The Leapfrog Group and other safety-minded organizations have called for installation and implementation of computerized physician order entry (CPOE) systems, which are designed to provide checks on the administration of medications. Hospitals and other institutions have been reluctant to accede to Leapfrog's demands, citing both cost issues at a time when revenues and margins are constricted and concerns over the medical malpractice implications of installing computerized systems.
An article in the journal Health Affairs expressed concern, stating, "Efforts by aggressive malpractice attorneys could rapidly transform Leapfrog's safety standards from marketplace advantages for compliant hospitals to performance expectations required by law."
The APA's task force, while reporting positively on the advantages of CPOE, suggested examining other types of automated monitoring systems, including personal computer- and personal digital assistant-based programs. "Clearly the trend is toward automation, streamlining data entry and supporting clinical reasoning," the report stated. "Psychiatry can benefit from the steep wave of momentum dedicated to this area already."
In the area of seclusion and restraint, the task force cited studies showing that between 50 and 150 "patient deaths occur annually as a result of seclusion and restraint and most go unreported." New standards have been adopted by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and the Centers for Medicare & Medicaid Services (CMS) aimed at reducing the use of restraint and seclusion.
However, the task force report stated, "Clinical culture is the issue," and "All [levels of staff] have to believe in this minimization approach and need the assurance that physical safety will be optimized despite the restricted use of force with patients." The report also noted, "Since 1992, the use of restraints in all settings decreased from more than 13,000 hours per calendar year (5,000 patients) to 6.25 hours for the month of March 2002 (approximately 2,500 patients)."
The report also pointed out, "The use of modern, atypical antipsychotics has offered opportunity for improved management" of patients without the use of seclusion and restraint.
The third area chosen by the committee for this year's program efforts was suicide, which the task force report noted is the eighth leading cause of death in the United States. "Each day 86 of the 1,500 who attempt suicide die trying," the report stated.
According to JCAHO, a number of protocol deficiencies that can be improved can be found in hospital-based suicides. These include incomplete or inadequate suicide assessment methods, incomplete reassessment, incomplete orientation and training of staff or inadequate staffing levels, incomplete or infrequent patient observations, incomplete communication among caregivers or unavailable information, and inadequate care planning.