CPOE and Prescribing Errors Daniel Ceppos University of Maryland School of Nursing Purpose The purpose of this review is to evaluate the evidence for effectiveness of CPOE systems in reducing prescribing errors in both inpatient and outpatient settings. <ul><li>Conclusions </li></ul><ul><li>It is unclear whether CPOE reduces prescribing errors. </li></ul><ul><li>Further research is necessary. </li></ul><ul><li>Nursing students should continue to learn about the dangers of prescribing errors. </li></ul><ul><li>Nurses working with CPOE should remain vigilant for prescribing errors. </li></ul>Background CPOE systems allow electronic order entry for medications, labs, imaging, referrals, and procedures (Devine et al., 2010). CDS systems are sometimes used with CPOE to check medication orders for errors (Kadmon et al., 2009). While several healthcare associations have endorsed CPOE, the role of CPOE in reducing prescribing orders remains unclear (Kadmon et al., 2009). Methods Databases searched : Ovid Medline and CINAHL Key words : “CPOE,” “medication” and “error” Inclusion criteria : Peer-reviewed articles, English language, published 2001–2011. Exclusion criteria : Systematic reviews, integrated reviews, meta-analyses, studies on transcription errors or prescribing error epidemiology, and laboratory and simulation studies. <ul><li>Findings </li></ul><ul><li>Quality of evidence was moderate to poor. </li></ul><ul><li>Large variability in interventions makes it difficult to draw conclusions from the findings. </li></ul><ul><li>Most studies found CPOE reduced prescribing error rate. </li></ul><ul><li>It is unclear which errors were reduced and how much CPOE reduced potential patient harm. </li></ul><ul><li>It is unclear whether the reductions in prescribing error were due to CPOE or CDS. </li></ul>Key Terms CDS : clinical decision support CPOE : computerized provider order entry Medication error : an error at any step in the medication process (Krahenbuhl-Melcher et al., 2007). Prescribing error : an error in prescribing decision or prescription writing (Dean et al., 2000). Transcription error : An error in prescription transcription or misinterpretation of prescriptions (Krahenbuhl-Melcher et al., 2007). Literature Profile The author reviewed the abstracts of all 71 hits. Nine studies ultimately met inclusion criteria. Seven of these were available and were reviewed. Of these seven, three were evidence level IIB, one was IIC, two were IIIB, and onc was IIIC. References Dean, B., Barber, N., & Schachter, M. (2000). What is a prescribing error? Quality in Health Care, 9 (4), 232-237. Devine, E. B., Hansen, R. N., Wilson-Norton, J. L., Lawless, N., Fisk, A. W., Blough, D. K.,... Sullivan, S. D. (2010). The impact of computerized provider order entry on medication errors in a multispecialty group practice. Journal of the American Medical Informatics Association, 17 (1), 78-84. Kadmon, G., Bron-Harlev, E., Nahum, E., Schiller, O., Haski, G., & Shonfeld, T. (2009). Computerized order entry with limited decision support to prevent prescription errors in a PICU. Pediatrics, 124 (3), 935-940. Krahenbuhl-Melcher, A., Schlienger, R., Lampert, M., Haschke, M., Drewe, J., & Krahenbuhl, S. (2007). Drug-related problems in hospitals: A review of the recent literature. Drug Safety, 30 (5), 379-407. Abstract While several health-care associations have endorsed computerized provider order entry (CPOE) as a tool in reducing medication errors, the role of CPOE in reducing prescribing orders remains unclear. The purpose of this review is to evaluate the evidence for CPOE's role in reducing prescribing errors in inpatient and outpatient settings. The author conducted a search of Ovid Medline and CINAHL databases and ultimately reviewed seven articles that met inclusion criteria. Given the current evidence, it is unclear how much CPOE reduce potential patient harm. Further research is needed to determine the efficacy of CPOE in reducing prescribing errors.
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