PURPOSE: Computerized Physician Order Entry (CPOE) systems offer the potential for improved utilization of ICU safety protocols. We examined the effects of a change from a legacy CPOE system (E7000, Eclipsys Corp. Boca Raton FL,) to Cerner Millenium (Kansas City, MO) CPOE in a 24 bed MICU-SICU.
METHODS: We evaluated medications use in ICU patients one year preceding and one year following CPOE transition on 1/16/05. Order sets in the legacy system were reviewed and updated. Drug allergy checking, drug-drug interaction and dose range checking were introduced. Data from Project IMPACT, collected on a 50% random sample of patients, were reviewed retrospectively; univariate comparisons were conducted with p<0.05 considered significant. Mortality outcomes were severity-adjusted using the Mortality Probability Model (MPM-II), and LOS by Rapoport-Teres methodology (Crit Care Med 1994 22: 1385).
RESULTS: Significant increases were noted in heparin/LWMH use for DVT prophylaxis (40% pre to 52% post); sequential compression devices (86% to 94%) and proton pump inhibitors or H2 blockers for gastric cytoprotection (34 to 49%). No change was noted in use of insulin infusions (44 vs. 41%) or corticosteroids (23 vs. 20%). Hospital survival for ICU patients did not significantly change (80.2% pre; 81.1% post); both were higher than MPM-II prediction. There were no significant differences in rates of ARDS, DVT, GI Bleeding, ARF, HIT, MI or in ICU mortality. Unadjusted ICU LOS (5.5 to 4.5 days) and hospital LOS (16.3 to 14.1 days) decreased (p<0.012), but the change was not significant when adjusted for severity of illness.
CONCLUSION: Medication administration for stress-ulcer and DVT prophylaxis increased after a new CPOE system with clinical decision support alerts was implemented. ICU complications, severity-adjusted mortality and LOS were unchanged; contrasting to a recent report of increased mortality after CPOE implementation (Han, Pediatrics 2005 116:1506).
CLINICAL IMPLICATIONS: CPOE systems may be associated with improved ICU care.
DISCLOSURE: Thomas Higgins, Consultant fee, speaker bureau, advisory committee, etc. Critical Care Transformation Committee, and Chair, Project IMPACT Research Committee, Cerner Corporation, Kansas City, MO.