Фармацевтика Аналитика Акта

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Impact of Computerized Physician Order Entry on Medication Prescription Errors in Patients Hospitalized in a Chest Diseases Ward

Elena Villamanan, Eduardo Armada, Yolanda Larrubia, Margarita Ruano, Marta Moro, Alicia Herrero and Rodolfo Alvarez-Sala

Background: Many adverse drug events are related to medication errors during the ordering process and may be preventable. Computerized physician order entry (CPOE) appears as an effective tool in reducing them.
Methods: We conducted a before-after prospective study in a chest diseases ward of an academic medical center. We compared rates of medication errors in medical orders during three phases: one before (manual prescription) and two after implementation of CPOE, at one and two months after. Secondarily we assessed error characteristics, process of medication use management and economic impact.
Results: We detected 422 medication errors in 3257 medications prescribed: 352 in manual prescription phase (34.9% error rate) versus 45 one month after CPOE implementation (4.1% error rate)-88.2% relative risk reduction (p<0.001) and 25 after two months (2.2% error rate)-93.7% relative risk reduction (p<0.001). Main causes of error using manual prescription were lapsus in the ordering stage (68%) while using CPOE were lack of technology management (66.7% after one month and 68% after two months). Errors fell significantly for all drug types when comparing electronic versus manual prescription. We also found a significant reduction of non-drug-related errors, from 14.2% without the use of CPOE to 0.8% with its use (p<0.001) and in the amount of time spent preparing medication in pharmacy department. On average monthly drug costs fell 30%.
Conclusions: CPOE substantially reduces medication errors and non-drug-related errors as well as improves the process of medication use management and appears to have a positive economic impact