Potential benefits and problems with computerized prescriber order entry: Analysis of a voluntary medication error-reporting database
ABSTRACT The potential benefits and problems associated with computerized prescriber-order-entry (CPOE) systems were studied.
A national voluntary medication error-reporting database, Medmarx, was used to compare facilities that had CPOE with those that did not have CPOE. The characteristics of medication errors reportedly caused by CPOE were explored, and the text descriptions of these errors were qualitatively analyzed.
Facilities with CPOE reported fewer inpatient medication errors and more outpatient medication errors than facilities without CPOE, but the statistical significance of these differences could not be determined. Facilities with CPOE less frequently reported medication errors that reached patients (p < 0.01) or harmed patients (p < 0.01). More than 7000 CPOE-related medication errors were reported over seven months in 2003, and about 0.1% of them resulted in harm or adverse events. The most common CPOE errors were dosing errors (i.e., wrong dose, wrong dosage form, or extra dose). Both quantitative and qualitative analyses indicate that CPOE could lead to medication errors not only because of faulty computer interface, mis-communication with other systems, and lack of adequate decision support but also because of common human errors such as knowledge deficit, distractions, inexperience, and typing errors.
A national, voluntary medication error-reporting database cannot be used to determine the effectiveness of a CPOE system in reducing medication errors because of the variability in the number of reports from different institutions. However, it may provide valuable information on the specific types of errors related to CPOE systems.
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ABSTRACT: Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P<0.001). Dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians' compliance with the system's recommendations.Journal of Medical Systems 07/2009; · 1.37 Impact Factor
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ABSTRACT: Medical errors are common, costly, and can potentially be life threatening to patients. Recent studies have established that Computer Provider Order Entry (CPOE) systems reduce medical errors as well as improve safety, quality, and value of patient care. However, research regarding adoption factors associated with CPOE systems is limited. Therefore, the purpose of this review was to determine adoption factors by identifying the frequency of barriers through the analysis of literature and research. A systematic literature review was conducted from EBSCO Host and Google Scholar. The search criteria focused on publication date, keywords, and peer reviewed articles. The final set established for evaluation was ten articles. The authors summarized each article and then identified common barriers. Throughout the ten articles, 31 barriers were identified; 15 of which were unique. The three most frequent barriers identified were: process changes (23 %), training (13 %), and efficacy (10 %). The results of this review identify to policy makers levers to incentivize to encourage adoption. The results also illustrate to vendors the importance of factors to include in both marketing and development. The leadership of healthcare organizations should be encouraged to see such results and know that their concerns are heard. If policy makers and vendors help healthcare organizations overcome barriers to adoption, the organization has a better chance of successful CPOE implementation. If successfully implemented, a CPOE system can improve the process of care, quality of care, and patient outcomes; all of which address issues of Meaningful Use.Journal of Medical Systems 02/2015; 39(2):198. DOI:10.1007/s10916-015-0198-2 · 1.37 Impact Factor