Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors

Abstract

DVERSE DRUG EVENTS (ADES) are estimated to injure or kill more than 770 000 people in hospitals annually. 1 Prescribing errors are the most frequent source. 2-5 Computerized physician order entry (CPOE) systems are widely viewed as crucial for reducing prescribing errors 2,3,6-17 and saving hundreds of billions in annual costs. 18,19 Computerized physician order entry system advocates include researchers, clinicians, hospital administrators, pharmacists, business councils, the Institute of Medicine, state legislatures, health care agencies, and the lay public. 2,3,6-10,12,14-17,20-22 These systems are expected to become more prevalent in response to resident working-hour limitations and related care discontinuities 23 and will supposedly offset causes (eg, job dissatisfaction) and effects (eg, ADEs) of nursing shortages. 24,25 Such a system is increasingly recommended for outpatient practices (BOX). Adoption of CPOE perhaps gathered such strong support because its promise is so great, effects of medica-See also pp 1223 and 1261.

Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit

“…Prescribers need to develop a thorough, systematic approach to prescribing, similar to that which they employ for diagnosis. This aspect of our findings is in accordance with a recent study that identified that a CPOE system frequently increased the probability of prescribing errors [ 13 ].…”

Evaluation of the Impact of a CPOE System on Nurse-physician Communication

“…Similar concerns about nurse-physician communication and collaboration have been reported in evaluating CPOE systems being implemented in different locations [11,13,38]. Our findings in this study are also in line with Koppel et al [4] and Beuscart-Zephir et al [13], in the sense that they help to understand and to improve the impact of hidden factors that can lead to a CPOE system having unintended negative effects [39]. Therefore, evaluating the impact of a CPOE system on interoperability can be used to inform about the effect of the system on coordination and collaboration throughout the medication process and, as a result, about whether the system reduces errors in practice.…”

Quality and Safety Outcomes of a Hospital Merger Following a Full Integration at a Safety Net Hospital

“…Similar results are seen with transitions to EHRs, where early increases in adverse events are later outweighed by long-term improvements. 14 , 15 An eventual sustained improvement in mortality is likewise seen in our study. While SPC analysis showed an improvement in readmissions, ITS analysis confirmed this trend was also observed before the merger.…”

“…It is common for quality outcomes to transiently worsen right after a significant systemic change. Similar results are seen with transitions to EHRs, where early increases in adverse events are later outweighed by long-term improvements . An eventual sustained improvement in mortality is likewise seen in our study.…”