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The Potential Impact of Computerized Prescriber Order Entry

Anne Bobb, RPh; Kristine Gleason, RPh; Marla Husch, RPh; Joe Feinglass, PhD; Paul R. Yarnold, PhD; Gary A. Noskin, MD

Arch Intern Med. 2004;164:785-792.

Background  Adverse drug events (ADEs) are the most common cause of injury to hospitalized patients and are often preventable. Medication errors resulting in preventable ADEs most commonly occur at the prescribing stage.

Objectives  To describe the epidemiology of medication prescribing errors averted by pharmacists and to assess the likelihood that these errors would be prevented by implementing computerized prescriber order entry (CPOE).

Methods  At a 700-bed academic medical center in Chicago, Ill, clinical staff pharmacists saved all orders that contained a prescribing error for a week in early 2002. Pharmacist investigators subsequently classified drug class, error type, proximal cause, phase of hospitalization, and potential for patient harm and rated the likelihood that CPOE would have prevented the prescribing error.

Results  A total of 1111 prescribing errors were identified (62.4 errors per 1000 medication orders), most occurring on admission (64%). Of these, 30.8% were rated clinically significant and were most frequently related to anti-infective medication orders, incorrect dose, and medication knowledge deficiency. Of all verified prescribing errors, 64.4% were rated as likely to be prevented with CPOE (including 43% of the potentially harmful errors), 13.2% unlikely to be prevented with CPOE, and 22.4% possibly prevented with CPOE depending on specific CPOE system characteristics.

Conclusions  Prescribing errors are common in the hospital setting. While CPOE systems could improve practitioner prescribing, design and implementation of a CPOE system should focus on errors with the greatest potential for patient harm. Pharmacist involvement, in addition to a CPOE system with advanced clinical decision support, is vital for achieving maximum medication safety.

From the Division of Operations and Quality, Patient Safety, Northwestern Memorial Hospital (Mss Bobb, Gleason, and Husch and Dr Noskin), and the Department of Medicine, Divisions of General Internal Medicine (Dr Feinglass), Emergency Medicine (Dr Yarnold), and Infectious Diseases (Dr Noskin), Feinberg School of Medicine Northwestern University, Chicago, Ill. The authors have no relevant financial interest in this article.

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