P106 Impact of a computerised physician order entry system on medication safety in paediatrics

BackgroundOne of the most critical steps in the medication process on paediatric wards is the drug prescription.1 Studies have shown that the use of electronic systems may improve the quality of prescribing and reduces medication errors in paediatric inpatients.2This study aims to investigate the impact of a computerised physician order entry (CPOE) system (incl. decision support for dosing) on adverse drug reactions (ADR) and medication errors (ME) in comparison to paper-based prescribing and documentation.MethodsA prospective pre-post study was conducted at a general paediatric ward. All patients aged 17 years or younger that were treated for at least 24 hours during the study periods (5 months pre and post implementation) were observed. Adverse events were identified by intensive chart review.The primary outcome measure was the incidence of clinically relevant ADRs and MEs. Events were assessed regarding causality (WHO), severity (WHO and additionally Dean & Barber for MEs) and preventability (Shumock).3Results338 patients with medication were included in the paper-based prescribing cohort (phase I) and 320 patients with medication in the electronic prescribing cohort (phase II). Median age was 7 (IQR 2 - 14) and 6 (IQR 1 - 13), respectively. In each cohort patients received a median number of 4 different drugs.Potentially harmful MEs were less often observed in the cohort with electronic prescribing (n=231 vs. n=549). The mean number per patient significantly decreased from 1.62 to 0.72 (p< 0.05).During the hospitalisation 2.1% (n=7) patients in phase I and 2.8% (n=9) in phase II experienced clinically relevant ADRs whereof two (0.6%) in each cohort originated from MEs.ConclusionThe implementation of a CPOE system significantly reduces medication errors, particularly those potentially harming patients but has less impact on ADRs.ReferencesFortescue EB, Kaushal R, Landrigan CP, McKenna KJ, Clapp MD, Federico F, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;111(4Pt 1):722–9.Maaskant JM, Vermeulen H, Apampa B, Fernando B, Ghaleb MA, Neubert A, et al. Interventions for reducing medication errors in children in hospital. The Cochrane database of systematic reviews. 2015;3:Cd006208.Dean BS and Barber ND. A validated, reliable method of scoring the severity of medication errors. Am J Health Syst Pharm 1999;56(1):57–62.Disclosure(s)Nothing to disclose

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Scoping Review of Computerized Physician Order Entry Systems in Reducing Medical Errors

Evidence Based Health Policy Management and Economics ◽

10.18502/jebhpme.v5i2.6559 ◽

2021 ◽

Author(s):

Gisoo Alizadeh ◽

Adineh Jafarzadeh ◽

Mohammad Farough Khosravi

Keyword(s):

Medication Errors ◽

Medical Errors ◽

Scoping Review ◽

Positive Impact ◽

Research Question ◽

Economic Consequences ◽

Order Entry ◽

Positive Effects ◽

Physician Order Entry ◽

The Impact

Background: Medical errors have dramatic clinical and economic consequences. Using various information technology can reduce medical errors and improve services’ quality via preventing medical errors. In this study, the role of a computerized medical order entry system was investigated in reducing medical errors. Methods: This study was conducted as a scoping review. The research question was formulated; then, the inclusion and exclusion criteria, keywords (such as medical errors, adverse event, physician order entry system and control) and search strategy were determined. International databases(Scopus, ProQuest, and PubMed) and manual searches were used. The studies that had the inclusion criteria were entered into the study and were evaluated qualitatively, then information of studies was extracted and summarized. Results: In total, 16 studies were included. Most studies were about medication errors and adverse medication events. So, it is possible to claim more confidently about reducing medication errors to adverse medication events, since in studies, the impact of this system on medication errors had been further discussed. Some studies have pointed to an increase in error reports due to better checking and error entry with this system, and in general, the positive impact of this action has been mentioned in minimizing errors, especially medication errors and adverse medication events. Positive and significant effects have also been reported on prescribing errors, especially medication prescriptions. Conclusion: Computerization of medical orders through its positive effects, can be considered a useful and appropriate intervention in increasing patient safety if implemented completely and correctly.

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Computer Physician Order Entry (CPOE)

Healthcare Administration ◽

10.4018/978-1-4666-6339-8.ch036 ◽

2015 ◽

pp. 726-742

Author(s):

Alberto Coustasse ◽

Joseph Shaffer ◽

David Conley ◽

Julia Coliflower ◽

Stacie Deslich ◽

...

Keyword(s):

Medication Errors ◽

Financial Incentives ◽

English Language ◽

Adverse Drug Events ◽

Improve Patient Safety ◽

Healthcare Providers ◽

The United States ◽

Order Entry ◽

Clerical Workers ◽

Physician Order Entry

In an effort to reduce Adverse Drug Events (ADEs) and to improve patient safety, funding has been earmarked to improve the rate of adoption of Computerized Physician Order Entry (CPOE) among healthcare providers. It has been shown that the ordering stage of medications is where most medication errors and preventable ADEs occur. The purpose of this study was to examine the implementation CPOE systems in hospitals to determine benefits and concerns of this technology in the United States healthcare system. A review of the literature published in the last 13 years (since 2000) in the English language was performed to complete this investigation. CPOE has emerged as a valuable tool to improve medical efficiency and to decrease medication errors and ADEs. Efficiencies were found to reduce the overall workload of nurses, clerical workers and pharmacists. CPOE has proven to be a secure way of transferring physician orders electronically thus helping hospitals and physicians practice a more effective and better quality of care with less medical errors which has led to decreased operating expenses. While barriers such as lack of professional buy in, and cost of implementation have hindered the widespread use and growth of CPOE systems, these barriers are being overcome with the financial incentives from the HITECH Act, and with the increased savings of CPOE implementation, which may motivate more healthcare systems to adopt CPOE.

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Utilization of an Integrated Electronic Health Record in the Emergency Department to Increase Prospective Medication Order Review by Pharmacists

Journal of Pharmacy Practice ◽

10.1177/0897190017735390 ◽

2017 ◽

Vol 31 (6) ◽

pp. 636-641 ◽

Cited By ~ 1

Author(s):

Megan E. Barra ◽

Sarah E. Culbreth ◽

Katelyn W. Sylvester ◽

Megan A. Rocchio

Keyword(s):

Emergency Department ◽

Phase I ◽

Median Time ◽

Phase Ii ◽

Medication Administration ◽

Medication Order ◽

Order Entry ◽

Record System ◽

Versus Phase ◽

The Impact

Purpose: The objective of this study is to evaluate the impact of an integrated medical record system on prospective medication order verification by pharmacists in the emergency department (ED) of a level I trauma center. Methods: This was a single-center retrospective analysis comparing medication orders verified by a pharmacist during a 7-day period in 2013 (phase I) versus 2015 (phase II). Outcome measures include the percentage of medication orders reviewed by a pharmacist prior to administration and time from order entry to each of the following: pharmacist review, medication procurement from an automated dispensing cabinet (ADC), and medication administration. Results: In total, 5450 medication orders were included in the study. The percentage of medication orders reviewed by a pharmacist prior to administration increased from 51.8% to 94% in phase I versus phase II, respectively ( P < .001). Median time from order entry to pharmacist verification decreased from 13 to 4 minutes in phase I versus phase II, respectively ( P < .001). Time from order entry to ADC dispense increased from a median of 9 minutes in phase I to 15 minutes in phase II ( P < .001). Time from order entry to nursing administration increased from a median time of 15 minutes in phase I to 23 minutes in phase II ( P < .001). Conclusion: Implementation of prospective pharmacist order verification in the ED increased the percentage of medications reviewed by a pharmacist prior to administration and improved pharmacist efficiency in the medication verification process. This increase in pharmacist review was associated with a marginal increase in time to medication procurement and administration.

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