The failure of computerized prescriptions or the failure of interfaces in medical software?

5-193
Category: Quality Assurance / Medication Safety
Title: Effect of electronic prescribing on medication reconciliation
Primary Author: Jill Covyeou, Ferris State University College of Pharmacy, 1458 W. Center
Rd.- Suite 1, Essexville, MI, 48732; Email: jill.covyeou@mclaren.org
Purpose: Lack of medication documentation is linked to 46% of all medication errors, up to
20% of adverse drug events, and up to 27% of all prescribing errors in hospitalized patients
(demonstrating that inaccuracies in the outpatient medication list can be responsible for
complications in the hospitalized patient). In this study we look to see if implementation of an
electronic prescribing system increases medication reconciliation accuracy in a family practice
residency clinic.
Methods: This chart review was conducted in two phases. In the first phase medication
reconciliation accuracy was measured using handwritten paper forms. In the phase 2 study,
medication reconciliation accuracy was assessed after implementation of an electronic
prescribing system. Audits consisted of a chart review to determine the accuracy of the
medication lists. Any new medications prescribed had to appear on the list and any medications
discontinued had to have been removed from the medication list. The provider must have also
documented that the medication list was reviewed with the patient on the day of the visit and that
they provided the patient with an updated medication list before they left. A medication list was
considered to be accurate if it contained all the required information, and inaccurate if it was
missing any information. Of the lists that were considered inaccurate, it was also determined
where they were deficient (one list could be found deficient in more than one area).
Results: Over the course of phase 1, 17 audits were completed and a total of 650 charts were
reviewed. The percentage of medication lists with inaccuracies over phase 1 was 51% (49% were
considered accurate). In phase 1, the most common reason for a medication list being inaccurate
was that the provider did not document that the medication list was reviewed on the day of the
visit (42%). Over the course of phase 2, 15 chart audits were completed and a total of 923 charts
were reviewed. The percentage of medication lists with inaccuracies during phase 2 was 37%
(63% were considered accurate). Once again, the most common reason for a medication list
being inaccurate was an undocumented date (63%), which may indicate that provider motivation
to perform the medication reconciliation is a major factor in medication list accuracy. When
comparing phase 1 to phase 2, the percentage of medication lists that were accurate significantly
increased from 49% to 63% (p<0 .001="" p="">Conclusion: While electronic prescribing did significantly increase the accuracy of medication
lists, the 14% increase is far from a complete solution. A multifaceted approach (technology,
provider education, and patient education) will most likely be required to further increase the
accuracy of medication lists and prevent medication errors in both the inpatient and outpatient
setting.


5-189
Category: Quality Assurance / Medication Safety
Title: Assessment of the impact of computerized prescriber order entry (CPOE) system on the
reported occurrence of medication errors in a community hospital
Primary Author: Ramadas Balasubramanian, Carolinas Medical Center-Pineville, Department
of Pharmacy, 10628 Park Road, Charlotte, NC, 28210; Email:
ramadas.balasubramanian@carolinashealthcare.org
Additional Author(s):
David Bilotta
Joseph Bero
Ashlee Andreason
Carolyn Kerr
Purpose: To assess the impact of the CPOE system on the reported occurrence of medication
errors in a community hospital.
Methods: The implementation of CPOE and other electronic services is thought to reduce
medication errors and increase patient safety in hospitals. In late 2011, CPOE CANOPY system
was implemented hospital-wide in our community hospital. Several standard shared baselines
were developed. In early 2012, the number of beds in our hospital increased from 110 to 240,
and the hospital pharmacy operation became 24-hours. The purpose of this study was to assess
the impact of CPOE system on the occurrence of reported medication errors. A medication error
was defined as an error which occurred in the process of ordering or delivering a medication.
The medication errors were categorized as omission, wrong time, unauthorized drug, improper
dose, wrong dosage form, wrong drug preparation, wrong administration technique, deteriorated
drug, monitoring. This retrospective study consisted of comparing the reports of different
medication error types during January-October 2008 (Pre-CPOE) and January- October 2012
(Post-CPOE). The medication errors were reported per 1000 doses of medications dispensed.
The percentages were calculated using Microsoft Excel. Chi-square tests were used to evaluate
the association of CPOE with increase or decrease in medication errors with a P-value of less
than 0.05 considered significant. This study was exempt from Institutional Review Board
approval.
Results: The total number of doses of medications dispensed from the pharmacy increased from
665,172 in 2008 (Pre-CPOE) to 1,044,014 in 2012 (57 percent) (Post-CPOE). The total number
of reported medication errors also increased from 161 in 2008 to 319 in 2012 (98.1 percent).
These increases in medication errors could certainly be attributed to the total volume and
increased hospital beds and 24-7 pharmacy operation. However, the medication errors per 1000
doses dispensed as a volume-adjusted quality measure also increased from 0.24 in 2008 to 0.31
in 2012. The top four types of medication errors reported for 2008 versus 2012 as a percentage
were as follows, respectively--omission error--13.7, 20.7, wrong time error--11.2, 16.9,
unauthorized drug--38.5, 31.3, and improper dose--20.5, 14.4. Medication administration factors,
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followed by order processing and dispensing factors accounted for the top three reasons
contributing to these reported medication errors in both 2008 and 2012. Overall, the total number
of medication errors reported increased statistically significantly in 2012 versus 2008 compared
with the number of doses dispensed (P less than 0.05). However, the four top medication errors
shown above did not have statistical significancePre- versus Post-CPOE implementation.
Conclusion: Overall, the reported occurrence of medication errors increased Post-CPOE
implementation. This is attributable to the overall growth of the hospital. However, fewer
medication errors such as unauthorized drug, and improper dose were reported since the CPOE
implementation which could be due to the elimination of hand-written and illegible orders. But,
the omission and wrong time errors had increased. The inflexibility of the commercially
available CPOE software could also have played a role in the results of the study. In summary,
CPOE system has not helped with the reduction of medication errors in our hospital, despite the
expectation to the contrary.

http://www.ashp.org/DocLibrary/Midyear13/Professional-Poster-Abstracts.pdf

http://www.medpagetoday.com/MeetingCoverage/ASHP/43400?