Publications (1)0 Total impact
ABSTRACT: The National Quality Forum has designated computerized physician order entry (CPOE)Vthe electronic entry of physicians' orders into a clinical computer system for patient careVas 1 of their 30 Safe Practices for Better Healthcare in 2003. Since that time, the body of knowledge and experience with CPOE has grown considerably. This article reexamines the objectives, requirements for achieving these objectives, and evidence of efficacy for this practice, and evaluates new published studies in CPOE. It reviews relevant issues of medication safety, the likely impact of CPOE, the efficacy of CPOE in various studies, key measures of impact of the practice, and important implementation issues. Although it is clear that CPOE can cause errors as well as prevent them, the evidence clearly suggests that CPOE reduces the rates of medication errors and serious medication errors, although studies with adequate power to assess the impact of CPOE on the preventable adverse drug event rate have not been performed. Finally, updates and revisions to the current National Quality Forum CPOE practice standard and implementation examples are suggested. C omputerized Physician Order Entry (CPOE) has attracted significant attention recently as the ability of this practice to impact the safety of care has been challenged, and the complexity and significant costs of implementation of this health care intervention become clearer. 1 The principal justification for recommending CPOE as a patient safety best practice has come from studies that have measured the impact of CPOE on medication safety: specifically preventing medication errors and serious medication errors. 2,3 Although a number of studies have measured the impact on the preventable adverse drug event (ADE) rate, the studies that have been done have not been powered to detect differences in the preventable ADE rate, and the assumption has been that reducing serious medication errors (errors with the potential for harm or those that cause actual harm) will correlate with a decrease in the preventable ADE rate. Although this is very likely a valid assumption, it is also probably true that it is easier to decrease the number of near-misses than the number of preventable ADEs. Another issue is that the true magnitude of the medication safety problem as measured by harm (i.e., ADEs) or by medication errors is still being elucidated, especially in the ambulatory setting, but also in inpatient settings. 4Y6 It has long been recognized that ADEsVharm to patients by drugsVconstitute the single most common source of patient harm in the inpatient hospital setting. 7 However, estimates of the frequency of ADEs vary, and there is no single agreed-upon criterion standard measure or estimate of the incidence of ADEs among hospital inpatients. Methods include classic chart review, self-reporting, observation, computerized surveillance, and targeted chart review. 8 Studies of inpatient ADEs suggest that the more we look, the more we find, 9 and the same is true in the outpatient setting, where contacting patients has resulted in identifica-tion of much higher ADE rates than chart review. 4 The goals of this report are to: (1) summarize the evidence of the magnitude of the problem of medication safety; (2) to discuss key concepts relating to medication safety; (3) to review the measures that have been used to assess the impact of CPOE on medication safety, (4) to summarize the old and new evidence on the impact of CPOE on medication safety, (5) to discuss briefly keys to successful implementation, and (6) to present proposed revisions to the current standards based on the new evidence.