The Influence that Electronic Prescribing Has on Medication Errors and Preventable Adverse Drug Events: an Interrupted Time-series Study
- Jasperien E van Doormaal,
- Patricia M L A van den Bemt,
- Rianne J Zaal,
- Antoine C G Egberts,
- Bertil W Lenderink,
- Jos G W Kosterink,
- Flora M Haaijer-Ruskamp,
- Peter G M Mol
- Affiliations of the authors: Department of Hospital and Clinical Pharmacy(JvD,JK), University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Pharmacology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands(PvdB,AE); Department of Hospital and Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Hospital and Clinical Pharmacy, TweeSteden Hospital and St Elisabeth Hospital, Tilburg, the Netherlands; Department of Hospital and Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands(AE)
- Correspondence: JE van Doormaal, University Medical Center Groningen, Department of Clinical Pharmacy, P.O. Box 30,001, 9,700 RB Groningen, The Netherlands Email: <j.e.van.doormaal{at}apoth.umcg.nl>
- Received 9 December 2008
- Accepted 16 August 2009
Abstract
Objective This study evaluated the effect of a Computerized Physician Order Entry system with basic Clinical Decision Support (CPOE/CDSS) on the incidence of medication errors (MEs) and preventable adverse drug events (pADEs).
Design Interrupted time-series design.
Measurements The primary outcome measurements comprised the percentage of medication orders with one or more MEs and the percentage of patients with one or more pADEs.
Results Pre-implementation, the mean percentage of medication orders containing at least one ME was 55%, whereas this became 17% post-implementation. The introduction of CPOE/CDSS has led to a significant immediate absolute reduction of 40.3% (95% CI: −45.13%; −35.48%) in medication orders with one or more errors.
Pre-implementation, the mean percentage of admitted patients experiencing at least one pADE was 15.5%, as opposed to 7.3% post-implementation. However, this decrease could not be attributed to the introduction of CPOE/CDSS: taking into consideration the interrupted time-series design, the immediate change was not significant (−0.42%, 95% CI: −15.52%; 14.68%) because of the observed underlying negative trend during the pre-CPOE period of −4.04% [95% CI: −7.70%; −0.38%] per month.
Conclusions This study has shown that CPOE/CDSS reduces the incidence of medication errors. However, a direct effect on actual patient harm (pADEs) was not demonstrated.
Footnotes
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This work (file Number 94504109) was funded by an unconditional grant from the Netherlands Organization for Health Research and Development (ZonMw). This agency played no role in the collection, analysis and interpretation of the data or in the decision to submit the manuscript for publication.
