Who should take a CPOE Evaluation Tool?
Adult and general hospitals that have CPOE implemented in at least one inpatient unit of the hospital are asked to complete a CPOE Evaluation Tool as part of Section 2 of the Leapfrog Hospital Survey. The testing of a hospital’s CPOE system is a key part of the Leapfrog Hospital Survey and all survey deadlines apply to the CPOE Evaluation Tool as well.
What is the CPOE Evaluation Tool?
The CPOE Evaluation Tool is a timed test that provides a hospital with a set of patient scenarios, along with a corresponding set of inpatient medication orders, that users enter into their hospital’s CPOE and related clinical systems. Those conducting the test record the warnings or other responses, if any, from their hospital’s CPOE system onto a paper answer sheet, report those results back at via the CPOE Tool website, and receive immediate scoring and feedback summarizing the results of the test. The scenarios and test protocols include potential drug-drug or drug-diagnosis interactions, drug-allergy interaction, therapeutic duplication, and dosage errors. Hospitals are scored on their CPOE systems ability to alert prescribers to these common, serious medication errors.
The CPOE Evaluation Tool includes both a Sample Test and the Adult Inpatient Test. All hospitals are urged to complete the Sample Test prior to the Adult Inpatient Test. Only the Adult Inpatient Test is used for scoring and public reporting.
How Do I Access CPOE Evaluation Tool?
Hospitals can log in to the Adult Inpatient CPOE Tool from the Survey Dashboard, once they have submitted Section 2 of the online survey indicating they have implemented CPOE in at least one inpatient unit. The CPOE Tool button will not appear on the survey dashboard until Section 1 and Section 2 of the online survey has been submitted. You can always return to complete and submit the rest of the survey at a later date (Sections 3-9). Download the CPOE Quick Start Guide here.
How is the Test Conducted?
Once you submit Section 2 in the online survey tool, the “CPOE Tool” button will appear on the Survey Dashboard. A brief demographics form will need to be completed. Once the demographics form is complete, continue on to the next screen to select a Sample or Adult Inpatient Test from the dropdown menu.
Taking the test involves five steps:
|Step 1||Download and print the test Patient Descriptions, then log out of the test.|
|Step 2||Set up test patients in your hospital’s clinical and administrative systems.|
|Step 3||Log back into the test to download and print the Medication Orders and paper answer sheet, then log out. Once you log out of Step 3, timing for Step 4 begins.|
|You will have 4 hours to complete steps 1-3 above.|
|Step 4||Complete order entry as directed, and record the advice and information your hospital’s CPOE system provides to the prescriber on the paper answer sheet.|
|Step 5||Log back into the test to complete and submit the online answer sheet, and receive immediate scoring and feedback report.|
|You will have 2.5 hours to complete steps 4-5 above.|
The same time limit applies to both the Sample and Adult Inpatient Tests. For each test started, you have:
- four hours elapsed time to complete Steps 1-3, then
- two and a half hours elapsed time to complete Steps 4-5.
Elapsed time runs continuously, 24/7, and is not interrupted or suspended during “non-business hours.” If you exceed these time limits, the CPOE Tool will "time out" and consider the test “incomplete.” The test will be recorded in the online survey as “Incomplete Test” and Leapfrog will not give credit to your hospital for taking that test. It is not possible to go back to a previous step in the test.
More information is available in the CPOE Evaluation Tool Instructions.
Planning for the Test
- Read all instructions in this Leapfrog CPOE Test User Instructions document. Download a copy of the Quick Start Guide and review the CPOE Tool section.
- Set-up the team to perform patient set-up and enter the orders. Hospitals involved in testing have found the following areas of expertise are needed to establish the test patients:
- ADT/Registration to admit/register the patients and assign them a bed
- Laboratory to enter laboratory results – primarily chemistry, hematology, drug levels, and microbiology
- Nursing to enter in patient profiles, allergy and assessment information
- At least one physician is required (though some hospitals have recommended having a back-up physician on-call, just in case an emergency comes up) to enter the orders. The maximum time required for the physician is 2 hours. Note: The physician entering the orders should be the “typical” physician ordering on a daily basis. (Some hospitals set decision support at different levels for residents, medical students, attendings, etc. Hospitals that have set different levels of decision support should enter orders and report the results using the minimum level of medication safety checking.)
- A coordinator, typically an individual from clinical IS. Some hospitals found it useful to have a pharmacist familiar with CPOE present during order entry
- Line up the resources:
- Reserve your time
- Brief and schedule technical or other support persons for loading the patients (Step 2) into your admitting/discharge, lab, pharmacy or other systems – review steps with them, schedule their availability for the four-hour time period allotted for Steps 1-5
- Brief and schedule prescriber(s) for order entry (Step 4)
- Ascertain that the test system mirrors order management and clinical decision support in the current production system. If the two are not in sync, either update the test system or plan to conduct the test in the operational system. (Some hospitals already use test patients in the production system; if this is not the case, make necessary arrangements to disregard orders and potential billing charges for test patients.) If you opt to use your production system, depending on your CPOE system (and its integration with ADT), you might need to have at least fifteen (15) open beds in order to simulate patient admissions for the test.
- Make sure you have a valid 16-digit security code and can access the CPOE Tool from the Survey Dashboard. Go ahead and click on the “CPOE Tool” button (this doesn’t start any test; you’ll be warned before the clock starts running on any test).
- Complete the Organization Information beforehand. (This also doesn’t start any test but needs to be completed, and should be reviewed and updated if previously completed, before starting any test.) Once completed/updated, you can logout or proceed to the test. Some of the information may not be readily available. See Example A on page 12 to review the types of required information for this section.
- Complete the Sample Test (see detailed instructions below) as a dry run, preferably with the same resources to be involved in the eventual test.
How Will the Results Be Used?
Results from the CPOE Evaluation Tool will be combined with a hospital’s CPOE implementation status to determine its overall score on the CPOE standard. More information is available in Scoring and Results.
How is the CPOE Evaluation Tool scored?
More information about the CPOE Evaluation Tool scoring can be found in Scoring and Results.