Role of computerized physician order entry systems in facilitating medication errors.

Department of Sociology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104 USA.
JAMA The Journal of the American Medical Association (Impact Factor: 29.98). 04/2005; 293(10):1197-203. DOI: 10.1001/jama.293.10.1197
Source: PubMed

ABSTRACT Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE.
To identify and quantify the role of CPOE in facilitating prescription error risks.
We performed a qualitative and quantitative study of house staff interaction with a CPOE system at a tertiary-care teaching hospital (2002-2004). We surveyed house staff (N = 261; 88% of CPOE users); conducted 5 focus groups and 32 intensive one-on-one interviews with house staff, information technology leaders, pharmacy leaders, attending physicians, and nurses; shadowed house staff and nurses; and observed them using CPOE. Participants included house staff, nurses, and hospital leaders.
Examples of medication errors caused or exacerbated by the CPOE system.
We found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients' medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction.
In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.

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    ABSTRACT: Background: Computerised Physician Order Entry (CPOE) systems have the potential to lead to improvements in the quality and efficiency of health care delivery. However, CPOE systems have been found to be difficult and complex to implement and there has been an increased awareness of the need for rigorous evaluation techniques. To date pathology CPOE systems have not been widely researched or evaluated. System Simulation (SysSim) is the application of computer simulation to explore, understand and improve the interaction between structure and action in the health care sector. Objectives: This paper describes the methods for designing a robust SysSim model and illustrates how it will be used to examine the impact of CPOE on care delivery and outcomes. Methods: The model development will use integrated simulation methods that incorporate both agent and system dynamic approaches using the Anylogic object-oriented, Java-based software package. The model will be built using a comprehensive, iterative approach incorporating testing and refinement stages that include: conceptual development and construction; model calibration; simulation and policy testing; and performance experimentation. Results: Our review of the literature identified 10 domains which have been the focus of evaluations of the impact CPOE on pathology services and these have used 39 different indicators. The problem however is that the information contained in individual indicators is usually presented in isolation from other important indicator data. Discussion and conclusions: SysSim allows us to link up data and information and demonstrates how indicators interact and as such provides a powerful evaluation technique. SysSim makes it possible to take a holistic view to evaluation and implementation priorities, based on the understanding that many things are connected to each other. It has the potential to improve planning in complex healthcare environments and to a) investigate the impact of pathology CPOE systems; b) develop methods to increase their uptake and efficiency; and c) evaluate possible response scenarios for dealing with the challenges of implementation.

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