Reducing Medication Error Rates Research Articles

Modulators Influencing Medication Alert Acceptance: An Explorative Review.

Clinical decision support systems (CDSSs) use alerts to enhance medication safety and reduce medication error rates. A major challenge of medication alerts is their low acceptance rate, limiting their potential benefit. A structured overview about modulators influencing alert acceptance is lacking. Therefore, we aimed to review and compile qualitative and quantitative modulators of alert acceptance and organize them in a comprehensive model. In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, a literature search in PubMed was started in February 2018 and continued until October 2021. From all included articles, qualitative and quantitative parameters and their impact on alert acceptance were extracted. Related parameters were then grouped into factors, allocated to superordinate determinants, and subsequently further allocated into five categories that were already known to influence alert acceptance. Out of 539 articles, 60 were included. A total of 391 single parameters were extracted (e.g., patients' comorbidity) and grouped into 75 factors (e.g., comorbidity), and 25 determinants (e.g., complexity) were consequently assigned to the predefined five categories, i.e., CDSS, care provider, patient, setting, and involved drug. More than half of all factors were qualitatively assessed (n = 21) or quantitatively inconclusive (n = 19). Furthermore, 33 quantitative factors clearly influenced alert acceptance (positive correlation: e.g., alert type, patients' comorbidity; negative correlation: e.g., number of alerts per care provider, moment of alert display in the workflow). Two factors (alert frequency, laboratory value) showed contradictory effects, meaning that acceptance was significantly influenced both positively and negatively by these factors, depending on the study. Interventional studies have been performed for only 12 factors while all other factors were evaluated descriptively. This review compiles modulators of alert acceptance distinguished by being studied quantitatively or qualitatively and indicates their effect magnitude whenever possible. Additionally, it describes how further research should be designed to comprehensively quantify the effect of alert modulators.

Impact of a pharmacist‐to‐dose direct oral anticoagulant protocol on medication errors at an academic medical center

AbstractBackgroundDirect oral anticoagulants (DOACs) are considered high‐risk medications and pose a serious threat to patients if mismanaged. Furthermore, medication error rates involving DOACs in the acute care setting range from 25% to 40%. To reduce medication error rates at our institution, we implemented a pharmacist‐driven DOAC protocol that permitted pharmacists to independently order and monitor DOACs pursuant to a consult order.ObjectiveTo determine the impact of a pharmacist‐to‐dose DOAC protocol on medication errors at an academic medical center.MethodsThis was a retrospective, single‐center cohort study using a pre‐post design to evaluate the impact of a pharmacist‐to‐dose DOAC protocol on rates of medication errors. Patient data were evaluated during a 6‐month period before and after the implementation of the protocol. Patients were excluded if they were receiving a DOAC for an indication other than venous thromboembolism and/or atrial fibrillation.ResultsA total of 502 patients (pre‐phase = 256; post‐phase = 246) admitted to the hospital and receiving a DOAC were included in the study. A total of 41 patients in the pre‐phase received a medication error involving a DOAC compared with 22 patients in the post‐phase (16% vs 8.9%; relative risk reduction 44%; P = .017). Rates of near misses were numerically higher in the post‐phase group (7.4% vs 11.8%; P = .1), and rates of discharge DOAC errors were numerically lower (8.5% vs 4.9%; P = .1). The most common error was underdosing (N = 31).ConclusionIn this study, the implementation of a pharmacist‐to‐dose DOAC protocol was associated with a 44% reduction in DOAC‐related medication errors. These findings underscore the impact of a protocolized approach to DOAC management, as well as the role of pharmacists in overseeing inpatient DOAC use and reducing medication errors.

Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis.

Medication errors are avoidable events that can occur at any stage of the medication use process. They are widespread in healthcare systems and are linked to an increased risk of morbidity and mortality. Several strategies have been studied to reduce their occurrence including different types of pharmacy-based interventions. One of the main pharmacist-led interventions is educational programs, which seem to have promising benefits. To describe and compare various pharmacist-led educational interventions delivered to healthcare providers and to evaluate their impact qualitatively and quantitatively on medication error rates. A systematic review and meta-analysis was conducted through searching Cochrane Library, EBSCO, EMBASE, Medline and Google Scholar from inception to June 2020. Only interventional studies that reported medication error rate change after the intervention were included. Two independent authors worked through the data extraction and quality assessment using Crowe Critical Appraisal Tool (CCAT). Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Research protocol is available in The International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42019116465. Twelve studies involving 115058 participants were included. The two main recipients of the educational interventions were nurses and resident physicians. Educational programs involved lectures, posters, practical teaching sessions, audit and feedback method and flash cards of high-risk abbreviations. All studies included educational sessions as part of their program, either alone or in combination with other approaches, and most studies used errors encountered before implementing the intervention to inform the content of these sessions. Educational programs led by a pharmacist were associated with significant reductions in the overall rate of medication errors occurrence (OR, 0.38; 95% CI, 0.22 to 0.65). Pharmacist-led educational interventions directed to healthcare providers are effective at reducing medication error rates. This review supports the implementation of pharmacist-led educational intervention aimed at reducing medication errors.

How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis.

ObjectiveTo conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS.Materials and MethodsWe searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed.ResultsThere was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18–8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72–0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence.Discussion and ConclusionDespite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.

Impact of pharmacist interventions on medication errors in hospitalized pediatric patients: a systematic review and meta-analysis.

Background Medication errors are avoidable events that may occur at any stage of the medication use process. Implementing a clinical pharmacist is one strategy that is believed to reduce the number ofmedication errors. Pediatric patients, who are more vulnerable to medication errors due to several contributing factors, may benefit from the interventions of a pharmacist. Aim of the review To qualitatively and quantitatively evaluate the impact of clinical pharmacist interventions on medication error rates for hospitalized pediatric patients. Methods PubMed, EMBASE, Cochrane Controlled Trials Register and Google Scholar search engines were searched from database inception to February 2020. Study selection, data extraction and quality assessment was conducted by two independent reviewers. Observational and interventional studies were included. Data extraction was done manually and the Crowe Critical Appraisal Tool was used to critically appraise eligible articles. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Results 19 studies were systematically reviewed and 6 studies (29,291 patients) were included in the meta-analysis. Pharmacist interventions involved delivering educational sessions, reviewing prescriptions, attending rounds and implementing a unit-based clinical pharmacist. The systematic review indicated that the most common trigger for pharmacist interventions was inappropriate dosing. Pharmacist involvement was associated with significant reductions in the overall rate of medication errors occurrence (OR 0.27; 95% CI 0.15 to 0.49). Conclusion Pharmacist interventions are effective for reducing medication error rates in hospitalized pediatric patients.

Reducing Medication Error Through a Collaborative Committee Structure: An Effort to Implement Change in a Community-Based Health System.

This article describes a methodology for implementation and sustainment of continuous quality improvement initiatives through committee structures aimed at reducing medication error rates. A committee structure was developed in a collaborative effort to analyze and reduce medication error rates. Interdisciplinary teams comprised of frontline staff met regularly to identify and resolve trending medication safety events and prepare and deliver education for staff. Continuous quality improvement initiatives supported by these committees included technical handling and administration of medication, medication reconciliation, and enhancements to standardized treatment protocols. Data were collected through a voluntary electronic safety event reporting system between March 2013 and March 2016, to evaluate the rate of medication errors and near-misses. A retrospective analysis of reported medication errors and near-misses was conducted. The medication error rate significantly declined over the study period as the rate of near-misses conversely increased. Initiatives supported by the oversight of collaborative committees were successful in decreasing medication error rates.

THE ROLE OF THE PAEDIATRIC CLINICAL PHARMACIST IN REDUCING MEDICATION ERRORS: A SYSTEMATIC LITERATURE REVIEW

Aim Clinical pharmacists in some countries are a recognised primary source for providing evidence based (where possible) information and advice, to ensure delivery of the correct, safest and most effective medication to patients.1 We wished to determine from the literature: the effect of paediatric clinical pharmacists9 activities on reducing medication error rates; the nature of pharmacists9 interventions to minimise or prevent medication errors in children; other pharmacists9 contributions to patient care. Methods Systematic search of five databases: EMBASE, International Pharmaceutical Abstracts, Ovid MEDLINE(R), Allied and Complementary Medicine and Cumulative Index to Nursing and Allied Health Literature to end of July 2013, using 74 keywords. Inclusion criteria: original research studies identifying the effect of pharmacists9 activities on reducing/detecting medication errors in neonatal or paediatric patients, or in the general population, where neonatal or paediatric data was separately identified. Results Twenty-five relevant studies were identified in 13 different countries (mostly the US followed by the UK). Studies used three methods of data collection to detect medication errors: chart review, review of incident reports and direct observation of nurses and parents administering medications. Pharmacists identified prescribing, administration and medication errors in general (where the type of error was not specified). Nine studies provided only the number of errors intercepted with no denominator. The remaining 16 studies identified the error rate using seven different denominators. These methodological variations made studies very difficult to compare. Pharmacists intercepted 29 types of medication errors, most commonly: wrong dose (21 studies); wrong drug (11); wrong route of administration (8); incomplete prescriptions (8) and omission of medications (8). Antibiotics were the most common group of medications where interventions were made. The acceptance rate of pharmacists9 recommendations by doctors was identified by nine studies and ranged between 24% (in US) and 98% (in Canada). Pharmacists made 15 different types of contributions. The most common were: provision of information in response to other healthcare professionals9 queries (7 studies); cost savings (e.g. €532 per patient saved in a German paediatric neurology ward as a result of preventing wastage of medications) (5); medication reconciliation (3); education of patients/parents in drug administration to facilitate adherence (3). Education was another successful initiative highlighted in six studies e.g. education of doctors decreased the prescribing dosing error rate from 61.8 to 1.3% of all orders in an Indian specialist children9s hospital.2 It decreased the nurse administration error rate from 40.4% to 7.9% of all administrations and parents from 96.6% to 5.6% of all administrations in Germany.3 Conclusion Paediatric clinical pharmacists use a wide range of initiatives to reduce and prevent medication errors mainly in the US and the UK. Little information is available from other parts of the world where such activities are also likely to be valuable.

Benefits and risks of using smart pumps to reduce medication error rates: a systematic review.

Smart infusion pumps have been introduced to prevent medication errors and have been widely adopted nationally in the USA, though they are not always used in Europe or other regions. Despite widespread usage of smart pumps, intravenous medication errors have not been fully eliminated. Through a systematic review of recent studies and reports regarding smart pump implementation and use, we aimed to identify the impact of smart pumps on error reduction and on the complex process of medication administration, and strategies to maximize the benefits of smart pumps. The medical literature related to the effects of smart pumps for improving patient safety was searched in PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (2000-2014) and relevant papers were selected by two researchers. After the literature search, 231 papers were identified and the full texts of 138 articles were assessed for eligibility. Of these, 22 were included after removal of papers that did not meet the inclusion criteria. We assessed both the benefits and negative effects of smart pumps from these studies. One of the benefits of using smart pumps was intercepting errors such as the wrong rate, wrong dose, and pump setting errors. Other benefits include reduction of adverse drug event rates, practice improvements, and cost effectiveness. Meanwhile, the current issues or negative effects related to using smart pumps were lower compliance rates of using smart pumps, the overriding of soft alerts, non-intercepted errors, or the possibility of using the wrong drug library. The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Opportunities for improvement include upgrading drug libraries, developing standardized drug libraries, decreasing the number of unnecessary warnings, and developing stronger approaches to minimize workarounds. Also, as with other clinical information systems, smart pumps should be implemented with the idea of using continuous quality improvement processes to iteratively improve their use.

Effectiveness of an electronic inpatient medication record in reducing medication errors in Singapore

This study examined the effectiveness of an inpatient electronic medication record system in reducing medication errors in Singaporean hospitals. This pre- and post-intervention study involving a control group was undertaken in two Singaporean acute care hospitals. In one hospital the inpatient electronic medication record system was implemented while in another hospital the paper-based medication record system was used. The mean incidence difference in medication errors of 0.06 between pre-intervention (0.72 per 1000 patient days) and post-intervention (0.78 per 1000 patient days) for the two hospitals was not statistically significant (95%, CI: [0.26, 0.20]). The mean incidence differences in medication errors relating to prescription, dispensing, and administration were also not statistically different. Common system failures involved a lack of medication knowledge by health professionals and a lack of a systematic approach in identifying correct dosages. There was no difference in the incidence of medication errors following the introduction of the electronic medication record system. More work is needed on how this system can reduce medication error rates and improve medication safety.

Effect of Computerized Provider Order Entry on Rate of Medication Errors in a Community Hospital Setting

Purpose Computerized provider order entry (CPOE) has been shown to reduce medication error rates by as much as 55%. The purpose of this study was to examine the effect of CPOE on the rate of medication errors at a not-for-profit community hospital. Methods A prospective, observational study was conducted utilizing a pharmacist-driven concurrent data collection tool to evaluate all medication errors intercepted by each pharmacist. The survey was conducted for 3 separate 1-week periods: once prior to CPOE implementation and twice post CPOE implementation. The primary outcome was the rate of medication errors reported via the pharmacist concurrent data collection tool pre and post CPOE. The secondary outcomes included the errors reported through a hospitalwide, self-reported adverse medication event system, the types of errors, and error severity. Results A statistically significant 41% reduction ( P < .01) in the rate of errors 3 months following CPOE implementation was observed. The secondary outcome of self-reported medication errors per adjusted patient day decreased significantly with a 25% reduction ( P < .05). The type of errors reported by the pharmacists changed notably pre and post CPOE implementation; however the severity of the reported errors did not change. Conclusion CPOE decreased the rate of medication errors at our community hospital 3 months post CPOE implementation. Errors were increased at 1 month post CPOE implementation, but not significantly. The types of errors changed post CPOE implementation, but distribution of error severity was unchanged.

A systematic review of the effectiveness of double checking in preventing medication errors

BackgroundMedication errors are unfortunately a constant problem in the medication treatment process. Different interventions are available to reduce or prevent medication errors from reaching the patient. Double checking by two...

Medication Error Analysis: A Systematic Approach

Medication errors are a common unfortunate occurrence in hospitals. One population that is particularly vulnerable are patients admitted to the Intensive Care Unit (ICU). ICU patients have a combination of rapidly changing medical conditions, laboratory values, and medications, which present a particular challenge for clinicians in practice in every aspect of patient care. Medication errors can occur in different phases (prescribing, distribution, administration, and monitoring) of the medication process and have a significant impact on morbidity and mortality. Medication error analysis requires a structured approach including: detection, reporting, and analysis, in order to provide the most efficient and practical information to the ICU team. In addition, a particular focus is made on the implementation of medication error prevention strategies such as evidenced-based protocols, team education, and technology. In an effort to reduce medication error rates in the ICU requires a collaborative, multi-disciplinary approach in order to be effective and consistent through time. Further research efforts are currently taking place in this challenging aspect of patient care to further provide more strategies for medication error detection, analysis, and prevention.

Development strategy and potential impact on medication safety for clinical rules: the lithium case

Introduction: Prescribing, administration and monitoring of drugs are complex and error sensitive processes. Physicians have to take into account many drug- and patient specific characteristics continuously during therapy. Appropriate use of information technology, especially the introduction of clinical decision support systems (CDSS) can substantially reduce medication error rates and improve patient safety [1, 2]. Strategies for the development of clinical rules used in these CDSS systems are not available. Purpose: The aim of this study was: (1) to evaluate a strategy for the development of clinical rules and (2) to determine the potential impact on medication safety of these clinical rules. Lithium therapy was chosen as a test concept. Methods: For the development of clinical rules we followed a Plan – Do – Check – Act (PDCA) cycle with a panel of experts. Standard literature sources were screened for patient characteristics, monitoring parameters and other characteristics that have to be taken into account during lithium therapy. We translated this information into clinical rules for the CDSS system Gaston®# # Gaston®: P.A.de Clerq, MEDECS b.v. http://www.medecs.nl (plan). These rules were retrospectively tested on patients admitted to the Catharina-hospital Eindhoven in 2004 and 2005 using lithium (do). Signals were checked in the electronic patients record on: (1) appropriateness and (2) the action undertaken by the physician compared to the action warranted by the CDSS. For every rule the Positive Predictive Value (PPV) was determined: number of appropriate signals produced /total number of signals. When the action undertaken was not right according to the clinical rules we scored this as a Potential Adverse Drug Event (PADE) (check). Results were discussed with an expert panel and the clinical rules adjusted according their consensus (act). Results: The PDCA strategy with an expert panel resulted in a package of clinical rules for patients starting with, or using lithium therapy. To design the definite clinical rules the input of the expert team was essential, because literature left to much room for interpretation in clinical practice. The clinical rules were tested on 38 patients starting with and 93 patients using lithium in 2004 or 2005. The PPV’s of these clinical rules varied from 0.2 to 1.0 (mean 0.8). We identified 81 PADE’s in 71 patients, that could have been prevented when the CDSS would have been active. Most important PADE’s were: 1) omitted determination of lithium plasma levels after reduction of creatinin clearance < 50 ml/min (4 times) and starting or stopping of an interacting drug (17 times); 2) determination of lithium, Thyroid Stimulating Hormone (TSH), leucocyte and calcium plasma levels every 3 or 6 months (resp. 17, 6, 2 and 4 times). An important limitation for the creation of higher PPV’s and for the identification of PADE’s was the lack of outpatient data. Further research is needed to show that this system is clinically applicable. Conclusion: A strategy of PDCA combined with an expert panel is a prerequisite for the development of clinical rules for drugs in a CDSS. We demonstrated that a CDSS is able to identify patients with potential adverse drug events. Therefore we conclude that application of CDSS can have a relevant impact on medication safety in clinical practice.

Medication Errors in an Internal Medicine Department. Evaluation of a Computerized Prescription System

Evaluation of a computerized physician order entry in an Internal Medicine Department, with a unit-dose distribution system. Pharmacy Department, Internal Medicine Department. S. Francisco Xavier Hospital, Lisbon, Portugal. This study was carried out in December 2001 and January 2002. After two years experience of the CPOE system, medication errors were evaluated prospectively, in an internal medical department of a 360-bed academic hospital. Data were collected once a week. Pharmacists reviewed all medical prescriptions as part of their routine work. Medication errors detected were recorded on a data collection form with a design based on the types of errors as defined by the American Society of Hospital Pharmacists (ASHP). Completed forms were reviewed and medication errors were classed according to ASHP guidelines. A total of 2268 orders were monitored (162 patients). In these orders, 73 medication errors (22.4% of the patients) were detected and documented (59 prescribing errors and 14 monitoring errors). The most common prescribing errors were deficiencies related to the right class but wrong drug (28.3%): omeprazole vs. ranitidine/sucralfate in stress ulcer prophylaxis; incorrect dose (30%) and unclear orders (13.3%). Errors related to incorrect frequency of administration (5%); maintenance of IV route (5%); duplicated drug therapy (11.7%); drug interactions (1.7%) and length of therapy (3.3%) were also detected. The 14 monitoring errors detected were failures to review a prescribed regimen for appropriateness and detection of problems. Computerized prescription order entry has demonstrated effectiveness in eliminating medication errors related to transcribing and patient identification. Nevertheless, medication errors related to prescription and monitoring still occur. The use of clinical decision support systems and pharmacist involvement is vital to achieve maximum medication safety and reduce medication error rates.

Assessing medication prescribing errors in pediatric intensive care units.

To evaluate a matrix for determining the predominant type, cause category, and rate of medication prescribing errors, and to explore the effectiveness of hospital-based improvement initiatives among pediatric intensive care units (PICUs). This study involved the prospective identification of medication errors for categorization and evaluation by using a matrix methodology. A pretest-posttest design without a control group was used to explore the impact of initiatives employed to reduce medication error rates and severity. PICUs in nine freestanding, collaborating tertiary care children's hospitals that participated in both baseline and postintervention analyses. We evaluated 12,026 PICU medication orders at baseline and 9,187 orders postintervention for prescribing errors, excluding resuscitation orders. A standardized tool and process captured error type, cause category, and severity for 2 wks before and after intervention. Three levels of error detection were used and included pharmacy order entry, PICU nurse order transcription, and team-based overview. Site-specific interventions were implemented, which included predominantly provider education as well as informational (47%) and dosing "assists" via preprinted orders, forcing functions, or prompts (39%). Of baseline orders, 11.1% had at least one prescribing error. The interception of prescribing errors improved 30.9% (1.6% of all orders at baseline, 2.0% post intervention). Preventable adverse drug events were uncommon (0.6% of all medication errors) and of low severity at baseline; most were wrong dose errors. The implementation of improvement initiatives, specific for each facility, resulted in a 31.6% reduction in prescribing errors from 11.1% to 7.6%. However, site results varied considerably. A benchmark for medication prescribing errors in the PICU was identified among nine children's hospitals. The methodology was successful in accounting for site-specific differences with regard to identifying and documenting errors as well as reporting results of improvement initiatives. Furthermore, the methodology employed was generalizable in the identification of predominant prescribing error types, which helped to track individual hospital improvement initiative development and implementation. Overall improvement in prescribing error rates was noted; however, considerable variation in the success of improvement initiatives was noted and bears further attention.

Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review.

Iatrogenic injuries related to medications are common, costly, and clinically significant. Computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) may reduce medication error rates. We identified trials that evaluated the effects of CPOE and CDSSs on medication safety by electronically searching MEDLINE and the Cochrane Library and by manually searching the bibliographies of retrieved articles. Studies were included for systematic review if the design was a randomized controlled trial, a nonrandomized controlled trial, or an observational study with controls and if the measured outcomes were clinical (eg, adverse drug events) or surrogate (eg, medication errors) markers. Two reviewers extracted all the data. Discussion resolved any disagreements. Five trials assessing CPOE and 7 assessing isolated CDSSs met the criteria. Of the CPOE studies, 2 demonstrated a marked decrease in the serious medication error rate, 1 an improvement in corollary orders, 1 an improvement in 5 prescribing behaviors, and 1 an improvement in nephrotoxic drug dose and frequency. Of the 7 studies evaluating isolated CDSSs, 3 demonstrated statistically significant improvements in antibiotic-associated medication errors or adverse drug events and 1 an improvement in theophylline-associated medication errors. The remaining 3 studies had nonsignificant results. Use of CPOE and isolated CDSSs can substantially reduce medication error rates, but most studies have not been powered to detect differences in adverse drug events and have evaluated a small number of "homegrown" systems. Research is needed to evaluate commercial systems, to compare the various applications, to identify key components of applications, and to identify factors related to successful implementation of these systems.

Computerized physician order entry systems in hospitals: mandates and incentives.

Concerns with health care quality and medical errors are evident in media reports and research studies. A number of studies have demonstrated that computerized physician order entry (CPOE) can reduce medication error rates. In response, the California government and the Leapfrog Group have called for hospitals to implement CPOE for medications. However, few hospitals now use CPOE. Barriers include the large investment needed and the state of commercial CPOE systems. We argue that government, employers, and insurers should share the costs of CPOE and should fund further research into its benefits and means of implementation.

Clinical computing: Use of a personal digital assistant in reducing medication error rates.

Clinical computing: Use of a personal digital assistant in reducing medication error rates.