Medication errors in patients with severe chronic kidney disease and acute coronary syndrome: the impact of computer-assisted decision support

Abstract

Objective: To evaluate the impact of computerized physician order entry (CPOE) with decision support on the frequency of antithrombotic medication errors in patients with chronic kidney disease (CKD) admitted with acute coronary syndrome (ACS) and to measure what effect it would have on in-hospital bleeding.

Patients and methods: We evaluated 80 patients with CKD who were admitted with ACS between January 1, 2009, and December 31, 2010, using either a standardized order set or CPOE with decision support to assess the frequency of medication errors and in-hospital bleeding.

Results: Of the 80 patients, 47 were admitted with standard orders vs 33 with CPOE. In-hospital bleeding occurred in 13 patients: 10 in the standard orders group vs 3 in the CPOE group (P=.12). In-hospital bleeding occurred in 5 (63%) of 8 patients receiving a contraindicated antithrombotic medication compared with 8 (11%) of 72 patients receiving appropriate medications (P=.002); the corresponding length of stay was 12.0 days compared with 6.8 days (P=.10). Contraindicated medications were given to no patients in the CPOE group vs 8 patients (17%) in the standard orders group (P=.01).

Conclusion: Medication errors occur frequently in patients with CKD admitted with ACS and result in a high risk of in-hospital bleeding. Use of CPOE with decision support is feasible in the ACS setting and may lead to improved patient safety.