Research Article

International Journal of Clinical Pharmacy

, Volume 35, Issue 4, pp 577-583

Potential medication errors associated with computer prescriber order entry

  • Elena VillamañánAffiliated withClinical Pharmacy Consultant, Pharmacy Department, La Paz University Hospital Email author 
  • , Yolanda LarrubiaAffiliated withClinical Pharmacy Consultant, Pharmacy Department, La Paz University Hospital
  • , Margarita RuanoAffiliated withClinical Pharmacy Consultant, Pharmacy Department, La Paz University Hospital
  • , Manuel VélezAffiliated withClinical Pharmacy Consultant, Pharmacy Department, La Paz University Hospital
  • , Eduardo ArmadaAffiliated withCardiology Consultant, Cardiology Department, La Paz University Hospital
  • , Alicia HerreroAffiliated withHead of Pharmacy Department, La Paz University Hospital
  • , Rodolfo Álvarez-SalaAffiliated withHead of Pneumology Department, La Paz University Hospital

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Abstract

Introduction To assess the frequency of medication errors (ME) induced or enhanced by computerized physician order entry (CPOE). Error type, drug classes involved, specialty, patient outcome and system failures were also evaluated. Methods Observational quantitative study in a large tertiary care medical center over March 2012 3 years after CPOE implementation. Pharmacists detected ME associated with CPOE (those that wouldn’t have occurred if the clinician had prescribed manually) and unassociated in pharmacological treatments in inpatients of 13 specialties (421 beds). Main outcome measured were ME associated and unassociated with CPOE. Results We found 714 ME with 85.857 drug prescriptions (a 0.8 % error rate, 95 % CI 0.6–0.7). Percentage of error associated with CPOE was 77.7 %. The main types of error related to CPOE were wrong medication selection (20.9 %) and improper data placement (20.3 %). Failures with medications prescribed in primary care, unavailable in the hospital pharmacy, were involved in 21.6 % of all ME. Errors involving surgical specialties were double those involving medical specialties (1.2 vs. 0.6 %). Most ME associated with CPOE were potential errors (90 %). During the study system failures occurred four times. Conclusions The use of CPOE minimises the occurrence of medication errors, however, they still occur. Most errors are associated with the CPOE technology. We therefore face a new challenge in the prevention of ME that require a change in strategy for patient safety. Continued training of prescribers, standardization of the electronic prescription programs and integration between computer applications in hospitals and with primary care should be a priority.

Keywords

Computerized physician order entry system COPE Hospital pharmacy Medication errors Prescribing Spain