While computerized physician order entry (CPOE) is expected to significantly reduce medication errors, systems must be implemented thoughtfully to avoid facilitating certain types of errors, according to a recent study. The study, supported by the Agency for Healthcare Research and Quality (AHRQ), looks at clinicians’ experience in using one CPOE system at a major urban teaching hospital. Though the findings may seem critical of CPOE, AHRQ Director Carolyn M. Clancy, MD, says that is not necessarily the case. She says the findings are typical for products early in their implementation.
"New health care information technology products usually go through an ongoing process of refinement and improvement as health care workers identify problems," she says. "Ideally, principles of human factors research, usability testing, and work flow impact should all be considered before products are released into the workplace."
Clancy says that while the findings are important, the study focuses on the experience of one hospital and one product and may not be easily applied to industry at large. "It means these products are in their early implementation period, and there will be a learning period to improve both these systems and make CPOE function at its best," she says.
Clancy says implementation problems would be minimized through testing before products are marketed, and through adaptation to meet the needs of individual clinical settings.
CPOE proven to reduce errors
The use of health information technology to reduce medical errors and improve patient safety has been extensively documented and supported in peer-reviewed literature, Clancy notes.
Last year, President Bush called for the widespread adoption and use of electronic medical records within the next 10 years and established the Office of the National Coordinator for Health Information Technology, headed by David Brailer, MD, PhD. "The findings from this study show that the particular way that computerized physician order entry products are developed and implemented makes all the difference in whether quality is improved," Brailer says. "This study emphasizes the important need for health information technology products to talk to one another so that patient information can be shared."
The study identified 22 situations in which the CPOE system increased the probability of medication errors.1 According to the study, these situations fell into two categories: information errors generated by fragmentation of data and hospitals’ many information systems; and interface problems between humans and machines, where the computer’s requirements are different than the way clinical work is organized.
Common CPOE errors cited
Some of the flaws identified by the study include:
- Medical staff may look to the CPOE system to determine minimal effective or usual dosage for infrequently used medications. However, the CPOE system may only reflect dosage sizes available at the pharmacy, which may differ from the minimal or usual dosage that should be prescribed. The flaw represents an inappropriate use of the data available on the CPOE system and could result in prescribing incorrect dosage.
- Clinicians might select the wrong patient file because names and drugs can be hard to read, computer mice are often imprecise, and patients’ names do not appear on all screens.
- A patient’s medication information is seldom synthesized on a single screen. Up to 20 screens might be needed to see all of a patient’s medications, increasing the likelihood of selecting a wrong medication.
- Because of the patient load and multiple tasks, nurses are often unable to enter timely information on the computer about the administration of drugs. The delayed information may affect later medication and clinical decisions.
- Computer downtime, whether for maintenance or in the event of crashes, can result in delays in medications reaching patients.
The study was based on interviews with medical staff, focus groups, shadowing staff as they worked, and a survey of interns and residents at a major urban teaching hospital with a widely used CPOE system.
Reference
1. Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293(10):1,197-1,203.
While computerized physician order entry (CPOE) is expected to significantly reduce medication errors, systems must be implemented thoughtfully to avoid facilitating certain types of errors, according to a recent study.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content