Minor Project Report: Effectiveness of CPOE in Reducing Errors

This report investigates the effectiveness of Computerized Physician Order Entry (CPOE) systems in reducing medication errors, particularly in pediatric intensive care units (ICUs). It highlights that CPOE systems aim to minimize errors related to transcription, communication, and handwriting, leading to improved medication efficiency and reduced distribution times. The report emphasizes the importance of CPOE in preventing duplicate orders, simplifying inventory management, and providing safety alerts for potentially unsafe prescriptions. It discusses the findings of several studies that demonstrate CPOE's positive impact on reducing medication errors across different stages of healthcare delivery, including prescription and administration. However, it also acknowledges challenges such as implementation costs and potential for false-positive alerts. The report incorporates a thematic analysis of existing literature, focusing on the role of CPOE in minimizing medication errors in pediatric ICUs, and concludes that while CPOE systems show promise, ongoing evaluation and refinement are necessary to optimize their effectiveness and ensure patient safety. Desklib provides access to this and other solved assignments for students.

Running head: MINOR PROJECT REPORT
Effectiveness of computerised physician order entry
Name of the Student
Name of the University
Author Note

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MINOR PROJECT REPORT
Introduction
Computerized physician order entry (CPOE) refers to the process undertaken by a
medical or healthcare professional that encompasses the act of entering medication orders or
all kinds of physician instructions, electronically, without the use of paper charts (Schiff et al.
2015). One of the primary benefits of adhering to CPOE is associated with the fact that this
technique has been successful in reducing medication errors that might be related to failure to
appropriately transcript the medication order, miscommunication during handovers or due to
poor handwriting.The orders entered electronically are communicated via a computer
network to the concerned medical staff and the associateddepartments such as, the laboratory,
pharmacy, or radiology, which in turn hold an essential responsibility for executing the
orders. CPOE has proved effective in reducing the time required for the distribution and
completion of the orders, while simultaneously increasing the medication efficiency (Ranji,
Rennke and Wachter 2014). This can be attributed to the fact that CPOEs reduce all forms of
transcriptionerrors that includes taking efforts to prevententry of duplicate orders, while
simplifying the management of the inventory and billing system. In other words, CPOE can
be defined as a form of patient management software. Thus, CPOEs create the provision of
electronically writing the entire range of orders and maintaining online medication
administration records, in addition to reviewing changes that are made to the orders. CPOEs
also prove useful in offering safety alerts, which get triggered due to entry of an unsafe order
such as, duplicate drug therapies. They have also proved effective in facilitating the process
of clinical decision making, thereby guiding healthcare professionals to less expensive
alternatives that increase the efficiency of patient care and safety.
CPOE systems are primarily designed with the aim ofmimicking the workflow of
paper-based patient charts. However, two common drawbacks of this technology that are
commonly cited include the time and money that it takes for the installation of a CPOE

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system across healthcare settings. Healthcare practitioner have used verbal and hand-written
communication orders for patients since ages, which were then transcribed by unit clerks,
ancillary staff and nurses before being executed. Injuries and adverse effects among patients
have often been correlated with manual order entries or handwritten notes that contribute to
poor legibility and subsequent errors (Khanna and 2014). Furthermore, prescribing errors
have also been identified as one of the largest kinds of avoidable medical errors in hospitals.
Research Objective
 To investigate the rates of medication errorsamong children in intensive care units.
 To evaluate the effectiveness of CPOE systems for reducing risks of medication error
among children in intensive care units.
Considering all forms of errors that might occur during healthcare delivery in pediatric
ICUs, medication errors have been recognised as the most frequent reason for adverse events
(Rinke et al. 2014). Adoption to CPOE has most often been slow owing to the resistance
faced from the providers, which in turn can be associated with the disruption of the
conventional methods of patient entry that have been followed since ages in existing care
settings. Thus, there is a need to determine the benefits of CPOE in reducing or eliminating
these errors in pediatric ICUs.
Background
Computerized physician order entry have been championed and promoted as a major
component of healthcare information technology. Although the concept of CPOE has evolved
over time, it gained importance in the past decade and has been defined as variety of
computer-based systems sharing some common features that are related to automation of the
medication ordering process, thereby ensuring legible, standardized, and complete orders.
One of the major criteria associated with the use of CPOE across healthcare systems was the

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use of computer assistance by the concerned healthcare providers for directly entering the
medication orders from a mobile or computer device. According to Nuckols et al.
(2014)Health Information Technology for Economic and Clinical Health Act resulted in
subsidization of the implementation of electronic health records by hospitals, with
computerized provider order entry for reducing rates of patient injuries that are caused by
preventable medication errors. The findings provided evidence for the fact that CPOE were
associated with more than 50% reduction in preventable medication error events. Reduction
in such medication error were associated with the subsidization of the CPOE system, which
was thought to directly contribute to an benefit on the health and safety of the patients.
Similar findings were opined by Alsweed et al. (2014) who conducted a study that focused on
investigating the impacts of CPOE on the front line staff and patient safety. Following
conduction of a cross-sectional survey, CPOE showed significant impacts in lowering rates of
medication errors (p = 0.001). Furthermore, responses from nursing professionals also
confirmed the fact that CPOE implementation improved patient safety and also enhanced the
perception of the nurses regarding their workflow.
Importance of electronic patient medication records were also illustrated in another
study that aimed to systematically explore available evidences for determining effectiveness
of these computerised measures for pharmacy order entry (Ojeleye et al. 2013). Statistically
significant reductions were observed in rates of medication errors among patients suffering
from renal insufficiency and pregnant women belonging to the category D. Thus, the review
helped in establishing the potential of electronic pharmacy entries in reducing medication
errors. Similarities in the findings were also established by an observational study that
attempted to assess the impacts of CPOE implementation on pharmaceutical checking of
medication errors in the three drug management stages (Hernandez et al. 2015). Following an
installation of CPOE across a 66-bed orthopaedic surgical unit in a teaching hospital, a 92%

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reduction and 17.5% reduction was observed in the rates of prescribing errors and
administration errors. However, CPOE failed to show any significant effects on the rates of
dispensing errors in the surgical unit. Therefore, the study was effective in establishing the
fact that CPOEs are a convenient system that can improve the safety and quality of drug
management, thereby reducing adverse effects on the patient.
CPOE systems were also implemented for investigating the rates and nature of
medication errors in three clinical stages of the medication process that corresponded to
prescription, administration and documentation (Cho et al. 2014). An analysis of the results
indicates that 53.6% of the issued prescriptions contained at least one kind of medication
error. Furthermore, verbal order errors that contributed to incorrect entries of prescriptions
accounted for two-thirds of the entire error rates. Thus, the findings helped in establishing the
fact that in spite of the long experience with CPOE, there are huge rates of medication errors
at all stages of the healthcare delivery process.
Project Design

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Outcomes
Systematic Review: Thematic Analysis
Theme: Computerized physician order entry (CPOE) to minimize the risk of medication
error among children in intensive care unit
Sethuraman et al. (2015) conducted a prospective comparison of outpatient sample,
medication prescription 5 months before and after the implementation of computerised
physician order entry (CPOE) with electronic medication alert system (EMAS). Sethuraman
et al. (2015) noted types of errors, their rates, alert types, their significance and response of
the physician. Their analysis elucidated that the CPOR with clinical decision support was
associated with reducing in the medication prescription errors in the paediatric emergency
department (PED) by 29% in comparison with the setup where there are no application of
CPOE. However, no reduction was noted in serious errors. The observed decrease in the
medication errors was significantly associated with the decrease in the rate of antibiotics
administration and dosage errors. However, this reduction came at a cost to user of 43%
(approx) false-positive alerts and overriding of crucial dose range checking the alerts in 11%
of prescriptions. The importance of the study conducted by Sethuraman et al. (2015) is, it was
the first ever study conducted in PED which is said to have highest rate of medication errors
and half of them are preventable (Nelson and Selbst 2015). Their study results aligned with
the study conducted by (Kadmon et al. 2009). Kadmon et al. (2009) study revealed that
introduction of CPOE led to slight reduction of the potential adverse events and medication
errors. However, addition of the clinical decision support system, helped to reduce the rate of
the medication error significantly. Walsh et al. (2006) however, only a minor reduction in the
medication error under the application of CPOR in the paediatric unity with dosing checking

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alerts. The significant reduction in the medication prescription error under PED was observed
by Sethuraman et al. (2015) because they included medication prescriptions at discharge and
analysed only four different medication errors. These include dosing, frequency, and allergy
and drug-to drug interaction. Moreover, they also did not include duplicate orders in their
study like missing weight, violations of the hospital policy. The findings of the study mainly
highlighted that the errors are more likely to occur when the nurses are required to handle
more than one prescription for a single patients. This handling of multiple prescriptions for a
single patients increases the sense of stress or a feeling of rush to complete numerous
prescriptions while maintaining thorough output of patients. The effective of CPOE is its
reduces the chances of manual error via easy automated documentation and thereby reducing
stress among the healthcare physicians.

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References
Alsweed, F., Alshaikh, A., Ahmed, A., Yunus, F. and Househ, M., 2014. Impact of
computerised provider order entry system on nursing workflow, patient safety, and
medication errors: perspectives from the front line. International journal of electronic
healthcare, 7(4), pp.287-300.
Cho, I., Park, H., Choi, Y.J., Hwang, M.H. and Bates, D.W., 2014. Understanding the nature
of medication errors in an ICU with a computerized physician order entry system. PLoS
One, 9(12), p.e114243.
Hernandez, F., Majoul, E., Montes-Palacios, C., Antignac, M., Cherrier, B., Doursounian, L.,
Feron, J.M., Robert, C., Hejblum, G., Fernandez, C. and Hindlet, P., 2015. An observational
study of the impact of a computerized physician order entry system on the rate of medication
errors in an orthopaedic surgery unit. PloS one, 10(7), p.e0134101.
Kadmon, G., Bron-Harlev, E., Nahum, E., Schiller, O., Haski, G. and Shonfeld, T., 2009.
Computerized order entry with limited decision support to prevent prescription errors in a
PICU. Pediatrics, 124(3), pp.935-940.
Khanna, R. and Yen, T., 2014. Computerized physician order entry: promise, perils, and
experience. The Neurohospitalist, 4(1), pp.26-33.
Nelson, C.E. and Selbst, S.M., 2015. Electronic prescription writing errors in the pediatric
emergency department. Pediatric emergency care, 31(5), pp.368-372.
Nuckols, T.K., Smith-Spangler, C., Morton, S.C., Asch, S.M., Patel, V.M., Anderson, L.J.,
Deichsel, E.L. and Shekelle, P.G., 2014. The effectiveness of computerized order entry at

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reducing preventable adverse drug events and medication errors in hospital settings: a
systematic review and meta-analysis. Systematic reviews, 3(1), p.56.
Ojeleye, O., Avery, A., Gupta, V. and Boyd, M., 2013. The evidence for the effectiveness of
safety alerts in electronic patient medication record systems at the point of pharmacy order
entry: a systematic review. BMC medical informatics and decision making, 13(1), p.69.
Ranji, S.R., Rennke, S. and Wachter, R.M., 2014. Computerised provider order entry
combined with clinical decision support systems to improve medication safety: a narrative
review. BMJ QualSaf, 23(9), pp.773-780.
Rinke, M.L., Bundy, D.G., Velasquez, C.A., Rao, S., Zerhouni, Y., Lobner, K., Blanck, J.F.
and Miller, M.R., 2014. Interventions to reduce pediatric medication errors: a systematic
review. Pediatrics, pp.peds-2013.
Schiff, G.D., Amato, M.G., Eguale, T., Boehne, J.J., Wright, A., Koppel, R., Rashidee, A.H.,
Elson, R.B., Whitney, D.L., Thach, T.T. and Bates, D.W., 2015. Computerised physician
order entry-related medication errors: analysis of reported errors and vulnerability testing of
current systems. BMJ QualSaf, 24(4), pp.264-271.
Sethuraman, U., Kannikeswaran, N., Murray, K.P., Zidan, M.A. and Chamberlain, J.M.,
2015. Prescription errors before and after introduction of electronic medication alert system
in a pediatric emergency department. Academic Emergency Medicine, 22(6), pp.714-719.
Walsh, K.E., Adams, W.G., Bauchner, H., Vinci, R.J., Chessare, J.B., Cooper, M.R., Hebert,
P.M., Schainker, E.G. and Landrigan, C.P., 2006. Medication errors related to computerized
order entry for children. Pediatrics, 118(5), pp.1872-1879.