Optimized Computerized Order Entry can Reduce Errors in Electronic Prescriptions and Associated Pharmacy Calls to Clarify (CTC)

Summary

Background

After implementation of a system-wide EMR within our university system, e-prescribing is now commonplace.

Objective

The authors conducted a study to assess whether optimization of computerized provider order entry (CPOE) can reduce errors in these electronically transmitted prescriptions and would require less frequent interventions from pharmacists, in particular the need for them to “call to clarify” (CTC) details of particular prescriptions. Secondary analysis based on cost assumptions was preformed to presume cost differences before and after optimization changes.

Materials and Methods

In order to generate complete, error-free prescriptions, optimization changes were implemented in the form of in line validation messages. These messages were generated if (1) an order did not specify a provider or pharmacy; (2) the DEA requirements were not met; (3) character limits were exceeded in patient sig or demographics or (4) administration instructions had breaks or had both discrete and free text elements. Retrospectively, prescriptions were randomly selected from a nine month period before and after implementing changes. These prescriptions were analyzed by a pharmacist and a nurse to identify types of errors that would require a CTC to a prescribing provider. Errors were compared statistically to determine effectiveness of changes pre and post optimization.

Results

A total of 602 prescriptions were analyzed; 301 before changes and 301 after changes. Of these prescriptions, 20.27% had errors before changes and 12.96% had errors after changes. The decline in the error rate was considered statistically significant for p<0.05. The cost savings were estimated at $76 per 100 prescriptions for pharmacist and physician time-cost estimates combined.

Conclusions

Implementing optimization changes to the CPOE resulted in a reduction in error rate requiring pharmacist CTC. This study identifies effective optimization changes for electronic prescribing that can reduce prescribing errors and may result in cost saving.

Keywords

Electronic prescribing - medication errors - CPOE - electronic health records - cost

• References

• 1 Manasse HR. Increase in US medicatlon-error deaths (Letter). Lancet 1998; 351 9116 1655.
• 2 Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc 2013; 20 (03) 470-476.
• 3 Grossman JM, Cross DA, Boukus ER, Cohen GR. Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies. Journal of the American Medical Informatics Association 2012; 19 (03) 353-359.
• 4 Lapane KL, Waring ME, Dubé C, Schneider KL. E-Prescribing and Patient Safety: Results From a Mixed Method Study. Am J Pharm Benefits 2011; 03 (02) e24-e34.
• 5 Warholak TL, Rupp MT. Analysis of community chain pharmacists’ interventions on electronic prescriptions. J Am Pharm Assoc (2003). 2009 49. 01 59-64 Available from: http://japha.org/article.aspx?doi=10.1331/JAPhA.2009.08013
• 6 Whittemore K. Guidelines for Creating High-Quality Electronic Prescriptions In The Ambulatory Healthcare Setting. http://surescripts.com 2010: 1-18 Available from: http://surescripts.com/docs/default- source/Resources/quality_e-prescription_guidelines_surescripts.pdf
• 7 Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma’Luf N, Boyle D, Leape L. The Impact of Computerized Physician Order Entry on Medication Error Prevention. J Am Med Informatics Assoc 1999; 06 (04) 313-321.
• 8 Taylor J, a Loan L, a Kamara J, Blackburn S, Whitney D. Medication administration variances before and after implementation of computerized physician order entry in a neonatal intensive care unit. Pediatrics 2008; 121 (01) 123-128.
• 9 Bizovi KE, Beckley BE, McDade MC, Adams AL, Lowe R, a Zechnich AD, Hedges JR. The Effect of Computer-assisted Prescription Writing on Emergency Department Prescription Errors. Acad Emerg Med 2002; 09 (11) 1168-1175.
• 10 Cordero L, Kuehn L, Kumar RR, Mekhjian HS. Impact of computerized physician order entry on clinical practice in a newborn intensive care unit. J Perinatol 2004; 24 (02) 88-93.
• 11 Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme JF, Lloyd JF, Burke JP. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998; 338 (04) 232-238.
• 12 Igboechi CA, Ng CL, Yang CS, Buckner AN. Impact of computerized prescriber order entry on medication errors at an acute tertiary care hospital. Hosp Pharm Thomas Land 2003; 38 (03) 227-231.
• 13 Kim GR, Chen AR, Arceci RJ, Mitchell SH, Kokoszka KM, Daniel D, Lehmann CU. Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis. Arch Pediatr Adolesc Med 2006; 160 (05) 495-498.
• 14 Mahoney CD, Berard-Collins CM, Coleman R, Amaral JF, Cotter CM. Effects of an integrated clinical information system on medication safety in a multi-hospital setting. Am J Health Syst Pharm 2007; 64 (18) 1969-1977.
• 15 Walsh KE, Landrigan CP, Adams WG, Vinci RJ, Chessare JB, Cooper MR, Hebert PM, Schainker EG, McLaughlin TJ, Bauchner H. Effect of computer order entry on prevention of serious medication errors in hospitalized children. Pediatrics 2008; 121 (03) e421-e427.
• 16 Bradley VM, Steltenkamp CL, Hite KB. Evaluation of reported medication errors before and after implementation of computerized practitioner order entry. J Healthc Inf Manag 2006; 20 (04) 46-53.
• 17 Gandhi TK, Weingart SN, Seger AC, Borus J, Burdick E, Poon EG, Leape LL, Bates DW. Outpatient prescribing errors and the impact of computerized prescribing. J Gen Intern Med 2005; 20 (09) 837-841.