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 staffpharmacists 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 1000medication 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 advancedclinical decision support, is vital for achieving maximum medication safety.
INTRODUCTION | |
The Institute of Medicine brought the shortcomings of the American health care system to the national spotlight with its report To Err Is Human.1 Adverse drug events (ADEs), defined as injuries resulting from medical interventions related to the administration of a drug, are the most commoncause of injury to hospitalized patients and are often preventable.2-4 Computerized prescriber order entry (CPOE), an application in which prescribers write orders online, has been shown to decrease medication errors by 55% to 80%.5-7 The Leapfrog Group,8 created to mobilize employer purchasing power to drive market share to hospitals that have demonstrated improvements in safety, has identifiedimplementation of CPOE as critical to improving the safety of hospital care. Bates et al2 found that medication errors resulting in preventable ADEs most commonly occur at the ordering stage. Although medication errors are common, only a small percentage actually lead to patient harm.9 There remains considerable controversy about whether currently available CPOE systems will prevent the errors thatactually lead to patient harm.10-12 Development of CPOE systems in US hospitals is in its infancy. A closer look at errors with the potential to lead to preventable ADEs is warranted. The present study was designed to analyze prescribing errors at a large midwestern teaching hospital that is currently implementing a CPOE system. After several pilot studies,13 clinical staff pharmacists for 1 weekprospectively identified all orders that contained medication prescribing errors. Study investigators verified and formally rated each of the identified prescribing errors. In addition to classifying drug class, error type, proximal cause, phase of hospitalization, and potential severity, investigators rated the likelihood that CPOE would have prevented the error.
METHODS | |
| | |...