Abstract

Dalam banyak penerapannya, penggunaan sistem peresepan elektronik (computerized physician order entry, CPOE) dalam penulisan resep terbukti mampu menurunkan angka kesalahan peresepan obat (adverse drug event, ADE). Kesalahan pengobatan seperti kekeliruan penulisan nama obat, penentuan dosis, dan penggunaan jenis obat yang tepat untuk pasien dengan kondisi kesehatan tertentu di pelayanan kesehatan dapat ditekan. Namun, CPOE masih memiliki kelemahan seperti tambahan waktu untuk mengentri data pasien oleh para dokter ke dalam sistem. Untuk meng- evaluasi dampak persepsi pengguna tentang penerapan CPOE terhadap keselamatan pengobatan pasien, suatu penelitian kualitatif telah dilakukan di Gadjah Mada Medical Health Center yang telah mengadopsi sistem ini selama sepuluh tahun. Data dan informasi dikumpukan dengan wawancara mendalam terhadap sembilan dokter (tujuh dokter umum dan dua dokter spesialis) sebagai informen pengguna CPOE menggunakan pedoman wawancara, alat perekam suara, buku catat, dan daftar centang observasi. Hasil studi menunjukkan bahwa sepuluh tahun CPOE telah mampu meningkatkan efektivitas dan efisiensi pelayanan kesehatan, tetapi potensi ADE masih terjadi akibat gangguan komunikasi pasien-dokter karena perlunya waktu tambahan untuk entri data. Disimpulkan bahwa sistem CPOE belum mampu mendukung pengambilan keputusan untuk mencegah ADE dalam pengobatan pasien. In most of its applications, Computerized Physician Order Entry (CPOE) has been improved patient safety by reducing medication errors and subsequent adverse drug events (ADEs). Medication error such as elixir in writing, determination of dose, and correct drug type used for patient with certain health condition in health services can be reduced. But, the CPOE still has some weknesses such as additional time to entry the patient information by physician to the sistem. To evaluate the impact of end-user perception using CPOE sistem on patient safety medication, a qualitative research has been conducted at Gadjah Mada Medical Health Center which has adopted this sistem for ten years. Data and informations were collected by in-depth interviewing nine physicians (seven general docters and two specialists) as end-user informen using interview guide, tape recorder, note-book, and checklist observation tools. The results show that ten year CPOE implemention has improved the effectiveness and efficiency of medical health care, but potential adverse drug event (ADE) such as drug prescription errors still occur as a result of patient-physician communication distraction due to additional time for data entry. It is concluded that CPOE sistem has not been able to support decision to prevent the ADEs in patient medication.

References

1. Colpaert K, Claus B, Somers A, Vandewoude K, Robays H, Decruyenaere J. Impact of computerized physician order entry on medication prescription errors in the intensive care unit: a controlled cross-sectional trial. Critical Care. 2006; 10(1): R21. 2. Battles JB, Lilford RJ. Organizing patient safety research to identify risks and hazards. Quality & Safety in Health Care. 2003;12 Suppl 2: ii2-7. 3. Kuperman GJ, Bobb A, Payne TH, Avery AJ, Gandhi TK, Burns G, et al. Medication-related clinical decision support in computerized provider order entry systems: a review. Journal of American Medical Informatic Association. 2007; 14(1): 29-40. 4. Galanter WL, Didomenico RJ, Polikaitis A. A trial of automated decision support alerts for contraindicated medications using computerized physician order entry. Journal of American Medical Informatic Association. 2005; 12(3): 269-74. 5. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Archives of Internal Medicine. 2003; 163(12): 1409-16. 6. Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff (Millwood). 2004; 23(4): 184-90. 7. Wess ML, Embi PJ, Besier JL, Lowry CH, Anderson PF, Besier JC, et al. Effect of a computerized provider order entry (CPOE) system on medication orders at a community hospital and university hospital. AMIA Annual Symposium Proceedings. 2007:796-800. 8. Devine EB, Hansen RN, Wilson-Norton JL, Lawless NM, Fisk AW, Blough DK, et al. The impact of computerized provider order entry on medication errors in a multispecialty group practice. Journal of American Medical Informatic Association. 2010; 17(1): 78-84. 9. Kusmarini P, Dwiprahasto I, Wardani P. Penerimaan dokter dan waktu tunggu pada peresepan elektronik dibandingkan peresepan manual. Jurnal Manajemen Pelayanan Kesehatan. 2011; 14(3): 133-8. 10. Anonim. E-prescribing. London, UK: Open Clinical [online]. 2005 [cited 2010 April 14]. Available from: www.openclinical.org/e-prescribing. html. 11. Campbell EM, Guappone KP, Sittig DF, Dykstra RH, Ash JS. Computerized provider order entry adoption: implications for clinical Workflow. Journal of General Internal Medicine. 2009; 24(1): 21-6. 12. Berger RG, Kichak JP. Computerized physician order entry: helpful or harmful? Journal of the American Medical Informatics Association. 2004 Mar-Apr; 11(2): 100-3. 13. Ash JS, Sittig DF, Campbell E, Guappone K, Dykstra RH. An unintended consequence of CPOE implementation: shifts in power, control, and autonomy. AMIA Annual Symposium Proceeding. 2006:11-5. 14. Niazkhani Z, Pirnejad H, Berg M, Aarts J. The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review. Journal of American Medical Informatics Association. 2009; 16(4): 539-49. 15. Callen JL, Westbrook JI, Braithwaite J. The effect of physicians longterm use of CPOE on Their Test Management Work Practices. Journal of American Medical Informatics Association. 2006; 13(6): 643-52. 16. Miller RA, Gardner RM, Johnson KB, Hripcsak G. Clinical decision support and electronic prescribing systems: a time for responsible thought and action. Journal of American Medical Informatics Association. 2005; 12(4): 403-9. 17. Stelfox HT, Palmisani S, Scurlock C, Orav EJ, Bates DW. The to err is human report and the patient safety literature. Quality and Safety in Health Care. 2006; 15(3): 174-8. 18. Bates DW. Aconversation with the editor on improving patient safety, quality of care, and outcomes by using information technology. Proc (Bayl Univ Med Cent). 2005; 18(2): 158-64. 19. Yin RK. Studi kasus: desain dan metode. Edisi revisi ed. Mudzakir MD, editor. Jakarta: PT Rajagrafindo Persada; 2003. 20. Ash JS, Gorman PN, Hersh WR. Physician order entry in U.S. hospitals. AMIA Annual Symposium Proceeding. 1998: 235-9. 21. Schaubhut RM, Jones C. A systems approach to medication error reduction. Journal of Nursing Care Quality. 2000; 14(3): 13-27. 22. Schedlbauer A, Prasad V, Mulvaney C, Phansalkar S, Stanton W, Bates DW, et al. What evidence supports the use of computerized alerts and prompts to improve clinicians’ prescribing behavior? Journal of American Medical Informatics Association. 2009; 16(4): 531-8.

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