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The Effect of Computerized Physician Order Entry and Decision Support System on Medication Errors in the Neonatal Ward: Experiences from an Iranian Teaching Hospital

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Abstract

Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P < 0.001). Dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians’ compliance with the system’s recommendations.

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Acknowledgements

The authors appreciate the tremendous executive and scientific support from the head of the neonatal ward of the Besat hospital, Dr. Fatemeh Eghbalian; and the chairman of the Paediatrics Department of Hamadan University of Medical Sciences (HUMS), Dr. Nasrollah Pezeshki. We are grateful for the excellent advice on the GFR calculator and renal adjustment for neonates given by Dr. Emad Momtaz, a faculty member of the Paediatrics Department of HUMS. We also thank Dr. Mesfin Tessma and Mrs Elisabeth Berg at the Karolinska Institute for their valuable statistical consultancies.

This study was supported by grants from the World Bank; the National Public Health Management Centre (NPMC), Tabriz, Iran; and the Hamadan University of Medical Sciences and Health Services, Hamadan, Iran. The sponsors had no involvement in the design, data collection, analysis, interpretation of data, writing of the manuscript, or the decision to submit the manuscript for publication.

Conflict of interest

None of the authors has any financial relationship with the local company who developed the system. The authors do not see any conflicts of interests in this study.

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Authors and Affiliations

  1. Department of Learning, Informatics, Management and Ethics (LIME), Berzelius väg 3, Karolinska Institutet, 171 77, Stockholm, Sweden

    Alireza Kazemi, Johan Ellenius, Faramarz Pourasghar & Uno GH Fors

  2. Management Information Systems Centre, Hamadan University of Medical Sciences, Hamadan, Iran

    Alireza Kazemi

  3. National Public Health Management Centre (NPMC), Tabriz, Iran

    Alireza Kazemi

  4. School of Health Services Management and Informatics, Iran University of Medical Sciences, Tehran, Iran

    Shahram Tofighi

  5. Department of Cardiology, Gorgan University of Medical Sciences, Gorgan, Iran

    Aref Salehi

  6. Department of Paediatrics, Hamadan University of Medical Sciences, Hamadan, Iran

    Ali Amanati

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  1. Alireza Kazemi
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Correspondence to Alireza Kazemi.

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Authors’ contribution

All authors contributed to the final approval of the submitted manuscript.

Alireza Kazemi contributed to conception and design of the study, performed observations, conducted the analysis with co-authors, and drafted the manuscript.

Johan Ellenius was involved in conception of the study, analysis, and revising the manuscript.

Faramarz Pourasghar was involved in data collection and revising the manuscript.

Shahram Tofighi was involved in conception of the study, and revising the manuscript.

Aref Salehi was involved in design of the study and revising the manuscript.

Ali Amanati was involved in data collection and revising the manuscript.

Uno Fors contributed to development of the study, analysis, and revising the manuscript.

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Kazemi, A., Ellenius, J., Pourasghar, F. et al. The Effect of Computerized Physician Order Entry and Decision Support System on Medication Errors in the Neonatal Ward: Experiences from an Iranian Teaching Hospital. J Med Syst 35, 25–37 (2011). https://doi.org/10.1007/s10916-009-9338-x

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  • DOI: https://doi.org/10.1007/s10916-009-9338-x

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