Prepare for CPOE Tool

 

Who should take a CPOE Evaluation Tool?

In 2021, as part of Leapfrog’s continued response to COVID-19, adult and general hospitals have two options to achieve Leapfrog’s CPOE Standard:

Option 1: adult and general hospital must (1) ensure that licensed prescribers enter at least 85% of inpatient medication orders via a computer system that includes decision support software to reduce prescribing errors.

Option 2: adult and general hospital must (1) ensure that licensed prescribers enter at least 85% of inpatient medication orders via a computer system that includes decision support software to reduce prescribing errors, and (2) demonstrate, via a test, that its inpatient CPOE system can alert physicians to at least 60% of frequent serious medication errors known to cause harm to patients.

Hospitals that choose to take the Adult Inpatient Test via the CPOE Evaluation Tool will have their score from the Test included in their Overall CPOE Score, regardless of the score and without exception.

 

What is the CPOE Evaluation Tool?

The CPOE Evaluation Tool was designed by medication safety experts and researchers at Brigham and Women's Hospital and the University of Utah to test the ability of inpatient CPOE systems to alert licensed prescribers to frequent serious medication errors known to cause harm to patients. In addition, the Tool was designed to help hospitals improve on their use of clinical decision support to reduce adverse drug events and improve medication safety. The Tool was first included in the Leapfrog Hospital Survey in 2008. 

The CPOE Evaluation Tool includes both a Sample Test and an Adult Inpatient Test. All hospitals are urged to complete the Sample Test prior to the Adult Inpatient Test. Only a hospital's score on the Adult Inpatient Test is used to determine their overall performance on Leapfrog's CPOE Standard.

The timed Test provides users with a set of Test Patients, along with a corresponding set of Test Orders, that users enter into their hospital’s CPOE and related clinical systems. The physician conducting the Test records the advice or information they received, if any, from their hospital’s CPOE system onto the Orders and Observation Sheet, and then completes the Online Answer Form. Users receive immediate scoring and feedback summarizing the results of the Test. The Tool includes ten Order Checking Categories including inappropriate drug combinations, drug allergy, single and daily dose limits, and others. More information about the Order Checking Categories included in the CPOE Evaluation Tool is available in the CPOE Guidance Document.

 

How Do I Access the CPOE Evaluation Tool?

Hospitals can access the CPOE Evaluation Tool from the Survey Dashboard once they have completed and affirmed Section 2 Medication Safety - CPOE via the Online Hospital Survey Tool. Users can return to complete and submit the rest of the Survey (Sections 1 and 3-10) prior to the deadline.  

 

How is the Test Conducted?

Once you affirm Section 2 in the Online Survey Tool, the “Take CPOE Tool” button will appear on the Survey Dashboard. A brief hospital information form will need to be completed. Once the form is complete, continue on to the next screen to select a Sample or Adult Inpatient Test from the drop-down menu.

Time Limits and Steps 

Time Limits

Steps

Steps 1 - 2 must be completed within 3 hours.

Step 1: (a) Print a list of Test Patients and (b) log out of the Tool.

Step 2: (a) Enter the Test Patients in your hospital's production environment (or a test environment that mirrors your production environment exactly) and (b) log back into the Tool to confirm completion of Step 2 and proceed to Step 3 before the 3-hour time limit ends.

Steps 3 - 6 must be completed within 3 hours

 

Important Note 1:

Any remaining time from Steps 1 and 2 does not carry over to this portion of the test. 

Important Note 2:

We recommend leaving at least 45 minutes to perform Step 5. 
 

Step 3: (a) Print the Orders and Observation Sheet and (b) log out of the Tool. 

Step 4: (a) Have a prescriber who routinely orders medications through your inpatient CPOE system enter and sign the Test Order(s) assigned to each Test Patient, (b) the prescriber must record any advice or information he/she receives from the system onto the Orders and Observation Sheet, (c) discontinue the Test Order(s) before moving on to the next order, and then (d) log back in to the Tool to confirm completion of Step 4 and proceed to Step 5. 

 

Note: Do not record any advice or information on the Orders and Observation Sheet that was sent directly to a pharmacist.

Step 5: (a) Record the responses from the Orders and Observation Sheet onto the Online Answer Form (b) review the Online Answer Form for accuracy and completeness (c) submit the Online Answer Form and then proceed to Step 6. 

Step 6: Complete and submit the Affirmation. 

IMPORTANT NOTICE: If you close the browser before submitting the Affirmation, you will not be able to return to the Test for 120 days and your hospital will receive a score of “Incomplete Evaluation”.

Step 7 has no time limit.

Step 7: View and print your results.

 

The same time limit applies to both the Sample and Adult Inpatient Tests. For each test started, you have:

  • 3 hours elapsed time to complete Steps 1-2, then
  • 3 hours elapsed time to complete Steps 3-6

Elapsed time runs continuously, 24/7, and is not interrupted or suspended during “non-business hours.” If you exceed these time limits, the Tool will "time out" and consider the Test “incomplete.” The Test will be recorded in the Online Survey as “Incomplete Evaluation” 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 detailed information, including how to plan for the Test, is available in the CPOE Evaluation Tool Instructions
 

How is the CPOE Evaluation Tool scored?

Nine of the ten order checking categories included in the CPOE Evaluation Tool represent an area where a serious adverse drug event (ADE) could occur if the CPOE system’s clinical decision support fails to alert the prescriber. The tenth order checking category includes Test Orders that, if presented interruptedly, could contribute to alert fatigue. More information about the CPOE Evaluation Tool scoring is available in the scoring algorithms document.
 

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 the scoring algorithms document.

Please note: Hospitals that choose to take the Adult Inpatient Test via the CPOE Evaluation Tool will have their score from the Test included in their Overall CPOE Score, regardless of the score and without exception. This means that hospitals that fail the deception analysis or time out of the test will be scored and publicly reported as Limited Achievement on Leapfrog’s CPOE Standard.

 

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