The impact of computerized provider order entry on medication errors in a multispecialty group practice.
OBJECTIVE
Computerized provider order entry (CPOE) has been shown to improve patient safety by reducing medication errors and subsequent adverse drug events (ADEs). Studies demonstrating these benefits have been conducted primarily in the inpatient setting, with fewer in the ambulatory setting. The objective was to evaluate the effect of a basic, ambulatory CPOE system on medication errors and associated ADEs.


METHODS
This quasiexperimental, pretest-post-test study was conducted in a community-based, multispecialty health system not affiliated with an academic medical center. The intervention was a basic CPOE system with limited clinical decision support capabilities.


METHODS
Comparison of prescriptions written before (n=5016 handwritten) to after (n=5153 electronically prescribed) implementation of the CPOE system. The primary outcome was the occurrence of error(s); secondary outcomes were types and severity of errors.


RESULTS
Frequency of errors declined from 18.2% to 8.2%-a reduction in adjusted odds of 70% (OR: 0.30; 95% CI 0.23 to 0.40). The largest reductions were seen in adjusted odds of errors of illegibility (97%), use of inappropriate abbreviations (94%) and missing information (85%). There was a 57% reduction in adjusted odds of errors that did not cause harm (potential ADEs) (OR 0.43; 95% CI 0.38 to 0.49). The reduction in the number of errors that caused harm (preventable ADEs) was not statistically significant, perhaps due to few errors in this category.


CONCLUSIONS
A basic CPOE system in a community setting was associated with a significant reduction in medication errors of most types and severity levels.
Devine
Emily Beth
EB
Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, Washington 98195-7630, USA. bdevine@u.washington.edu
Hansen
Ryan N
RN
Wilson-Norton
Jennifer L
JL
Lawless
N M
NM
Fisk
Albert W
AW
Blough
David K
DK
Martin
Diane P
DP
Sullivan
Sean D
SD
D000368:Aged; D000555:Ambulatory Care Information Systems; D016000:Cluster Analysis; D055695:Electronic Prescribing; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D008509:Medication Systems; D009096:Multi-Institutional Systems; D014481:United States