The Impact of Computerized Physician Order Entry on Medication Error Prevention

Bates, David W.; Teich, Jonathan M.; Lee, Joshua; Seger, Diane L.; Kuperman, Gilad J.; Ma’Luf, Nell; Boyle, Deborah; Leape, Lucian L.

doi:10.1136/jamia.1999.00660313

Cited by 1,025 publications

(666 citation statements)

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“…9 In another report, CPOE with clinical decision-support software led to a more dramatic reduction of 81%. 10 Additionally, pharmacist involvement on medical rounds has reduced adverse drug events by 78%. 11 The frequency of prescribing errors found in this study was similar to that found in previous literature, although the variation in the definitions limits this comparison somewhat.…”

Section: Discussionmentioning

confidence: 99%

Assessing the impact of an educational program on decreasing prescribing errors at a university hospital

Peeters

Pinto

2009

Journal of Hospital Medicine

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BACKGROUND: Several complex and costly interventions reduce medication errors. Little exists on the effectiveness of providing education and feedback to institutional clinicians as a means of reducing errors. OBJECTIVE: To determine the impact on prescribing errors of a pharmacist‐led educational intervention. DESIGN: Prospective, interrupted time series study. SETTING: This study was conducted among internal medicine residents at the 320‐bed University of Toledo Medical Center. INTERVENTION: The educational intervention was conducted during a 6‐month period beginning in November 2006. The intervention included an initial hour‐long lecture followed by biweekly and then monthly discussions that used timely, institution‐specific examples of prescribing errors. MEASUREMENTS: Data were collected at 5 time points: month 0 (preintervention period); months 1, 3, and 6 (intervention period); and month 7 (postintervention period). Errors were identified, transcribed, coded, and entered into a database. The primary outcome was the frequency of prescribing errors during each period. A Bonferroni‐adjusted chi‐square analysis was conducted with an a priori experiment‐wise alpha of 0.05. RESULTS: A reduction in prescribing errors of 33% following the first intervention month and a mean 26% reduction during the study period were observed (P < 0.0025). The frequencies of preintervention and postintervention errors did not differ significantly. CONCLUSIONS: A straightforward educational intervention reduced prescribing errors during the period of active intervention, but this effect was not sustained. Ongoing communication and education about institution‐specific medication errors appear warranted. Journal of Hospital Medicine 2009;4:97–101. © 2009 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Assessing the impact of an educational program on decreasing prescribing errors at a university hospital

Peeters

Pinto

2009

Journal of Hospital Medicine

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“…10,11 Decision support describes a technique in which diagnostic and management recommendations are provided to clinicians, usually at the point-of-care, and has been shown to improve care, 12,13 decrease costs, 14,15 and reduce errors. 16,17 Kaushal et al 18 identified critically ill neonates receiving intravenous infusions as one of the highest-risk population with a three-fold greater risk for medication order errors. Electronic physician order entry systems reduce serious medical errors by 55 to 81%, 16,19 and prototypic neonatal nutrition systems have been described.…”

Section: Introductionmentioning

confidence: 99%

“…16,17 Kaushal et al 18 identified critically ill neonates receiving intravenous infusions as one of the highest-risk population with a three-fold greater risk for medication order errors. Electronic physician order entry systems reduce serious medical errors by 55 to 81%, 16,19 and prototypic neonatal nutrition systems have been described. 20,21 Despite the potential advantages of clinical decision support, it is used infrequently.…”

Section: Introductionmentioning

confidence: 99%

A Survey of Neonatal Parenteral Nutrition Design Practices in North Carolina

Porcelli

2004

J Perinatol

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BACKGROUND:Parenteral nutrition is an important component of postnatal hospital care for very-low-birth-weight infants (VLBW; birth weight r1500 g). Designing and preparing parenteral nutrition for VLBW infants is a complicated process requiring many nutrition decisions and mathematical computations, a process most medical centers have developed independently. The goal of this project was to examine the nutrition design practices and resources of regional neonatal intensive care units (NICUs). METHODS:In depth interviews were conducted with neonatal nutrition health-care providers at eight medium to large NICUs in North Carolina to describe the patient population, the nutrition support staff, nutrition decisionmaking procedures and resources, the design of parenteral nutrition, and problems with parenteral nutrition design and preparation. RESULTS:The eight centers reported an average of 182 VLBW infant admissions and prepared 4810 parenteral nutrition orders per year. Five centers employed experienced neonatal nutrition staff to offer decision support. Six centers used paper parenteral nutrition order forms, all of which provided some decision guidance such as a recommended ordering dose range. Selfreported medical mistakes included incorrect parenteral nutrition additive dilutions and incorrect supplementation of parenteral nutrition additives. CONCLUSIONS:Most NICUs offered nutrition resource personnel and used paper parenteral nutrition order forms, which offered a wide range of decision guidance. About half the reported medical errors could be addressed using electronic parenteral nutrition design; however, a broader, more general approach to the entire design and administration system would reduce more errors. Last, as development of electronic neonatal nutrition resources in the clinical arena progresses, standards for recording neonatal nutrition content, and evaluating the effect of decision support need to be identified.

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“…15 Electronic physician order entry with real-time practice guidance 16,17 represents the best long term solution for neonatal PN order design to reduce errors and risk of injury to VLBW infants. 18,19 VLBW infants receiving intravenous PN were identified by Kaushal et al 20 as one of the highest risk groups for medical error related injury because of their multiple complex intravenous infusions, narrow therapeutic range and low tolerance for pharmaceutical errors. Electronic order entry and design can significantly reduce medical errors 21,22 and improve PN mineral content.…”

Section: Discussionmentioning

confidence: 99%

Practice ordering guidance for neonatal parenteral nutrition

Porcelli

2007

J Perinatol

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Objective: Neonatal parenteral nutrition (PN) is designed for very low birth weight infants (BWp1500 g) for whom enteral feedings are inadequate. Evaluating the clinical practice guidance (CPG) content of printed paper order forms could provide a baseline for comparison and serve as a reference for electronic neonatal nutrition order design systems.Methods: A scoring system for clinical practice guidance was developed and applied to nine institutions printed paper PN order forms. CPG scores were assigned as: (1) generic reminder only, (2) prompt with order entry space, (3) patient specific reminder only, (4) patient specific recommendation with order entry space. User-friendliness and form completion time were also recorded.Results: The overall CPG score for the six most common PN components was 1.85±0.68 (mean±1s.d.), consistent with a generic reminder, but short of a specific nutrient dose order field. Amino acid received the highest CPG score, 2.05±0.64; vitamins rated the lowest. The institution of origin was an independent predictor of the CPG score.Conclusions: Paper neonatal PN order forms offer relatively little CPG. Significant form variation and format reflects the need to standardize neonatal PN design as the neonatal PN design moves from paper to electronic ordering systems.

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The Impact of Computerized Physician Order Entry on Medication Error Prevention

Abstract: Computerized POE substantially decreased the rate of non-missed-dose medication errors. A major reduction in errors was achieved with the initial version of the system, and further reductions were found with addition of decision support features.

Cited by 1,025 publications

References 20 publications

Assessing the impact of an educational program on decreasing prescribing errors at a university hospital

Assessing the impact of an educational program on decreasing prescribing errors at a university hospital

A Survey of Neonatal Parenteral Nutrition Design Practices in North Carolina

Practice ordering guidance for neonatal parenteral nutrition

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