A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care

Abstract

Slight, S.P. (2017) 'A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care.', Journal of the American Medical Informatics Association., 24 (2). pp. 432-440.Further information on publisher's website:https://doi.org/10.1093/jamia/ocw119Publisher's copyright statement:This is a pre-copyedited, author-produced PDF of an article accepted for publication inJournal of the American Medical Informatics Association following peer review. The version of recordis available on the JAMIA website at https://doi.org/10.1093/jamia/ocw119Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. ABSTRACT ObjectiveTo understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems. Materials and MethodsWe conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken. ResultsA total of 1,185 publications were identified, of which 34were included in the review. We identified eight key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, non-intuitive or inflexible ordering, repeat prescriptions and automated processes, users' work processes, and CDS systems. Displaying an incomplete list of a patient's medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error prone workarounds, such as the addition of contradictory free-text comments. Users' misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors. Discussion and ConclusionsHuman factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users' workflow expectations. BACKGROUND AND SIGNIFICANCE

Foundation year one and year two doctors’ prescribing errors: a comparison of their causes

“…FY1 doctors described difficulties with medication charts but FY2 doctors instead described difficulties with the electronic systems for prescribing in general practice. This confirms some of the problems of electronic prescribing systems found previously27 leading to recent advice for junior doctors using electronic systems being provided by the Royal College of Physicians 21…”

Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital

“…A sociotechnical approach has identified workflow and communication issues as contributory factors 14 15 32–34. A recent review provides valuable insights into prescribing error causation, focusing on issues associated with the EP system itself and user–EP interaction 31. However, there has been little work exploring causes of prescribing errors using models of human error in the context of EP.…”

Oral bisphosphonate use and age‐related macular degeneration: retrospective cohort and nested case–control study

“…Included in the limitations is the fact that prescriptions in the CPRD may have been misclassified in terms of BP exposure owing to data entry errors by general practitioners and other potential sources of error in the use of electronic systems …”