Prepare for CPOE Tool

 

Who should take a CPOE Evaluation Tool?

On the 2021 Leapfrog Hospital Survey, adult and general hospitals that have CPOE implemented in at least one inpatient unit of the hospital will be 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 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 eleven 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 CPOE Evaluation Tool?

Once the 2021 Leapfrog Hopsital Survey opens on April 1, 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, will be available on April 1 in the CPOE Evaluation Tool Instructions

 

How is the CPOE Evaluation Tool scored?

The overall score is based on the performance of the hospital’s CPOE clinical decision support to alert prescribers to frequent serious medication errors known to cause harm to patients. In addition, the test includes a number of orders that could result in a fatal adverse drug event. Any of these potentially fatal orders not flagged by the clinical decision support are listed on the results page of the CPOE Evaluation Tool. In addition, the Test Orders include a number of orders that could contribute to alert fatigue if clinical decision support is displayed reporting potential harm. Any Alert Fatigue orders for which advice or information was reported are also listed on the results page of the CPOE Evaluation Tool. More information about the CPOE Evaluation Tool scoring algorithm can be found in Proposed Changes to the 2021 Leapfrog Hospital Survey.

 

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 Proposed Changes to the 2021 Leapfrog Hospital Survey.

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