The effect of Computerised Physician Order Entry on prescribing errors: An interrupted time-series study at a secondary referral hospital in Australia

McCourt, Elizabeth; Harper, Nicola; Butnoris, Margie; Friend, Richard H.; Dekker, Katharine; Ayre, Justine; Tai, Bonnie; Pelecanos, Anita; Stowasser, Danielle A; Coombes, Ian; Dunn, Timothy; Donovan, Peter

doi:10.1016/j.ijmedinf.2022.104829

Cited by 5 publications

(7 citation statements)

References 12 publications

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“…A study from the Netherlands demonstrated reductions in errors across administrative and dosing errors, but not therapeutic errors 10 . In contrast, a similar study in Australia showed statistically significant reductions in therapeutic errors after the implementation of CPOE 5 .…”

Section: Discussionmentioning

confidence: 71%

“…Additionally, in the included studies the electronic systems implemented generally consisted of basic CPOE or CDSS systems, while none appeared to examine the impact of the transition to a fully digital hospital, including CPOE, CDSS, EHR and AMDS. Our recent work in our health service examined a smaller hospital site implementing a hybrid system of paper-based and digital prescribing on medical wards in 2018 5 . This work used an interrupted time series (ITS) design and found that digital prescribing resulted in reductions in prescribing errors with some evidence of reduction in actual patient harm 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Our recent work in our health service examined a smaller hospital site implementing a hybrid system of paper-based and digital prescribing on medical wards in 2018 5 . This work used an interrupted time series (ITS) design and found that digital prescribing resulted in reductions in prescribing errors with some evidence of reduction in actual patient harm 5 . However, other electronic systems such as EHR or AMDS were not implemented as part of this evaluation.…”

Section: Introductionmentioning

confidence: 99%

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The impact of transition to a digital hospital on medication errors (TIME study)

Engstrom,

McCourt,

Canning

et al. 2023

npj Digit. Med.

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Digital transformation in healthcare improves the safety of health systems. Within our health service, a new digital hospital has been established and two wards from a neighbouring paper-based hospital transitioned into the new digital hospital. This created an opportunity to evaluate the impact of complete digital transformation on medication safety. Here we discuss the impact of transition from a paper-based to digital hospital on voluntarily reported medication incidents and prescribing errors. This study utilises an interrupted time-series design and takes place across two wards as they transition from a paper to a digital hospital. Two data sources are used to assess impacts on medication incidents and prescribing errors: (1) voluntarily reported medication incidents and 2) a chart audit of medications prescribed on the study wards. The chart audit collects data on procedural, dosing and therapeutic prescribing errors. There are 588 errors extracted from incident reporting software during the study period. The average monthly number of errors reduces from 12.5 pre- to 7.5 post-transition (p < 0.001). In the chart audit, 5072 medication orders are reviewed pre-transition and 3699 reviewed post-transition. The rates of orders with one or more error reduces significantly after transition (52.8% pre- vs. 15.7% post-, p < 0.001). There are significant reductions in procedural (32.1% pre- vs. 1.3% post-, p < 0.001), and dosing errors (32.3% pre- vs. 14% post-, p < 0.001), but not therapeutic errors (0.6% pre- vs. 0.7% post-, p = 0.478). Transition to a digital hospital is associated with reductions in voluntarily reported medication incidents and prescribing errors.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of transition to a digital hospital on medication errors (TIME study)

Engstrom,

McCourt,

Canning

et al. 2023

npj Digit. Med.

Self Cite

View full text Add to dashboard Cite

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“…A number of interventions have been implemented to reduce PEs. Examples include the use of Computerized Physician Order Entry (CPOE) and Clinical Decision Support Systems (CDSS), [17][18][19][20][21] educating medical students and residents in appropriate prescribing, [22][23][24][25] and the inclusion of specialists with expertise in appropriate prescribing, such as clinical pharmacists, in clinical wards or teams. [26][27][28][29][30] Although these interventions have been shown to protect against PEs in the trial context, in-hospital PEs and associated harms still occur in daily practice, [31][32][33] requiring a different approach to address this global challenge.…”

Section: Introductionmentioning

confidence: 99%

Quality indicators for appropriate in‐hospital pharmacotherapeutic stewardship: An international modified Delphi study

Mahomedradja,

Tichelaar,

Mokkink

et al. 2024

Brit J Clinical Pharma

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AimsIn‐hospital prescribing errors may result in patient harm, such as prolonged hospitalisation and hospital (re)admission, and may be an emotional burden for the prescribers and healthcare professionals involved. Despite efforts, in‐hospital prescribing errors and related harm still occur, necessitating an innovative approach. We therefore propose a novel approach, in‐hospital pharmacotherapeutic stewardship (IPS). The aim of this study was to reach consensus on a set of quality indicators (QIs) as a basis for IPS.MethodsA three‐round modified Delphi procedure was performed. Potential QIs were retrieved from two systematic searches of the literature, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) statement. In two written questionnaires and a focus meeting (held between the written questionnaire rounds), potential QIs were appraised by an international, multidisciplinary expert panel composed of members of the European Association for Clinical Pharmacology and Therapeutics (EACPT).ResultsThe expert panel rated 59 QIs and four general statements, of which 35 QIs were accepted with consensus rates ranging between 79% and 97%. These QIs describe the activities of an IPS programme, the team delivering IPS, the patients eligible for the programme and the outcome measures that should be used to evaluate the care delivered.ConclusionsA framework of 35 QIs for an IPS programme was systematically developed. These QIs can guide hospitals in setting up a pharmacotherapeutic stewardship programme to reduce in‐hospital prescribing errors and improve in‐hospital medication safety.

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“…(7) Studies assessing the impact of CPOE on medication prescriptions have consistently shown improvements in error rates and adverse drug interactions. (8)(9)(10)(11)(12)(13) The impact of CPOE on operational processes has been assessed in a limited number of studies, with a focus on medicine dispensing. (14,15) However, the impact of CPOE on LTAT across a whole hospital system over time and the potential operational efficiency gains have not yet been assessed.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Electronic Order Communications on Laboratory Turnaround Times in Acute Hospital Care

Gallier,

Zou,

Evison

et al. 2024

Preprint

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ObjectiveTo examine the impact of computerised physician order entry (CPOE) systems upon laboratory turnaround times (LTAT), namely the time from recording the collection of a blood sample to the results being reported, within a large acute hospital.Materials and methods1,810,311 blood samples taken between 1stJanuary 2014 and 31stDecember 2019 were included. Changes in LTAT over the 24 months pre- and 18 months post-CPOE implementation were analysed using a segmented regression approach. The primary analysis assessed the median LTAT across the whole hospital, with secondary analyses assessing subgroups defined by clinical settings.ResultsCPOE implementation was associated with a step-change reduction in the median LTAT of 31.7 minutes (95% CI: 25.5-37.9, p<0.001). This was sustained over eighteen months post- implementation of CPOE despite the number of samples increasing by an average of 31% in this post-implementation period. Analysis by broad clinical specialty found all subgroups of wards considered to have a significant reduction in LTAT post-CPOE, either in the form of a step-change reduction, or an increasing rate of change.Discussion and ConclusionThe implementation of CPOE within an acute hospital improves the average LTAT over a prolonged period, despite an increase in the number of samples collected. This could improve care efficiencies. Understanding the likely reduction in LTAT also provides information to support an economic evaluation of the implementation of such a system into a new setting.

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The effect of Computerised Physician Order Entry on prescribing errors: An interrupted time-series study at a secondary referral hospital in Australia

Cited by 5 publications

References 12 publications

The impact of transition to a digital hospital on medication errors (TIME study)

The impact of transition to a digital hospital on medication errors (TIME study)

Quality indicators for appropriate in‐hospital pharmacotherapeutic stewardship: An international modified Delphi study

The Impact of Electronic Order Communications on Laboratory Turnaround Times in Acute Hospital Care

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