Health Information Technology

Computerized provider order entry significantly reduces medication errors in an ambulatory setting

Computerized provider order entry (CPOE) has been shown to improve patient safety by reducing medication errors and subsequent adverse drug events in inpatient settings. It can also achieve this in ambulatory settings, according to a new study. Investigators found that use of a CPOE system in a multispecialty group practice reduced the medication errors from 18.2 percent to 8.2 percent—a reduction of 70 percent.

The greatest reductions in the odds of medication error were due to fewer errors of illegibility (97 percent), followed by inappropriate abbreviations (94 percent), and missing information (85 percent). Despite the CPOE system's lack of clinical decision support (CDS) alerts, reductions in the odds of drug-disease interaction (79 percent) and drug-drug interaction (76 percent) errors were significant. Also significant was a reduction in the odds of wrong medication strength (81 percent).

CPOE was associated with a significant 57 percent reduction in the odds of an error occurring that did not cause harm to the patient. The reduction in the odds of an error occurring that did cause harm was not significant, probably due to the small number of errors in this category, note Emily Beth Devine, Ph.D., of the University of Washington, and coinvestigators. Their study was conducted in a setting of 400 providers caring for 250,000 patients in 14 locations and 60 clinics. The providers, evenly distributed between primary care and specialty providers, together wrote over 2.7 million prescriptions during 2008. The homegrown, basic CPOE system used in the study is Web-based, uses point-and-click functionality, and integrates e-prescribing into an existing electronic health record. For the study, 10,169 prescriptions were evaluated.

The researchers concluded that even a basic CPOE system, without CDS alerts, can have a favorable impact on medication safety. Their study was supported by the Agency for Healthcare Research and Quality (HS15319 and HS14739).

See "The impact of computerized provider order entry on medication errors in a multispecialty group practice," by Dr. Devine, Ryan N. Hansen, Pharm.D., Jennifer L. Wilson-Norton, M.B.A., and others in the January 2010 Journal of the American Medical Informatics Association 17, pp. 78-84.

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