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| Bringing Applied Behavior Analysis into the Healthcare Setting |
| Monday, May 29, 2006 |
| 10:30 AM–11:50 AM |
| Cairo |
| Area: OBM; Domain: Applied Research |
| Chair: E. Scott Geller (Virginia Polytechnic Institute and State University) |
| Discussant: Timothy D. Ludwig (Appalachian State University) |
| Abstract: Almost 200,000 U.S. deaths in 2004 were attributed to human error in health-care situations. A few hospitals have benefited from behavioral interventions aimed at improving hospital staff safety. Focusing on the behavior change of caregivers could also improve patient safety. As with other settings, there are cultural barriers to successful implementation of error management, incident reporting systems, and safety programs in hospitals. It is estimated that 7,000 people die annually due to preventable medication errors in hospitals, and a majority of medication errors have been linked to the medication ordering process, where physicians traditionally write medication orders by hand. In one study presented here, data were collected on caregivers’ compliance to hospital standards when ordering medication and the delay between ordering and receiving antibiotics. These compliance and efficiency data were obtained before and after Computerized Physician Order Entry (CPOE) implementation, whereby medication could be ordered electronically. The second study compared the impact of three behavior-based interventions (awareness, awareness/group feedback, awareness/group feedback/social comparison) designed to increase use of CPOE in a 521-bed medical center where numerous physicians use the traditional hand-written method. The research will be discussed within the context of a vision to improve patient safety with applied behavior analysis. |
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| The Challenges of Extending Organizational Behavior Management the Business of Healthcare. |
| IAN J. EHRHART (Virginia Polytechnic Institute and State University), E. Scott Geller (Virginia Polytechnic Institute and State University) |
| Abstract: Behavioral principles have been used to address many different societal issues, including environmental protection, transportation safety, and occupational injuries. However, healthcare organizations have been essentially ignored by behavior analysts. Yet, hospitals, short-term care facilities, nursing homes, and doctors’ offices, to name a few, would benefit from behavioral interventions targeting both patient safety (e.g., medication errors) and practitioner/staff safety (e.g., sharps injuries). Indeed, an article in the New York Times reported the estimated loss of 192,000 U.S. lives in 2004 due to hospital errors. However, as with other settings, there are healthcare cultural barriers to successful implementation of error management, incident reporting systems, and safety programs. This overview paper will examine the challenges of applying the principles of organizational behavior management to the healthcare setting, specifically hospital cultures, thereby setting the stage for the two data-based presentations to follow. Areas to be explored include a) patient safety issues (e.g., medication errors), b) practitioner safety issues (e.g., needlesticks), and to a large extent c) potential barriers to the successful implementation of behavior-based programs in the healthcare setting. Specific barriers include a culture of blame, error acceptance, the complexity of the healthcare system, overwhelming job demands, multitasking, individualism, communication, hierarchies, and professional autonomy. |
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| The Impact of Computerized Medication Ordering on Efficiency and Error Rate. |
| DAVID MICHAEL HARRIS (Virginia Polytechnic Institute and State University), Patrick A. Rhodes (Virginia Polytechnic Institute and State University), Thomas R. Cunningham (Virginia Polytechnic Institute and State University), Douglas Wiegand (Virginia Polytechnic Institute and State University) |
| Abstract: This data-based paper will present objective and reliable observations obtained at two regional hospitals. The research investigated the impact of a Computerized Physician Order Entry (CPOE) system on several physician medication ordering behaviors. Many people are injured each year as a result of adverse drug events, and CPOE is considered critical to greatly reducing this number. The primary dependent measures are order compliance, time-to-first-dose of antibiotic, and reported medication incidents. Data were collected on written order compliance to hospital standards for medication ordering. Data were also collected on time-to-first dose of antibiotic orders because research shows that quicker antibiotic administration can lead to shorter hospital stays and better patient outcomes. These data were obtained by reviewing over 1,000 incidents of medication ordering over a span of four months. Data compare compliance and efficiency measures pre- and post-CPOE implementation, as well as between- and within-group comparisons of written and CPOE orders. Overall measures of reported medication incidents from the intervention hospital are compared to those of a control hospital site. These data were collected weekly at both sites over the same four-month period. Empirical findings will be presented as well as implications for future CPOE system implementation and patient safety. |
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| Intervening to Change the Way Physicians Order Medications in a Hospital. |
| THOMAS R. CUNNINGHAM (Virginia Polytechnic Institute and State University), Steven W. Clarke (Virginia Polytechnic Institute and State University), Ian J. Ehrhart (Virginia Polytechnic Institute and State University), E. Scott Geller (Virginia Polytechnic Institute and State University) |
| Abstract: It is estimated 7,000 people die annually due to preventable medication errors in U.S. hospitals (Institute of Medicine, 1999), and a majority of these medication errors have been linked to the medication-ordering process, especially at the prescribing phase where physicians traditionally write their medication orders by hand. Handwritten medication orders are often illegible, incomplete, or do not meet standards for compliance. Previous research indicates that adoption of Computerized Physician Order Entry (CPOE) will reduce medication errors in a hospital setting and therefore improve patient safety. The aim of this study was to increase patient safety by developing and evaluating interventions to increase and sustain CPOE use in hospital settings. The impact of three behavior-based interventions on CPOE adoption and use among physicians working in a 521-bed medical center were evaluated: 1) awareness – information to promote CPOE, 2) awareness/group feedback – awareness campaign plus graphs of order compliance and efficiency data for paper- versus CPOE-based medication orders, and 3) awareness/group feedback/social comparison – group feedback of CPOE adoption and usage rates at intervention versus control hospital sites in addition to previous intervention components. The results of this study serve to inform the development of large-scale interventions to increase hospital-wide use of CPOE. |
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