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Observational Study
. 2021 Oct 11;11(10):e045778.
doi: 10.1136/bmjopen-2020-045778.

Characteristics of pharmacist's interventions triggered by prescribing errors related to computerised physician order entry in French hospitals: a cross-sectional observational study

Manon Videau  1   2 , Bruno Charpiat  2   3 , Céline Vermorel  2 , Jean-Luc Bosson  2 , Ornella Conort  4 , Pierrick Bedouch  5   2 ; SFPC VIP– Act-IP group
Collaborators, Affiliations
Observational Study

Characteristics of pharmacist's interventions triggered by prescribing errors related to computerised physician order entry in French hospitals: a cross-sectional observational study

Manon Videau et al. BMJ Open. .

Abstract

Objectives: Computerised physician order entry (CPOE) systems facilitate the review of medication orders by pharmacists. Reports have emerged that show conception flaws or the misuse of CPOE systems generate prescribing errors. We aimed to characterise pharmacist interventions (PIs) triggered by prescribing errors identified as system-related errors (PISREs) in French hospitals.

Design: This was a cross-sectional observational study based on PIs prospectively documented in the Act-IP observatory database from January 2014 to December 2018.

Setting: PISREs from 319 French computerised healthcare facilities were analysed.

Participants: Among the 319 French hospitals, 232 (72.7%) performed SRE interventions, involving 652 (51%) pharmacists.

Results: Among the 331 678 PIs recorded, 27 058 were qualified as due to SREs (8.2%). The main drug-related problems associated with PISREs were supratherapeutic (27.5%) and subtherapeutic dosage (17.2%), non-conformity with guidelines/contraindications (22.4%) and improper administration (17.9%). The PI prescriber acceptation rate was 78.9% for SREs vs 67.6% for other types of errors. The PISRE ratio was estimated relative to the total number of PIs. Concerning the certification status of CPOE systems, the PISRE ratio was 9.4% for non-certified systems vs 5.5% for certified systems (p<0.001). The PISRE ratio for senior pharmacists was 9.2% and that for pharmacy residents 5.4% (p<0.001). Concerning prescriptions made by graduate prescribers and those made by residents, the PISRE ratio was 8.4% and 7.8%, respectively (p<0.001).

Conclusion: Computer-related prescribing errors are common. The PI acceptance rate by prescribers was higher than that observed for PIs that were not CPOE related. This suggests that physicians consider the potential clinical consequences of SREs for patients to be more frequently serious than interventions unrelated to CPOE. CPOE medication review requires continual pharmacist diligence to catch these errors. The significantly lower PISRE ratio for certified software should prompt patient safety agencies to undertake studies to identify the safest software and discard software that is potentially dangerous.

Keywords: adverse events; health & safety; health informatics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart, PISRE selection in Act-IP observatory (extraction on 11 February 2019). PI, pharmacist intervention; PISRE, prescribing errors identified as system-related error; SRE, system-related error.
Figure 2
Figure 2
Geographical location of French hospitals that entered data into the Act-IP observatory between 2014 and 2018.
See this image and copyright information in PMC

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