The impact of computerized physician order entry on medication error prevention.

Abstract

With interest we have read the article by Villamanan et al. [1]. They stated that medication errors (MEs) occur commonly in hospitals, and emphasized that while most such MEs have little potential for harm, they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events (ADE). It is written that ADEs ‘‘have a major impact on the healthcare system. Several studies over the last few years have shown that they are largely due to failures during the ordering stage of the medication process. About one-third of serious MEs occur in this phase’’ [1]. It is then argued that MEs have resulted in patient deaths each year, and can also cause adverse reactions that range from the minor occasions to major disabilities. Computerized Physician Order Entry (CPOE) is established to ensure that patients do not receive medication that is wrong or dangerous for them. MEs occur in the process of ordering, dispensing, or administering a medication at the wrong time or not at all, regardless of whether an injury occurred or whether the potential for injury was present. Two years ago, a survey was conducted by Kazemi et al. [2] that showed most of the MEs happen at the prescribing stage, and the most common type is dose error. ADEs occur three times more often in newborns than in adults. Result of this Iranian study show that ‘‘Drug dose related errors are usually the most frequent when clinicians prescribe treatments manually’’ [2]. They argue that ‘‘Research in Iran showed dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of MEs, and curtailed-interval was the least’’ [2]. It is concluded that the neonatal ward CPOE without decision support functionality neither reduces non-intercepted dose, nor frequency of MEs for antibiotics and for anticonvulsants. However, when paired with a dose decision support system, CPOE is capable of reducing these errors. The effects of CPOE on medication errors are also demonstrated in this research, and this is done according to different specialties. However, the new study fails to show the effect of CPOE according to either types of hospitals (public, private, non-profit) or where they are located (metropolis, urban or rural). It therefore could be concluded that use of CPOE minimizes the occurrence of MEs, however, they still occur. Most errors are associated with the CPOE technology. The health industry therefore faces a new challenge in the prevention of ME that require a change in strategy for patient safety. Processing a prescription drug order through a CPOE system decreases the likelihood of errors [3]. Systems such as these have the potential to both fix and cause problems, and require evaluation. As one of us coauthored elsewhere [4] on this matter, the reductions occurred because order entry both structured orders and facilitated the checking of them. Further reductions should be possible with additional decision support. Such refined systems should therefore be used more widely.