Critique 7. Measurement methods:(should be used in JC form as a strength or weakness) a)are the physiological measures/instruments/tools clearly described? Yes, collect data and record, Medication errors were identified after review of all orders during the study period and then further classified as potential ADEs, medication prescribing errors (MPE), and rule violations (RV).
b)are the techniques to administer, complete, and score (or accuracy and precision) the instruments provided? Yes, All medication orders were included in this analysis except for the following: fluids, dialysate, total parental nutrition (TPN)/ lipids, and chemotherapeutic agents. TPN and lipids had not been added to the CPOE system at the time of the study. Fluids, dialysate, and chemotherapy orders were entered in the CPOE system but will be evaluated at a later date. A designated clinical pharmacist reviewed all eligible orders.
Errors were entered into a database that included information such as patient name, age, weight, drug, presence of error, dose, interval, and route. Errors were identified and further classified into categories on the basis of the definitions and classifications listed and reviewed for accuracy and relevance by a second clinical pharmacist.
A physician reviewer independently evaluated all original medication orders for 10% of randomly selected patients in both the pre-CPOE and post-CPOE groups to determine level of agreement with clinical pharmacists. AS the article is valid and reliable, is accurate and precise.
c)are the reliability and validity of the instruments described? Did the researcher examine the reliability and validity of the instruments for the present sample? Yes, they measured both validity and reliability.
Validity: CPOE resulted excellent validity associated with medication ordering. CPOE resulted in a 95.9% (P _ .001) reduction in all types of errors associated with medication ordering. Article shows a significant reduction in MPEs (99.4%; P _ .001) and RVs (97.9%; P _ .001). A smaller but still significant reduction was found with potential ADEs (40.9%; P _ .001) after CPOE implementation.
Reliability: The interrater reliability was calculated using the percentage of agreement and the _ statistic. The _ statistic for interrater reliability between the physician reviewer and clinical pharmacist was 0.96. This corresponds to to excellent reliability. So, the article is considered both valid and reliable and the results of the study can be generalized from to th population.
d)if the instrument was developed for the study, is the instrument development process described? Not developed.
e)are the methods for recording data from physiological measures clearly described? No, he didn’t mention physiological measures clearly but they mention that COPE provide weight-based dosing (In vivo measures)
11. Evaluation: Recommendations for usefulness of the study in practice based on your critique. (should be used in JC form as a strength or weakness) a)Are the study findings consistent with those of previous research? Yes, (discussion)
b)Do you have confidence in the findings? Yes. The article has many strength. 1. Study design: control group, and use the whole population who were admitted to PCCU (consecutive)>>> more valid. 2. Large sample size.
3.controlling of confounding factors through a)There was a training for the staff , without evaluating the system. b)Long period of follow up of implementation (not significantly different) and was approximately same sample size in both pre (268 patients) and post-implementation (246 patients). c)Approximately choosing identical period of time before and after implementation
c)Do the findings add to nursing knowledge? Yes, because There was a training for the staff , without evaluating the system and the nurse is the one who administer the medications to patients according to prescriptions and s/he is responsible for her/his mistakes along with the doctor’s mistakes. In addition this CPOE provide information about (e.g. allergy, contraindications) that help the nurse in administering medications.
d)Are findings ready for use in practice? The findings is ready for use in practice if the CPOE is available but Designs of CPOE system used in articles are commercially available, so the effectiveness may not be assessed well because of unique needs of different hospitals, therefore it should be created or adapted for the institution. .
12. Assessment of References a)how many disciplines did they use for their literature search (are they appropriate)? 2, pharmacist, and doctors. B) Are the references current (within 5 years from publication)? If not, are they appropriate as a theory, landmark/classic study, or a way to conduct research? Not all, yes appropriate.
13. Credibility of the authors for this research study (Credibility of authors in JC form) a)is there collaboration with other disciplines? Yes, because the doctor is the one who prescribe the medication for the patient and pharmacy is the one who dispense medications prescribed by doctors , so they collaboration in medications prescribing and administering process. b)what is their level of education?
PharmD*, MD, MSCI, PharmD, BCPS, PharmD, MD, MPH. c)did they receive a grant? No, “We do not have any financial ties or obligations to the commercialization process of WizOrder. This study was not supported in any manner by McKesson (Atlanta GA).”