Prescription Errors and Outcomes Related to Inconsistent Information Transmitted Through Computerized Order Entry

Abstract

Background Although several types of computerized provider order entry (CPOE)-related errors may occur, errors related to inconsistent information within the same prescription (ie, mismatch between the structured template and the associated free-text field) have not been described, to our knowledge. We determined the nature and frequency of such errors and identified their potential predictive variables. Methods In this prospective study, we enrolled pharmacists to report prescriptions containing inconsistent communication over a 4-month period at a tertiary care facility. We also electronically retrieved all prescriptions written during the study period containing any comments in the free-text field and then randomly selected 500 for manual review to determine inconsistencies between free-text and structured fields. Of these, prescriptions without inconsistencies were categorized as controls. Data on potentially predictive variables from reported and unreported errors and controls were collected. For all inconsistencies, we determined their nature (eg, drug dosage or administration schedule) and potential harm and used multivariate logistic regression models to identify factors associated with errors and harm. Results Of 55 992 new prescriptions, 532 (0.95%) were reported to contain inconsistent communication, a rate comparable to that obtained from the unreported group. Drug dosage was the most common inconsistent element among both groups. Certain medications were more likely associated with errors, as was the inpatient setting (odds ratio, 3.30; 95% confidence interval, 2.18–5.00) and surgical subspecialty (odds ratio, 2.45; 95% confidence interval, 1.57–3.82). About 20% of errors could have resulted in moderate to severe harm, for which significant independent predictors were found. Conclusions Despite standardization of data entry, inconsistent communication in CPOE poses a significant risk to safety. Improving the usability of the CPOE interface and integrating it with workflow may reduce this risk.

Classification of antecedents towards safety use of health information technology: A systematic review

“…Competence builds on a foundation of basic skills, and knowledge [41]. Inadequate knowledge of the health IT mechanism or less familiar with the systems was common reason associated with errors [13,[42][43][44]. Lack of knowledge about health IT was the frequent reason for healthcare practitioners to use paper in conjunction with health IT.…”

“…Besides, the healthcare practitioners used their own way in completing tasks rather than to use the functions available in the systems [43]. Singh et al [42] discovered that inadequate knowledge of the prescription ordering mechanism was a common reason for the pharmacists to use free-text comment in 88.9% of cases rather than to use the structured template to fill the prescription. The used of free-text comment were often associated with errors in which 20.1% of the prescription errors resulted in considerable, very serious, serious permanent damage, or death.…”

Effects of hospital leadership, organizational systems, and ESWOS on medical error reduction

“…Computerized physician order entry (CPOE) systems, which allow health care providers to send patients' prescription orders, can help in preventing prescription errors and patient harm (Radley et al 2013). Singh et al (2009) reported approximately 1 % of 56,000 CPOE prescriptions contained errors. Radley et al's (2013) study showed a 12.5 % reduction of medical errors through the use of a CPOE system.…”

Interventions performed by New Zealand community pharmacists while dispensing prescription medications

“…The software used by prescribers should also be updated regularly to reflect the currently funded brand. • Whilst computer generated prescriptions may reduce some types of errors (such as legal requirements), they may introduce new errors [10] such as incorrect dose and dosage form selection and prescribers still need to exercise due care.…”