Leapfrog Group Analyzes Hospital Data on CPOE, Bar Code Medication Administration

The Leapfrog Group’s 2019 report on medication safety found that 65 percent of hospitals fully met the Leapfrog standard for computer physician order entry (CPOE) and 45 percent fully met its standard for bar code medication administration standards.

Leapfrog has collected and publicly reported safety and quality information about hospitals for 19 years. The report is based on results of the 2018 Leapfrog Hospital Survey, with data submitted by more than 2,000 U.S. hospitals, representing almost 70 percent of U.S. hospital beds. The report analyzes how well responding hospitals perform in deploying CPOE and bar code medication administration systems. Both reduce medication errors, the most common error made in hospitals.

The report is the first in a four-part series that will summarize findings across the 2018 Leapfrog Hospital Survey. Future reports will highlight hospital trends in maternity care, never events and surgical volumes. Results are available by hospital.

Leapfrog evaluates reporting hospitals on two aspects of CPOE use: percentage of inpatient medication orders entered through a CPOE system and performance on Leapfrog's CPOE Evaluation Tool, a simulation test designed to evaluate how well CPOE systems are alerting prescribers to potential errors. To meet Leapfrog's standard, hospitals must enter at least 85 percent of their inpatient medication orders via a CPOE system and prove that at least 60 percent of medication orders triggered the appropriate warning. In this report, Leapfrog finds the following among responding hospitals:

Sixty-five percent of hospitals fully met the Leapfrog standard.
Sixty-two percent of hospitals are ordering inpatient medications via a CPOE system the large majority of the time.
Seventy percent of hospitals proved through Leapfrog's CPOE Evaluation Tool that their CPOE system alerts physicians to common, serious prescribing errors.

Those hospitals that fully meet CPOE standards are more likely to be teaching than non-teaching (72 percent vs. 62 percent) and more likely to be urban than rural (68 percent vs. 47 percent).

"Leapfrog's CPOE standard is tough, because medication errors are a tough problem. People deserve to know that hospitals are using the best technology and using it wisely to protect their patients," said Leapfrog President and CEO Leah Binder, in a prepared statement.

Hospitals reporting to the Leapfrog Hospital Survey on bar code medication administration systems are evaluated on the extent to which barcoding is used and whether the hospital implements barcoding using best practices for patient safety. Among responding hospitals, 45 percent fully meet Leapfrog's standard for bar code medication administration standards, which are four-fold:

Have a bar code medication administration system connected to an electronic medication administration record in 100 percent of medical/surgical, labor and delivery and intensive care units (achieved by 98 percent of hospitals);
Scan both a patient's wristband and medication when administering medication at bedside at least 95 percent of the time (achieved by 70 percent of hospitals);
Implement decision supports to flag (1) wrong patient, (2) wrong medication, (3) wrong dose, (4) wrong time, (5) vital sign check, (6) patient-specific allergy check, and (7) second nurse check needed (achieved by 63 percent of hospitals); and,
Have at least six of eight best practices in place to prevent dangerous workarounds that impede the safety of the BCMA system (achieved by 78 percent of hospitals).

"What is promising about this year's bar code medication administration results is the increase in hospitals that fully met the standard," added Binder in her statement. "In the 2017 Survey, 34.5 of responding hospitals adhered to best practices in bar code administration. In the 2018 Survey, that number rose to 45 percent. We're moving in the right direction to save lives, but much more needs to be done. Given nearly all hospitals have this technology, there's no reason we shouldn't be at 100 percent compliance in effective use."