Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects.
OBJECTIVE
To examine the effect of interruptions and task complexity on error rates when prescribing with computerized provider order entry (CPOE) systems, and to categorize the types of prescribing errors.


METHODS
Two within-subject factors: task complexity (complex vs simple) and interruption (interruption vs no interruption). Thirty-two hospital doctors used a CPOE system in a computer laboratory to complete four prescribing tasks, half of which were interrupted using a counterbalanced design.


METHODS
Types of prescribing errors, error rate, resumption lag, and task completion time.


RESULTS
Errors in creating and updating electronic medication charts that were measured included failure to enter allergy information; selection of incorrect medication, dose, route, formulation, or frequency of administration from lists and drop-down menus presented by the CPOE system; incorrect entry or omission in entering administration times, start date, and free-text qualifiers; and omissions in prescribing and ceasing medications. When errors occurred, the error rates across the four prescribing tasks ranged from 0.5% (1 incorrect medication selected out of 192 chances for selecting a medication or error opportunities) to 16% (5 failures to enter allergy information out of 32 error opportunities). Any impact of interruptions on prescribing error rates and task completion times was not detected in our experiment. However, complex tasks took significantly longer to complete (F(1, 27)=137.9; p<0.001) and when execution was interrupted they required almost three times longer to resume compared to simple tasks (resumption lag complex=9.6 seconds, SD=5.6; resumption lag simple=3.4 seconds, SD=1.7; t(28)=6.186; p<0.001).


CONCLUSIONS
Most electronic prescribing errors found in this study could be described as slips in using the CPOE system to create and update electronic medication charts. Cues available within the user interface may have aided resumption of interrupted tasks making CPOE systems robust to some interruption effects. Further experiments are required to rule out any effect interruption might have on CPOE error rates.
Magrabi
Farah
F
Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia. f.magrabi@unsw.edu.au
Li
Simon Y W
SY
Day
Richard O
RO
Coiera
Enrico
E
D006801:Humans; D050316:Medical Order Entry Systems; D008505:Medical Staff, Hospital; D008508:Medication Errors / Q000706:statistics & numerical data*; D013647:Task Performance and Analysis
BMJ. 1998 Feb 28;316(7132):673-6
9522794
Br J Clin Pharmacol. 2008 Feb;65(2):230-7
17662088
Am J Health Syst Pharm. 2006 Feb 15;63(4):353-8
16452521
Yearb Med Inform. 2006;:20-5
17051290
Stud Health Technol Inform. 2007;129(Pt 2):958-62
17911857
JAMA. 2005 Mar 9;293(10):1197-203
15755942
Qual Saf Health Care. 2010 Aug;19(4):304-12
20378621
Am J Health Syst Pharm. 2007 Sep 15;64(18):1969-77
17823111
Crit Care. 2005 Oct 5;9(5):R516-21
16277713
J Exp Psychol Appl. 2008 Dec;14(4):299-313
19102614
Proc AMIA Annu Fall Symp. 1996;:17-21
8947619
J Am Med Inform Assoc. 2000 Sep-Oct;7(5):453-61
10984464
AMIA Annu Symp Proc. 2008 Nov 06;:257-61
18998968
J Am Med Inform Assoc. 2004 Mar-Apr;11(2):104-12
14633936
Int J Med Inform. 2009 May;78(5):293-307
19081295
J Exp Psychol Appl. 2008 Dec;14(4):314-28
19102615
Int J Med Inform. 2009 Apr;78 Suppl 1:S69-76
18786852
Am J Health Syst Pharm. 2005 Feb 15;62(4):416-9
15745896
J Exp Psychol Gen. 2006 Feb;135(1):103-15
16478319
Arch Intern Med. 2010 Apr 26;170(8):683-90
20421552
Arch Intern Med. 2009 May 25;169(10):982-9
19468092
Stud Health Technol Inform. 2010;160(Pt 1):784-8
20841793