Pediatric Informatics: Computer Applications in Child Health (Health ...

336 C.U. Lehmann and G.R. Kim
Table 26.1 Modified principles from the IOM “to err is human” report 1
Safety principles Methods to achieve
1. Culture of Safety (p166) Safety as a corporate priority
Safety as everyone’s responsibility
Safety efforts are assigned and overseen
Financial resources for analysis and redesign
Identification and Dealing with unsafe
practitioners
2. Anticipate Human Limitations (p170) Safe job design
Avoidance of the need to rely on memory
or vigilance
Use of constraints and forcing functions
Simplification and standardization
3. Team Work (p173) Training as a team
Inclusion of the patient in the planning for
safety and care
4. Anticipate the Unexpected (p174) Proactive approach: identify problems before
they become accidents
Inclusion of recovery plans in the design
Improving access to timely, accurate
information
5. Learning Environment (p178) Use of simulations
Encouragement to report errors and hazards
Non-punitive environment
Elimination of barriers to communication
Feedback and learning from errors
intra-clinic activities (Chapter 19), and when it connects ambulatory prescribers to
remote pharmacies, it is also called e-Prescribing. 2
Clinical Decision Support (CDS) is any knowledge-based tool that integrates
patient data into clinical workflow to improve care quality (and safety), patient
satisfaction and outcomes. CDS may:
Provide users access to patient-specific data and/or medical knowledge
Guide users’ actions or choices in diagnosis and/or therapy
Deliver timely knowledge-based prompts (such as alerts and reminders) to
users and
Collect and process data about clinical care processes, outcomes, and performance
to help users to understand and improve practice 3
CPOE may be classified according to the clinical environment in which it
operates and the degree to which CDS is incorporated. Ambulatory CPOE
(see Chapter 19) may vary from “Basic Rx” (printing basic prescriptions without
patient data or decision support) to “Advanced Rx-Dx” (full electronic data
interchange between physicians’ offices and pharmacies with patient-specific
decision support). 4 In inpatient settings, almost all CPOE systems include some
form of CDS.