Computerized Drug Order Systems Lead to Millions Fewer Hospital Medication Errors

Analysis of previous studies and several surveys of hospitals and hospital pharmacists has found that, as of 2008, use of e-prescribing was already averting millions of hospital medication errors per year.

Use of computerized provider order entry (CPOE) systems in hospitals helped avert more than 17 million medication errors per year in US hospitals as of 2008, according to the results of a study published online on February 20, 2013, in the Journal of the American Medical Informatics Association. The study drew on surveys carried out by the American Hospital Association (AHA) and the American Society of Health-System Pharmacists (ASHP) as well as a review of previously published studies.

According to the Institute of Medicine (IOM), hospitalized patients are subject on average to at least 1 medication error per day, exposing them to potential harm and increasing overall health costs. The IOM has recommended use of e-prescribing through CPOE systems to reduce such errors as well as patient harm.

Based on the 2007 AHA Annual Survey and the 2008 AHA Electronic Health Record Adoption Survey, the researchers estimated that as of 2008 approximately 34% (1589 of 4701) acute-care hospitals in the United States had adopted CPOE systems. Among hospitals that had adopted CPOE systems, they estimated that the mean implementation rate was 58.8%. Drawing on this estimate as well as data from the 2006 ASHP national survey of hospital pharmacies, the researchers estimated that, as of 2008, 26.1% of medication orders in acute-care hospitals were processed using CPOE systems.

To estimate the reduction in medication error rates attributable to use of CPOE systems, the researchers drew on a systematic literature review and meta-analytic random effects techniques. (The researchers followed the definitions of medication errors in the original studies, which included errors in ordering, transcribing, dispensing, administration, and monitoring. However, insofar as possible the researchers excluded adverse drug events and potential adverse drug events documented in the previous studies.)

The researchers estimated that processing a prescription drug order through a CPOE system reduces the chance of a medication error by 48%. Based on this effect and the extent of CPOE adoption and use in hospitals as of 2008, the researchers estimated that the overall rate of medication errors was reduced by 12.5% as a result of CPOE system use, which translates to 17.4 million medication errors averted in the United States in a single year.

Although the findings suggest that use of CPOE systems substantially reduces the frequency of medication errors in inpatient acute-care settings, the researchers note that it is unclear whether this translates to reduced harm for patients. In addition, they note that some studies have found that CPOE system use can introduce new opportunities for medication errors. For example, clinicians may choose the wrong drug or dose from pull-down menus, attribute a prescription to the wrong patient, or enter duplicate orders. In addition, pharmacy staff may incorrectly record the medication order information.

Nonetheless, the researchers note that based on the limited adoption rates of CPOE systems during the period covered by the study, there is room for many more medication errors to be averted through increased adoption.