title: Potential medication errors associated with computer prescriber order entry.
abstract: BACKGROUND
  To assess the frequency of medication errors (ME) induced or enhanced by computerized physician order entry (CPOE). Error type, drug classes involved, specialty, patient outcome and system failures were also evaluated.
  
  
  METHODS
  Observational quantitative study in a large tertiary care medical center over March 2012 3 years after CPOE implementation. Pharmacists detected ME associated with CPOE (those that wouldn't have occurred if the clinician had prescribed manually) and unassociated in pharmacological treatments in inpatients of 13 specialties (421 beds). Main outcome measured were ME associated and unassociated with CPOE.
  
  
  RESULTS
  We found 714 ME with 85.857 drug prescriptions (a 0.8 % error rate, 95 % CI 0.6-0.7). Percentage of error associated with CPOE was 77.7 %. The main types of error related to CPOE were wrong medication selection (20.9 %) and improper data placement (20.3 %). Failures with medications prescribed in primary care, unavailable in the hospital pharmacy, were involved in 21.6 % of all ME. Errors involving surgical specialties were double those involving medical specialties (1.2 vs. 0.6 %). Most ME associated with CPOE were potential errors (90 %). During the study system failures occurred four times.
  
  
  CONCLUSIONS
  The use of CPOE minimises the occurrence of medication errors, however, they still occur. Most errors are associated with the CPOE technology. We therefore face a new challenge in the prevention of ME that require a change in strategy for patient safety. Continued training of prescribers, standardization of the electronic prescription programs and integration between computer applications in hospitals and with primary care should be a priority.
authors.affiliation: Clinical Pharmacy Consultant, Pharmacy Department, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain. evillabueno@telefonica.net
authors.forename: Elena
authors.initials: E
authors.lastname: Villamañán
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Larrubia
authors.forename: Margarita
authors.initials: M
authors.lastname: Ruano
authors.forename: Manuel
authors.initials: M
authors.lastname: Vélez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Armada
authors.forename: Alicia
authors.initials: A
authors.lastname: Herrero
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Álvarez-Sala
mesh_terms: D006801:Humans; D008137:Longitudinal Studies; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital; D017063:Outcome Assessment, Health Care; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D062606:Tertiary Care Centers