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/clinical decision supportCDSS have been introduced and its effect on hospitals that have been entering orders using a paper system.

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.

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.

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.

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.

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?

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