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The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation
Author(s) -
Sanchez Cuervo M.,
Rojo Sanchis A.,
Pueyo Lopez C.,
Gomez de Salazar Lopez de Silanes E.,
Gramage Caro T.,
Bermejo Vicedo T.
Publication year - 2015
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12305
Subject(s) - order entry , medicine , medical prescription , computerized physician order entry , pharmacy , electronic prescribing , emergency medicine , pediatrics , medical emergency , family medicine , health care , nursing , economics , economic growth
Summary What is known and objective Computerized physician order entry ( CPOE ) systems reduce medical errors ( ME s). Nevertheless, a CPOE system may also lead to new types of errors, especially when it is first implemented. The objectives of this study were to determine the impact of a CPOE on the number of ME s and to identify the types of ME s in prescriptions issued by the Haematology Department 5 years after the implementation of the CPOE system. Methods We conducted a prospective analytical study on the implementation of a CPOE system at the Pharmacy Department of the Hospital Ramon y Cajal (Madrid, Spain). The study comprised three phases: a pre‐implementation phase, an implementation phase conducted in the Haematology Department and a post‐implementation phase, which was conducted 5 years after the implementation of the CPOE system. One hundred and fifty prescriptions per pre‐ and post‐implementation phase were consecutively included in the study. A previously described classification scheme was used to detect and classify ME s. Results and discussion The implementation of a CPOE system was associated with a large reduction in ME s. One hundred and fourteen patients (pre‐implementation phase) were compared to 82 patients (post‐implementation phase). The total number of ME s per 100 patients decreased from 236·8 (95% CI : 212·1–261·3) to 10·9 (95% CI : 5·8–19·6), with an absolute risk reduction of 36·2 (95% CI : 32·6–39·9). The percentage of prescriptions with an ME decreased from 37·5% to 1·2% ( P < 0.001). In the pre‐implementation phase, the drugs most frequently associated with ME s were rituximab (35·9%), cyclophosphamide (13%) and methotrexate (7%). In the post‐implementation phase, 44·4% of prescription errors involved methotrexate. Five years after the implementation of the CPOE system, the majority of ME s were eliminated, the number of remaining errors (quantity, concentration and ambiguous prescription errors) decreased, and no new types of ME were detected. What is new and conclusion The CPOE system almost completely eliminated ME s with antineoplastic drugs in the Haematology Department. No new types of ME s were observed once physicians had become accustomed to using the system. However, some ME s were not eliminated. Constant diligence is needed to analyse and evaluate ME s associated with the CPOE system and their causes, such that the limitations of CPOE can be identified and overcome and the medication‐use process associated with antineoplastic agents improved.