Advertisement

International Journal of Clinical Pharmacy

, Volume 41, Issue 1, pp 228–236 | Cite as

Medication prescribing errors: a pre- and post-computerized physician order entry retrospective study

  • Naïs RouayrouxEmail author
  • Violaine Calmels
  • Bérengére Bachelet
  • Brigitte Sallerin
  • Elodie Divol
Research Article
  • 105 Downloads

Abstract

Background The computerization of prescriptions with a computerized physician order entry contributes to securing the error-free drug supply, but is not risk-free. Objective: To determine the impact of a computerized physician order entry system on prescribing errors immediately after its implementation and 1 year later. Setting The Cardiology and Diabetology Departments at Toulouse University Hospital, France. Method The prescriptions were analysed by pharmacists over three 30-day periods for 3 consecutive years (N: computerization period, N − 1, N + 1). For each identified error, the prescriber was informed by a pharmaceutical intervention. The pharmaceutical interventions were counted and arranged according to the classification by the French Society of Clinical Pharmacy. Their average numbers and clinical impacts were compared for each period using t-tests and Kruskal–Wallis tests. Main outcome measure The average numbers of pharmaceutical interventions. Results In total, 12.1 pharmaceutical interventions per 100 patient days were done during the N − 1 period, 14.1 during N and 9.6 during N + 1. Among those, 3.6 (N) and 2.1 (N + 1) were related to the computerization itself, and 10.5 (N) and 7.5 (N + 1) were not. The average number of computerization-related pharmaceutical interventions significantly decreased from N to N + 1 (p = 0.04). The average number of classic interventions decreased from N − 1 to N + 1 (p = 0.02). The clinical impacts of the computerization related errors were similar to those of other errors. Conclusion The implementation of the computerized physician order entry induced the appearance of specific computerized-related errors, but the number of classic errors decreased. The entry-system related errors were not more severe than other errors, and the number decreased after 1 year.

Keywords

Computerized physician order entry Clinical pharmacy CPOE France Pharmaceutical interventions Prescribing errors 

Notes

Acknowledgements

We would like to thank the teams from the Cardiology and Diabetology Departments at the University Hospital Centre in Toulouse, France.

Funding

None.

Conflicts of interest

None.

References

  1. 1.
    Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma’Luf N, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6:313–21.CrossRefGoogle Scholar
  2. 2.
    Reckmann MH, Westbrook JI, Koh Y, Lo C, Day RO. Does computerized provider order entry reduce prescribing errors for hospital inpatients? a systematic review. J Am Med Inform Assoc. 2009;16:613–23.CrossRefGoogle Scholar
  3. 3.
    Charpiat B, Bedouch P, Conort O, Rose FX, Juste M, Roubille R, et al. Opportunities for medication errors and pharmacist’s interventions in the context of computerized prescription order entry: a review of data published by French hospital pharmacists. Ann Pharm Fr. 2012;70:62–74.CrossRefGoogle Scholar
  4. 4.
    Charles K, Cannon M, Hall R, Coustasse A. Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events? Perspect Health Inf Manag. 2014;11:1b.Google Scholar
  5. 5.
    Nuckols TK, Smith-Spangler C, Morton SC, Asch SM, Patel VM, Anderson LJ, et al. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Syst Rev. 2014;3:56.CrossRefGoogle Scholar
  6. 6.
    Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. J Am Med Assoc. 2005;293:1197–203.CrossRefGoogle Scholar
  7. 7.
    Ash JS, Sittig DF, Dykstra RH, Guappone K, Carpenter JD, Seshadri V. Categorizing the unintended sociotechnical consequences of computerized provider order entry. Int J Med Inf. 2007;76:S21–7.CrossRefGoogle Scholar
  8. 8.
    Bouchand F, Thomas A, Zerhouni L, Dauphin A, Conort O. Pharmacists’ interventions before and after prescription computerization in an internal medicine department. Presse Médicale. 2007;36:410–8.CrossRefGoogle Scholar
  9. 9.
    Légifrance. Article L1121-1. Code de la Santé Publique.Google Scholar
  10. 10.
    Légifrance. Article L1121-2. Code de la Santé Publique.Google Scholar
  11. 11.
    Bright JM, Tenni PC. The clinical services documentation (CSD) system for documenting clinical pharmacists’ services. Aust J Hosp Pharm. 2000;30:10–5.CrossRefGoogle Scholar
  12. 12.
    Allenet B, Bedouch P, Rose F-X, Escofier L, Roubille R, Charpiat B, et al. Validation of an instrument for the documentation of clinical pharmacists’ interventions. Pharm World Sci. 2006;28:181–8.CrossRefGoogle Scholar
  13. 13.
    Juste M. Recommendation of good practice in clinical pharmacy. Analysis of prescription and levels of pharmaceutical analysis. Le Pharm Hosp Clin. 2012;47:293–5.CrossRefGoogle Scholar
  14. 14.
    Chedru V, Juste M. Medical assessment of the pharmaceutical intervention clinical impact. Je Pharm Clin. 1997;16:254–8.Google Scholar
  15. 15.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:165.Google Scholar
  16. 16.
    Korb-Savoldelli V, Boussadi A, Durieux P, Sabatier B. Prevalence of computerized physician order entry systems-related medication prescription errors: a systematic review. Int J Med Inf. 2018;111:112–22.CrossRefGoogle Scholar
  17. 17.
    Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005;9:R516–21.CrossRefGoogle Scholar
  18. 18.
    Lecointre R, Dakessian MP, Mezzour A. Retrospective study of computerized medication errors in a surgical clinic. Le Pharmacien hospitalier et clinicien. Paris: Elsevier Masson SAS; 2014. p. 1–12.Google Scholar
  19. 19.
    Vialle V, Tiphaine T, Poirier Y, Raingeard E, Feldman D, Freville JC. To know, understand and combat medication errors related to computerized physician order entry. Ann Pharm Fr. 2011;69:165–76.CrossRefGoogle Scholar
  20. 20.
    Estellat C, Clombet I, Vautier S, Huault-Quentel J, Durieux P, Sabatier B. Impact of pharmacy validation in a computerized physician order entry context. Int J Qual Health Care. 2007;19:317–25.CrossRefGoogle Scholar
  21. 21.
    Leape LL, Cullen DJ, Dempsey Clapp M, Burdick E, Demonaco H, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;281:267–70.CrossRefGoogle Scholar
  22. 22.
    Khanna R, Yen T. Computerized physician order entry: promise, perils, and experience. Neurohospitalist. 2014;4:26–33.CrossRefGoogle Scholar
  23. 23.
    Gellert GA, Ramirez R, Webster SL. Toward the elimination of paper orders. Appl Clin Inform. 2016;7:33–42.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Clinical Pharmacy DepartmentToulouse University Hospital CentreToulouseFrance

Personalised recommendations