Computerized entry systems may have limited impact on patient harm

Computerized prescriber order entry (CPOE) systems decrease medication error, but they may not decrease patient harm due to medication error, according to the results of a study conducted at Northwestern Memorial Hospital and published this week in Archives of Internal Medicine.

"Medication errors are the single most common serious adverse event that occurs in hospitalized patients," said Gary Noskin, M.D., medical director of patient safety at Northwestern Memorial Hospital. "The implementation of CPOE has the potential to prevent the majority of these errors from reaching the patient; however, they may not actually decrease patient harm due to medication error."

"Because current CPOE systems have limited artificial intelligence, the involvement of the physicians and pharmacists remains critical to the medication process," adds Anne Bobb, RPh, a patient safety research pharmacist at Northwestern Memorial Hospital. "Pharmacists understand the complexity of medications and realize how many prescriptions are changed or altered on a daily basis before they reach the patient."

This study shows that a combination of pharmacist involvement and a CPOE system with significant clinical decision support will likely provide the best approach to improve medication safety among hospital patients. It is also important to develop other processes to complement CPOE, such as accurate medication histories on admission.

"Before implementing CPOE at Northwestern Memorial Hospital, we wanted to determine exactly where and why prescribing errors occur, because it is imperative to identify the root cause of the problems before you can fix them. We wanted to recognize the errors with the greatest potential for patient harm and then design our CPOE system and/or clinical decision support to target those areas first," said Dr. Noskin. "Sometimes it's necessary to look beyond even the most touted fixes to patient safety problems."

"Prescribing errors are common in the hospital, but are usually caught and corrected before reaching the patient," said Bobb. "The bottom line is that hospitals that have invested in CPOE and support clinical pharmacists have a greater likelihood of preventing medication errors."

Northwestern Memorial Hospital is currently implementing an electronic medical record and CPOE. The study of errors within its own hospital has helped a great deal in the design of the system. As well, the baseline data collected in this study could be used for comparison once the system is fully implemented.