title: The impact of computerised physician order entry on prescribing practices in a cardiothoracic intensive care unit.
abstract: This prospective, time series, cross-sectional study was designed to compare the quality of handwritten vs computerised prescriptions in a tertiary 25-bedded cardiothoracic intensive care unit. A total of 14,721 prescriptions for 613 patients were analysed over three periods of investigation: 7 months before; and 5 and 12 months after implementation of a clinical information system with computerised physician order entry capability. Errors in prescribing were common. Only (53%) of handwritten charts analysed had all immediate administration drugs prescribed correctly. Errors included omission of route 81 (8.0%), date of prescription 78 (7.7%), and time to be given 255 (25.2%), and 119 (11.7%) had no dose or an incorrect dose prescribed. All errors of completeness were abolished following implementation. The computerised system led to a significant improvement in prescribing safety, in a clinical area previously highlighted as having a high rate of adverse drug errors. Legibility, completeness and traceability are no longer possible sources of medication errors.
authors.affiliation: Addenbrookes Hospital, Cambridge, UK. ja297@cam.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Ali
authors.forename: L
authors.initials: L
authors.lastname: Barrow
authors.forename: A
authors.initials: A
authors.lastname: Vuylsteke
mesh_terms: D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards*; D004739:England; D006236:Handwriting; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards*; D050316:Medical Order Entry Systems / Q000458:organization & administration / Q000592:standards*; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures