Impact of computerized physician order entry on medication prescription errors in the intensive care unit: a controlled cross-sectional trial
Kirsten Colpaert, 1 Barbara Claus,2 Annemie Somers,3 Koenraad Vandewoude,4 Hugo Robays,5 and Johan Decruyenaere6
Question, Is the introduction of a computerized ICU system (Centricity Critical Care Clinisoft, GE Healthcare) reduced the incidence and severity of medication prescription errors (MPEs)?
It was reported that 44,000 to 98,000 people annually die in US hospitals as aresult of medical errors. There is an estimation that 7000 deaths occurs each year as a result of MPEs. MPEs can occur in all stages of medication process from prescribing to dispensing of the drug.
It was found that 1/100 of in hospital medication errors result in ADE and 7/100 have the potential to do so. In addition to that the cost ranges from $10 for a medication error without harm to more than $5,000 for serious ADE.
But in ICU (Intensive Care Unit) the occurrance of ADE may be twice as high as in non-ICUs so there must be a solution to prevent MPE occurance in ICUs.
Leapfrog group recommended CPOE as a major step to improve patient safety and reduce medication errors in USA. As CPOE has the potential to decrease the occurrence of illegible orders , inappropriate doses and incomplete orders.
This study was conducted in a tertiary care university hospital for aperiod of five weeks. ICIS (Intensive care Information System) which is a computerized system specifically designed for ICU it consists of CPOE and moderate level of CDSS with full connections to monitors,ventilators,syringe pumps and connection with the hospital information system for administrative patient data and laboratory results . ICIS was implemented in 8 beds unit and compared it with 14 beds PBUs and after 10 months of implementation of ICIS in the latter unit patients were assigned randomly to either of these units by an independent nurse. The medical staff consists of five senior intensivists and three residents rotated continuously over these units each one week.
The person who is responsible for discovering MPE was a surgical ICU-independent clinical pharmacist with experience in medication errors analyzed every medication order of randomly selected patients. All medications and fluid prescriptions were checked for errors in drug name, dosing,dosage interval, pharmaceutical form preparation instructions ,adequate drug monitoring, route of administration , double prescriptions , drug-drug interactions,….., and known allergy to prescribed drug.
During the five week study period they have analyzed a total of 2,510 medication and fluid prescriptions , comprising 1,286 in C-U and 1,224 in PB-U.
They identified three groups of severity of MPEs -minor MPEs (no potential to cause harm) -intercepted MPEs (potential to cause harm but intercepted on time) -serious MPEs (non-intercepted potential adverse drug events)
InC-U 44 MPEs occurred versus 331 in PB-U (3.4%-27%) the ICIS have the impact of 86.7% relative reduction for all types of errors. Also pharmaceutical form errors and infusion rate errors were minor MPE while double prescriptions and problem of trailed zeros (for example, aspirin 3g instead of 0.3g) were intercepted MPEs and dosing errors or incompleteness of low molecular weight heparin prescriptions.
On the other hand , In PB-U illegible writing , incomplete orders and abbreviations were minor MPEs while errors of negligence (e.g. wrong route of administration) or transcription errors were intercepted MPEs and dosing errors (especially for antibiotics and anti-epiletic drugs) were ADEs.
91% of MPE in PBU were due to dosing errors which is significantly higher than the proportion of dosing errors in C-U (41%)
In PBU as the number of drug orders increased there is a trend toward more prescription errors which is in contrast with C-U.
There is 7000 death incidences occur each year due to MPE. In this study they tried to determine whether using computerized ICU is beneficial or not. They have found that using ICIS (Intensive care Information System) which consists of CPOE and CDSS reduced MPEs by a percentage of 86.7%.In addition , using CPOE can protect against MPEs in patients with multiple drug prescriptions as they found that as the number of drug orders increase there is no trend toward prescription errors in C-U.
Reviewed by : Eman Zaghlul