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

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This is a review on an article in which computerized physician order entry CPOE/clinical decision supportCDSS have been introduced and its effect on hospitals that have been entering orders using a paper system.[1]

Introduction

The authors discuss the effects of the creation and implementation of a CPOE integrated with a CDSS. They believed that CPOE/CDSS systems would be effective in reducing medication errors and adverse drug events ADE "thereby improving patient safety."[1]


Methods

Interestingly the authors chose to perform this study using "an interrupted time series that is characterized by a series of measurements over time interrupted by an intervention"[1] The study was conducted at two different hospitals with a combined number of 1900 beds. If patients met criteria they were then asked to participate in the study. The study began with paper based order entry and data was subsequently gathered for approximately 5 months, the intervention then came when the CPOE was introduced. There was a time gap of approximately 2 months and the data was then collected post implementation of CPOE and CDSS. However, CDSS was not always implemented concurrently with CPOE.[1]


Discussion

Many different factors played a role in the implementation of the CPOE/CDSS as well as impact on the findings. However "physicians and nurses were positive about the way CPOE/CDSS" impacted the safety of the patient. Though data was collected from approximately 1500 patients whom met criteria during the study only 1000 consented to release of information and participation in the study.[1]

Conclusion

Utilization of CPOE/CDSS was a success in reduction medication errors, thus proving increase in patient safety. After initial adjustment to beginning the practice of CPOE then introducing CDSS, there was a significant decrease in medication errors, as well and increase in completeness of medication prescriptions.[1]

Comments

There is truth to be told when implementing a CPOE system, as I was present at many go-live instances for when the "swtich" of paper to electronic occurred, that many factors can and do effect the success of the project. I believe the authors captured some however I would also like to have known how much training was done and as well was the learning curve the same and did they implement the same EHR system at both facilities?

Related Article Review

1. Related article review: Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients

2. Related Article Review: Provider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 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,/,