Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)

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Computerized provider order entry (CPOE) systems allow providers to electronically enter patient services and medication orders. With the introduction of the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, CPOE systems in hospitals are capable of reducing medical errors and adverse drug reactions, especially when linked to clinical decision support systems (CDSS). The article, "Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)” from the Journal of the American Medical Informatics Associations demonstrates the relationship between the two systems. [1]


Abstract

CPOE systems are known for their cost savings, decrease of medication errors and ability to identify adverse drug reactions for the healthcare systems as part of federal regulations. However, CPOE systems can also increase the risk of opportunities for providers to accidently enter orders on wrong patient charts if they do not have visual cues . Wrong-patient selection occurs if a system has features that allows providers to search for patients charts rapidly, through "recent" patient list selections or through the ability to have multiple charts open during one session. The article describes how the UI-Health participated in a study, in which they created a group of CDS alerts to "prompt prescribers (providers) to add problems to the problem list when they were prescribing certain medications in the absence of certain documented problems." The alerts were aimed to improve the provider's situation awareness and patient safety. In the study, not only did the medication trigger an alert if the problem list was missing an active problem, it also offered a list of problems were linked to the medication and gave the provider the ability to add them at their discretion.

Results

Over the 6 year period of the study, the system fired 127,320 alerts for 79,304 encounters from 54,608 unique patients.[1] After further review only 32 intercepted wrong chart errors were identified within the 127, 320 alerts. Overall the alerts illustrate the concept of medication-problem list mismatches which aims to improve problem list documentation within the electronic medical record (EMR). The article also indicates that although the alerts prevent providers in entering wrong-patient errors, one of the better solutions is to restrict the providers the ability to have more than one patient chart open at a time. In addition, including a photo file of the patient on their chart may be beneficial as well to helping them identify and preventing an error.


Comments

Although, the article did a good representation of demonstrating the functionality of CDS rules when linked to CPOE systems and the effect of preventing wrong-patient errors, the study was limited to only one single medical center facility and used only a group of certain medications (without variation)over a 6 year period. If there had been a variation the interception rate could have varied than what was reported in the article. Although it is evident that CPOE systems can increase wrong-patient errors within EMRs, these type of errors are more evident when entered by the user rather than by the system. In conclusion, the indication-based alerts not only assisted in preventing wrong-patient errors but also in the improvement in the documentation of the problem list more so than expected.


References

  1. 1.0 1.1 Galanter W,Falck S, Burns M, et al. J AM Med Inform Assoc 2013; 20: 477-481 http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/?term=indication+based+prescribing+prevents+wrong-patient+medication+errors+in+computerized+provider+order+entry>