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J Am Med Inform Assoc 16:613-623 doi:10.1197/jamia.M3050
  • The Practice of Informatics
  • Review Paper

Does Computerized Provider Order Entry Reduce Prescribing Errors for Hospital Inpatients? A Systematic Review

  1. Margaret H Reckmann, BSc, BPharma,
  2. Johanna I Westbrook, GradDipAppEpid, MHA, PhDa,
  3. Yvonne Koh, BPharm(Hons)a,
  4. Connie Lo, BPharm(Hons)a,
  5. Richard O Day, MDb
  1. aHealth Informatics Research & Evaluation Unit, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
  2. bClinical Pharmacology, St Vincent’s Hospital, University of New South Wales, Sydney, NSW, Australia
  1. Correspondence: Professor J. Westbrook, Director, Health Informatics Research and Evaluation Unit, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe 1825, Sydney, Australia (Email: J.Westbrook{at}usyd.edu.au).
  • Received 23 October 2008
  • Accepted 13 May 2009

Abstract

Previous reviews have examined evidence of the impact of CPOE on medication errors, but have used highly variable definitions of “error”. We attempted to answer a very focused question, namely, what evidence exists that CPOE systems reduce prescribing errors among hospital inpatients? We identified 13 papers (reporting 12 studies) published between 1998 and 2007. Nine demonstrated a significant reduction in prescribing error rates for all or some drug types. Few studies examined changes in error severity, but minor errors were most often reported as decreasing. Several studies reported increases in the rate of duplicate orders and failures to discontinue drugs, often attributed to inappropriate selection from a dropdown menu or to an inability to view all active medication orders concurrently. The evidence-base reporting the effectiveness of CPOE to reduce prescribing errors is not compelling and is limited by modest study sample sizes and designs. Future studies should include larger samples including multiple sites, controlled study designs, and standardized error and severity reporting. The role of decision support in minimizing severe prescribing error rates also requires investigation.

Footnotes

  • This research was funded by a National Health & Medical Research Council Project grant (400929) and Program grant (568612). All authors declare that they have no competing interests.

  • Footnote: Failure modes and effects analysis (FMEA) is a methodology for redesigning health care processes as a proactive, systematic approach for identifying “the ways that a process or design can fail, why it might fail, and how it can be made safer.”47 Failure modes and effects analysis is directly applicable to the incorporation of IT such as CPOE into a complex process such as pediatric chemotherapy. Using the expertise of the oncologists and the CPOE team, the assessment identifies and prioritizes specific process errors (failure modes) and suggests ways that CPOE can help to mitigate them. The collection of data provides evidence and benchmarks for further improvement efforts.17

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