Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)

Abstract

Objective To determine whether indication-based computer order entry alerts intercept wrong-patient medication errors. Materials and methods At an academic medical center serving inpatients and outpatients, we developed and implemented a clinical decision support system to prompt clinicians for indications when certain medications were ordered without an appropriately coded indication on the problem list. Among all the alerts that fired, we identified every instance when a medication order was started but not completed and, within a fixed time interval, the same prescriber placed an order for the same medication for a different patient. We closely reviewed each of these instances to determine whether they were likely to have been intercepted errors. Results Over a 6-year period 127 320 alerts fired, which resulted in 32 intercepted wrong-patient errors, an interception rate of 0.25 per 1000 alerts. Neither the location of the prescriber nor the type of prescriber affected the interception rate. No intercepted errors were for patients with the same last name, but in 59% of the intercepted errors the prescriber had both patients' charts open when the first order was initiated. Discussion Indication alerts linked to the problem list have previously been shown to improve problem list completion. This analysis demonstrates another benefit, the interception of wrong-patient medication errors. Conclusions Indication-based alerts yielded a wrong-patient medication error interception rate of 0.25 per 1000 alerts. These alerts could be implemented independently or in combination with other strategies to decrease wrong-patient medication errors. BACKGROUND AND SIGNIFICANCE

Use of Temporary Names for Newborns and Associated Risks

“…Additional strategies aimed at preventing wrong-patient orders include using electronic decision support to verify patient identification before placing orders or alerting providers when orders are not consistent with the diseases listed in the problem list. 6,21,22 However, these interventions can be costly, dependent on the type of CPOE system, and their effectiveness may diminish over time due to alert fatigue. 23 Replacing a nondistinct naming convention with one that uses distinct names is a simple and effective intervention that is not costly, labor intensive, or dependent on new technology and may be easily implemented in most NICUs.…”

Intercepting Wrong-Patient Orders in a Computerized Provider Order Entry System

“…The study reported a patient-note mismatch rate of 0.5% and a 40% reduction of mismatches after the implementation of patient verification module. 21 Galanter et al found that a mandatory “indication” field in the CPOE might assist the providers with avoiding wrong-patient orders for medications, and estimated that over a 6 year period, 32 wrong-patient errors were intercepted as a result of this intervention 22 . Finally, Adelman et al studied two patient verification procedures prior to entering orders: the ‘ID-verify alert’, a verification module showing the patient’s name, age and gender, and the more complex ‘ID-reentry function’, which required the provider to re-enter the initials, gender and age.…”

Semantic Medical Prescriptions -- Towards Intelligent and Interoperable Medical Prescriptions

“…When user is writing the prescription, this 4 Extracted structured information from Wikipedia available at dbpedia.org 5 A bioinformatics and cheminformatics resource that combines detailed drug (i.e. chemical, pharmacological and pharmaceutical) data with comprehensive drug target (i.e.…”

“…[3]. As recently published by [4] hospitals' use of computerized prescriptions prevented 17 million drug errors in a single year in the United States. The Canadian Medical Association (CMA) and the Canadian Pharmacists Association (CPhA) have approved a joint statement on the future of e-prescribing that aims to have all prescriptions for Canadians created, signed and transmitted electronically by 2015.…”