Duplicate Orders: An Unintended Consequence of Computerized provider/physician order entry (CPOE) Implementation

This is a review of Magid, Forrer, and Shaha’s 2012 article, Duplicate Orders: An Unintended Consequence of Computerized provider/physician order entry (CPOE) Implementation: Analysis and Mitigation Strategies

Background

The benefits of computerized provider/physician order entry (CPOE) have been. CPOE, particularly with clinical decision support (CDS), has been shown to increase patient safety. CPOE has also been reported to improve:

• The utilization of health care services
• Decrease costs
• Reduce hospital length of stay
• Decrease medical errors
• Improve compliance with guidelines

CPOE systems improve legibility and decrease errors relating to look-alike, sound-alike medications. Reductions in medication errors have been noted for:

• Dosing
• Frequency
• Route
• Substitution
• Allergies

The authors’ objective in this report was to describe the nature of duplicate orders, report their analysis of them and describe the methods used to reduce them.

Methods

Duplicate medication orders (“duplicates”) were defined for the study as two or more active orders for the identical medication regardless of dose. The second order entered was labeled as the duplicate order. Certain orders were not considered to be duplicates and were excluded from analysis. These include:

• 1. Dose range ordering (e.g. acetaminophen: one pill for mild pain and two pills for severe pain)
• 2. Combination drug plus component (e.g. losartan/HCTZ plus HCTZ or Percocet plus acetaminophen)
• 3. The same drug prescribed for different indications (e.g. acetaminophen for pain and acetaminophen for fever)
• 4. Large volume parenterals

Results

A total of 316,160 orders were captured during the 84 weeks, averaging 3,764 orders per weekly sampling period.

• There were 5,442 duplicate orders over this period, an average duplication rate of 1.8%.
• The highest rate was 5.0% (211/4,220) in week 1, and the lowest rate was 0.3% (8/2,667) in week 75.
• The duplication rate was 0.82% (32/3,888) in the last week (84) of the study.

There was an 84.8% decrease in the duplication rate from week 1 (211 duplicates) to week 84 (32 duplicates), and a 94.6% decrease from the highest (week 1) to the lowest (week 75). The duplication rate of 3.7% Pre-interventions (780/21,081) was reduced to 0.9% Post-interventions (211/23,444); from nearly one duplicate for every 25 orders to fewer than nine in every 1,000 representing a decrease of 75.7%.