View source for The Influence that Electronic Prescribing has on Medication Errors and Preventable Adverse Drug Events: an Interrupted Time-Series Study

This is a review on an article in which computerized physician order entry [[CPOE|CPOE]]/clinical decision support[[CDS|CDSS]] have been introduced and its effect on hospitals that have been entering orders using a paper system.<ref name="Doormaal 2009">van Doormal JE, van den Bemut PMLA, Zeal RJ, Egberts ACG, Lenderink BW, Kosterink JGW, Haaijer-Rukamp FM, Mol PGM, 1 November 2009, The Influence that Electronic Prescribing has on Medication Errors and Preventable Adverse Drug Events: an Interrupted Time-Series Study,JAMIA 16,6,816-825 http://jamia.oxfordjournals.org/content/16/6/816,/,</ref>

===Introduction===

The purpose of this article was to determine the significance of electronic prescribing has on [[medication errors]] and preventing adverse effects.  The expectation was that legibility of orders, orders that did not lack any of the necessary elements and including [[Clinical decision support systems|Clinical Decision Support Systems (CDSS)]] into Care Provider Order Entry (CPOE) would help reduce medication errors, adverse effects, and increase medication safety. <ref name="CPOE">Van Doormaal, J.E.; Van Den Bemt, P.M.; Zaal, R.J.; Egberts, A.C.; Lenderink, B.W.; Kosterink, J.G.;  Haaijer-Ruskamp, F.M.; Mol, P.G. (2009). The Influence that Electronic Prescribing Has on Medication Errors and Preventable Adverse Drug Events: an Interrupted Time-series Study. Journal of the American Medical Informatics Association, 16(6), 816-825. http://jamia.oxfordjournals.org/content/16/6/816/</ref>

===Methods===

An interrupted time series study was used at two large teaching hospitals in the geriatric and internal medicine wards.  The patients had to be admitted for at least 24 hours to be included in this study.  Data was collected before implementation of CPOE and post-implementation.  During the pre-implementation phase, there was no decision support system in place.  During the intervention period, physicians used CPOE, during which CDSS was in place and helped to warn about dosaging, interactions, and allergies.  During the CPOE process, physicians were able to override the order, despite some of the alerts.  Medication errors and incidences of adverse drug effects were categorized into “prescribing” and “transcribing errors” and then “prescribing” errors were subdivided into “administrative” and “procedural” errors. <ref name="Methods">Methods http://jamia.oxfordjournals.org/content/16/6/816</ref>

===Results===

Over 500 patients were enrolled in the pre-implementation stage of the study, while over 600 patients were enrolled in the post-implementation portion.  Post-implementation of CPOE and CDSS showed a 40% reduction in medication errors.  <ref name="Results">Results http://jamia.oxfordjournals.org/content/16/6/816</ref>

===Conclusion===

In this study, the introduction of CPOE and CDSS showed a significant reduction in medication errors.  However, it also found that it was very simple for physicians to override or dismiss drug safety alerts that are created.  The biggest impact was the number of errors that were reduced due to lack of legibility.  v<ref name="Conclusion">Conclusion http://jamia.oxfordjournals.org/content/16/6/816</ref>

===Comments===

I did find that while the study discussed what type of errors were tracked, it did not mention what adverse effects they had on the patients.

== Related Articles ==

*[[E-prescribing]]
*[[Reduction of errors in hospitals due to adoption of computerized provider order entry systems]]
*[[Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)]]


===References===
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[[Category:Reviews]]
[[Category:CPOE]]
[[Category:Medication Error]]
[[Category:CDSS]]