Evaluation of the Impact of Computerized Prescriber Order Entry on Medication Use System Performance at an Academic Medical Center

Abstract

Purpose To evaluate the impact of computerized prescriber order entry (CPOE) on 3 elements of medication use system performance: inpatient medication override dispense rates from automated dispensing cabinets (ADCs), medication first-dose turnaround time (TAT), and pharmacist perception of the medication orders management process. Methods A pre-post intervention trial design was used to assess each of the 3 medication use system elements. The intervention was CPOE implementation. The ADC override outcomes evaluated were the total number of overrides and the presence of appropriate documentation for each override. One week random samples of override data from the pre-CPOE and post-CPOE time periods were analyzed. The medication TAT outcomes studied were mean time from order entry by the prescriber to time of order verification and mean time from order entry by the prescriber to time of medication administration. Electronically collected data post CPOE were compared to manually collected data pre CPOE. The primary pharmacist perception outcome assessed was overall satisfaction with the medication orders management process. The pre- and post-CPOE data were collected through an electronic survey conducted after CPOE implementation. Results Following the implementation of CPOE, the relative number of medication override dispenses decreased by 58%, but documentation worsened by 73%. The mean time from order entry to order verification improved by 76%, and the mean TAT for intravenous antibiotics improved by 31%. Pharmacist overall satisfaction with the medication orders management process improved by 23%. Conclusion The implementation of CPOE resulted in improvement in each of the 3 medication use system elements assessed.