The impact of computerized physician order entry on medication error prevention

Abstract

Background: Medication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events.

Objective: To evaluate the impact of computerized physician order entry (POE) with decision support in reducing the number of medication errors.

Design: Prospective time series analysis, with four periods.

Setting and participants: All patients admitted to three medical units were studied for seven to ten-week periods in four different years. The baseline period was before implementation of POE, and the remaining three were after. Sophistication of POE increased with each successive period.

Intervention: Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings.

Main outcome measure: Medication errors, excluding missed dose errors.

Results: During the study, the non-missed-dose medication error rate fell 81 percent, from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period (P < 0.0001). Non-intercepted serious medication errors (those with the potential to cause injury) fell 86 percent from baseline to period 3, the final period (P = 0.0003). Large differences were seen for all main types of medication errors: dose errors, frequency errors, route errors, substitution errors, and allergies. For example, in the baseline period there were ten allergy errors, but only two in the following three periods combined (P < 0.0001).

Conclusions: Computerized POE substantially decreased the rate of non-missed-dose medication errors. A major reduction in errors was achieved with the initial version of the system, and further reductions were found with addition of decision support features.

Figure 1

Event rates by period. Top, the non-missed-dose medication error rate per 1,000 patient-days, by period. This rate dropped 64 percent between baseline and period 1, then climbed 45 percent between periods 1 and 2, and finally fell 64 percent between periods 2 and 3; the overall decline was 81 percent (P < 0.0001). Middle, the missed dose error rate per 1,000 patient-days across periods, which climbed significantly during the study (P < 0.0001). Bottom, the non-intercepted serious medication error rate per 1,000 patient-days, which fell during the study (P = 0.0003). Non-intercepted serious medication errors were defined as either non-intercepted potential adverse drug events (ADEs) or preventable ADEs.