hospitals (n=187)	8,716 (52%)	311 (33%)
Pediatric Hospitals (n=37)	1,731 (42%)	62 (34%)