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Title The Impact of Computerized Physician Order Entry on Medication Error Prevention
Author(s) Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, MaLuf N, Boyle D, Leape L
Source JAMIA, Vol. 6, No. 4, Pages 313-321
Publication Date July/August 1999
Abstract Background: Medication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events. Objective: To evaluate the impact of physician order entry (POE) with decision support in reducing the number of medication errors. Design: Prospective time series analysis, with four periods. Settting and participants: All patients admitted to three medical units were studied for seven to ten-week periods in four different years. The baseline period was before implementation of POE, and the remaining three were after. Sophistication of POE increased with each successive period. Intervention: Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings. Main outcome measure: Medicatoin errors, excluding missed-dose errors. Results: During the study, the non-missed-dose medication error rate fell 81 percent, from 142 per 1000 patient days in the baseline period to 26.6 per 1000 patient days in the final period (P less than 0.0001). Non-intercepted serious medication errors (those with the potential to cause injury) fell 86 percent from baseline to period 3, the final period (P = 0.0003). Large differences were seen for all types of medication errors: dose errors, frequency errors, route errors, substitution errors, and allergies. For example, in the baseline period there were ten allergy errors, but only two in the following three periods combined (P less than 0.0001). Conclusions: Computerized POE substantially decreased the rate of non-missed-dose medicatoin errors. A major reduction in errors was achieved with the initial version of the system, and further reductions were found with the addition of decision support features.


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