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Clinical Trial
. 2009 Nov-Dec;16(6):816-25.
doi: 10.1197/jamia.M3099. Epub 2009 Aug 28.

The influence that electronic prescribing has on medication errors and preventable adverse drug events: an interrupted time-series study

Jasperien E van Doormaal  1 , Patricia M L A van den Bemt, Rianne J Zaal, Antoine C G Egberts, Bertil W Lenderink, Jos G W Kosterink, Flora M Haaijer-Ruskamp, Peter G M Mol
Affiliations
Clinical Trial

The influence that electronic prescribing has on medication errors and preventable adverse drug events: an interrupted time-series study

Jasperien E van Doormaal et al. J Am Med Inform Assoc. 2009 Nov-Dec.

Abstract

Objective: This study evaluated the effect of a Computerized Physician Order Entry system with basic Clinical Decision Support (CPOE/CDSS) on the incidence of medication errors (MEs) and preventable adverse drug events (pADEs).

Design: Interrupted time-series design.

Measurements: The primary outcome measurements comprised the percentage of medication orders with one or more MEs and the percentage of patients with one or more pADEs.

Results: Pre-implementation, the mean percentage of medication orders containing at least one ME was 55%, whereas this became 17% post-implementation. The introduction of CPOE/CDSS has led to a significant immediate absolute reduction of 40.3% (95% CI: -45.13%; -35.48%) in medication orders with one or more errors. Pre-implementation, the mean percentage of admitted patients experiencing at least one pADE was 15.5%, as opposed to 7.3% post-implementation. However, this decrease could not be attributed to the introduction of CPOE/CDSS: taking into consideration the interrupted time-series design, the immediate change was not significant (-0.42%, 95% CI: -15.52%; 14.68%) because of the observed underlying negative trend during the pre-CPOE period of -4.04% [95% CI: -7.70%; -0.38%] per month.

Conclusions: This study has shown that CPOE/CDSS reduces the incidence of medication errors. However, a direct effect on actual patient harm (pADEs) was not demonstrated.

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Figures

Figure 1
Figure 1
Study planning.
Figure 2
Figure 2
Flow chart of study population, medication orders (MOs), medication errors (MEs) and preventable adverse drug events (pADEs).
Figure 3
Figure 3
Impact of CPOE/CDSS on percentage of medication orders with one or more medication errors (total study population).
Figure 4
Figure 4
Impact of CPOE/CDSS on percentage of medication orders with one or more subtypes of medication errors. Panels (from left to right): administrative errors, dosing errors, therapeutic errors, transcribing errors.
Figure 5
Figure 5
Impact of CPOE/CDSS on percentage of admitted patients with one or more preventable Adverse Drug Events (pADEs).
See this image and copyright information in PMC

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