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Prescription errors in geriatric patients can be avoided by means of a computerized physician order entry (CPOE)

Verschreibungsfehler bei geriatrischen Patienten lassen sich mit einem elektronischen Verordnungssystem vermeiden

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Abstract

Background

The implementation of a computerized physician order entry (CPOE) can help reduce prescription errors in clinical practice.

Objective

The aim of this study was to evaluate the effects of a CPOE for geriatric patients with the two most common conditions for drug-induced iatrogenic diseases, dysphagia and renal failure.

Subjects and methods

A retrospective analysis of actual drug prescriptions versus CPOE recommendations in the geriatric department of the St. Marien Hospital in Cologne, Germany was carried out. Actual drug prescriptions were collected for 26 patients with dysphagia (15 female, 11 male, average age 82.3 ± 8.0 years) and 35 patients with renal failure (23 female, 12 male, average age 80.5 ± 6.7 years) which were compared with recommended prescriptions by means of a CPOE and discrepancies were statistically analyzed.

Results

Prescription errors for at least 1 drug were detected in 46 % of patients with renal failure and the administration of at least 1 drug with inadequate crushing was observed in 77 % of dysphagia patients.

Conclusion

Prescription errors appear to be frequent to highly frequent in the medical routine even in a highly specialized geriatric setting. Inaccuracies might be reduced by the implementation of a CPOE and even more if coupled to a decision support system. Drug-drug or drug-disease interactions, which are particularly high risks in patients with multimorbidities, multidrug therapy, renal failure or malnutrition, might be kept under control through careful verification of medication indications, organ function status as well as drug administration and preparation in cases of tube feeding.

Zusammenfassung

Hintergrund

Die Implementierung eines elektronischen Verordnungssystems („computerized physician order entry, CPOE“) kann Ärzte dabei unterstützen Verschreibungsfehler in der klinischen Praxis zu vermeiden.

Ziel

Ziel der Studie war die Evaluation der Effekte eines CPOE für geriatrische Patienten mit den 2 häufigsten Störungen, bei denen es zu medikamentös induzierten iatrogenen Erkrankungen kommen kann: Dysphagie und Niereninsuffizienz.

Material und Methoden

Die Studie fand auf einer akutgeriatrischen Station des St. Marien-Hospitals in Köln statt. Um die Fehlerhäufigkeit beim Verordnen von Arzneistoffen, deren Dosierung bei Niereninsuffizienz anzupassen ist, und bei hinsichtlich der Gabe bei Dysphagiepatienten problematischen Medikamenten zu ermitteln, wurden Verschreibungen retrospektiv mit einem CPOE überprüft. Dafür wurden die erfolgten Verordnungen für 26 Patienten mit Dysphagie (15 w, 11 m, 82,3 ± 8,0 Jahre) und 35 Patienten mit Niereninsuffizienz (23 w, 12 m, 80,5 ± 6,7 Jahre) verglichen mit den Empfehlungen des Programms, die Diskrepanzen wurden statistisch analysiert.

Ergebnisse

Mindestens einen Verordnungsfehler gab es bei 46 % der Niereninsuffizienzpatienten. Die Gabe mindestens eines Medikamentes, das unzureichend zerkleinert worden war, wurde bei 77 % der Dysphagiepatienten beobachtet.

Schlussfolgerung

Die Rate an Verordnungsfehlern scheint bei den untersuchten Patientenpopulationen recht hoch zu sein, obwohl die Analyse in einer auf Geriatrie spezialisierten Fachklinik stattfand. Die Implementierung eines CPOE, vor allem in Kombination mit einem Entscheidungsunterstützungssystem, könnte den Prozess der Verschreibung robuster gegenüber Fehlern machen. Pharmakologische Interaktionen und Kontraindikationen, für die bei geriatrischen Patienten aufgrund Multimorbidität bzw. Multimedikation und bei Patienten mit Niereninsuffizienz oder Mangelernährung ein besonders hohes Risiko besteht, können kontrolliert werden durch sorgfältige Verifizierung der Indikation, des funktionellen Organstatus sowie der Anwendung und der Vorbereitung des Medikaments für per Sonde ernährte Patienten.

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Authors and Affiliations

  1. Department of Geriatrics, St. Marien Hospital, Cologne, Germany

    S. Frisse, G. Röhrig MD, MPH, M.C. Polidori & R.-J. Schulz

  2. Ageing Clinical Research Department II of Internal Medicine, University Hospital Cologne, Herderstrasse 52, 4th floor, 50937, Cologne, Germany

    G. Röhrig MD, MPH & M.C. Polidori

  3. Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany

    J. Franklin

Authors
  1. S. Frisse
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  2. G. Röhrig MD, MPH
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  3. J. Franklin
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  4. M.C. Polidori
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  5. R.-J. Schulz
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Corresponding author

Correspondence to G. Röhrig MD, MPH.

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Conflict of interest

S. Frisse, G. Röhrig, J. Franklin, M.C. Polidori and R-J. Schulz declare that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the ethics committee of the University of Cologne and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form).

Additional information

M.C. Polidori und R-J. Schulz were equal supervisors.

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Frisse, S., Röhrig, G., Franklin, J. et al. Prescription errors in geriatric patients can be avoided by means of a computerized physician order entry (CPOE). Z Gerontol Geriat 49, 227–231 (2016). https://doi.org/10.1007/s00391-015-0911-2

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  • DOI: https://doi.org/10.1007/s00391-015-0911-2

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