CPOE cuts medication errors, study shows
A new report, supported by the Agency for Healthcare Research and Quality, demonstrates that processing prescriptions through computerized provider order entry can cut drug errors in half, and could avoid more than 17 million adverse incidents annually.
The authors of the study, "Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems," published in the Journal of the American Medical Informatics Association, started by taking a close look at published evidence on the impact of CPOE on hospital drug errors.
The researchers then combined this information with data on CPOE adoption and the volume of annual medication orders. The results estimated the reduction in drug errors for one year – and found that more widespread use of computerized entry could have a big impact on drug errors.
According to the Institute of Medicine hospitalized patients are subject to at least one medication error per day, on average, the study notes. At least a quarter of medication-related injuries are preventable, however, and an electronic order entry system can help reduce errors from poor handwriting or incorrect transcription. CPOE functionalities such as dosage support, adverse interaction alerts and clinical decision support can also help reduce errors.
Still, the researchers, from Cambridge, Mass.-based Institute for Healthcare Improvement and Abt Associates, and from Johns Hopkins University, write: "There is also some evidence that CPOE may cause errors."
Variations in clinical settings, and differences between commercial CPOE systems and those developed in-house, mean the track record for the systems so far – even as the HITECH Act offers incentive payments to spur adoption of the technology – is unclear. Moreover, the "quality of existing studies" has also varied, the study points out.
"We conducted a systematic literature review and applied random-effects meta-analytic techniques to derive a summary estimate of the effect of CPOE on medication errors," researchers explain.
"This pooled estimate was combined with data from the 2006 American Society of Health-System Pharmacists Annual Survey, the 2007 American Hospital Association Annual Survey, and the latter's 2008 Electronic Health Record Adoption Database supplement to estimate the percentage and absolute reduction in medication errors attributable to CPOE.
Their findings show that processing drugs via CPOE decreases the likelihood of error drug order by 48 percent.
"Given this effect size, and the degree of CPOE adoption and use in hospitals in 2008, we estimate a 12.5 percent reduction in medication errors, or ∼17.4 million medication errors averted in the USA in one year," they write.
But while the upshot is that CPOE "can substantially reduce the frequency of medication errors in inpatient acute-care settings," it's still unclear "whether this translates into reduced harm for patients," the researchers write.
At any rate, they add, even as CPOE has shown to prevent wrong medications, "adoption and use in U.S. hospitals remain modest."
While "further research is needed to better characterize links to patient harm," the study notes, "current policies to increase CPOE adoption and use will likely prevent millions of additional medication errors each year."
The researchers also say their meta-analytic estimation approach "may be useful for estimating other health IT-related impacts on the healthcare system and patient outcomes."
Read the full report in the Journal of the American Medical Informatics Association.
[See also: CPOE debate continues to set researchers at odds]