Learning from errors: analysis of medication order voiding in CPOE systems.
OBJECTIVE
Medication order voiding allows clinicians to indicate that an existing order was placed in error. We explored whether the order voiding function could be used to record and study medication ordering errors.


METHODS
We examined medication orders from an academic medical center for a 6-year period (2006-2011; n  = 5 804 150). We categorized orders based on status (void, not void) and clinician-provided reasons for voiding. We used multivariable logistic regression to investigate the association between order voiding and clinician, patient, and order characteristics. We conducted chart reviews on a random sample of voided orders ( n  = 198) to investigate the rate of medication ordering errors among voided orders, and the accuracy of clinician-provided reasons for voiding.


RESULTS
We found that 0.49% of all orders were voided. Order voiding was associated with clinician type (physician, pharmacist, nurse, student, other) and order type (inpatient, prescription, home medications by history). An estimated 70 ± 10% of voided orders were due to medication ordering errors. Clinician-provided reasons for voiding were reasonably predictive of the actual cause of error for duplicate orders (72%), but not for other reasons.


CONCLUSIONS
Medication safety initiatives require availability of error data to create repositories for learning and training. The voiding function is available in several electronic health record systems, so order voiding could provide a low-effort mechanism for self-reporting of medication ordering errors. Additional clinician training could help increase the quality of such reporting.
Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Thomas G
TG
Kannampallil
Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, Northwestern University, Chicago, IL, USA.
Joanna
J
Abraham
Department of Medicine, College of Medicine, University of Illinois at Chicago.
Anna
A
Solotskaya
Department of Medicine, College of Medicine, University of Illinois at Chicago.
Sneha G
SG
Philip
Department of Communication Studies, Center for Communication and Health, Northwestern University.
Bruce L
BL
Lambert
Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Gordon D
GD
Schiff
Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Adam
A
Wright
Department of Medicine, College of Medicine, University of Illinois at Chicago.|Department of Pharmacy Practice, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago.
William L
WL
Galanter
D000046:Academic Medical Centers; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D061214:Patient Safety; D012189:Retrospective Studies
CPOE; medication errors; medication order voiding; patient safety