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

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===Introduction===
 
===Introduction===
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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|ADE]] "thereby improving patient safety."<ref name="Doormaal 2009"></ref>
 
  
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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===
 
===Methods===
  
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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"<ref name="Doormaal 2009"></ref>  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.<ref name="Doormaal 2009"></ref>  
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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>
  
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===Results===
  
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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>
  
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===Discussion===
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===Conclusion===
  
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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.<ref name="Doormaal 2009"></ref>
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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>
  
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===Comments===
  
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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.
  
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===Conclusion===
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== Related Articles ==
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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.<ref name="Doormaal 2009"></ref>
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*[[E-prescribing]]
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*[[Reduction of errors in hospitals due to adoption of computerized provider order entry systems]]
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*[[Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)]]
  
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===Comments===
 
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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.  There are many different factors that effect the success or the outcome 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?
 
  
 
===References===
 
===References===
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[[Category:Reviews]]
 
[[Category:Reviews]]
 
[[Category:CPOE]]
 
[[Category:CPOE]]
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[[Category:CDS]]
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[[Category:Medication Error]]
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[[Category:CDSS]]

Latest revision as of 17:22, 6 October 2015

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 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 (CDSS) into Care Provider Order Entry (CPOE) would help reduce medication errors, adverse effects, and increase medication safety. [2]

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. [3]

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. [4]

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[5]

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


References

  1. ↑ 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,/,
  2. ↑ 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/
  3. ↑ Methods http://jamia.oxfordjournals.org/content/16/6/816
  4. ↑ Results http://jamia.oxfordjournals.org/content/16/6/816
  5. ↑ Conclusion http://jamia.oxfordjournals.org/content/16/6/816
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