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Original research
Impact of a commercial order entry system on prescribing errors amenable to computerised decision support in the hospital setting: a prospective pre-post study
  1. Sarah K Pontefract1,2,
  2. James Hodson2,
  3. Ann Slee3,4,
  4. Sonal Shah1,
  5. Alan J Girling5,
  6. Robin Williams6,
  7. Aziz Sheikh7,
  8. Jamie J Coleman2,8
  1. 1 Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
  2. 2 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3 Digital Technology, NHS England, London, UK
  4. 4 School of Health and Population Sciences, University of Edinburgh, Edinburgh, UK
  5. 5 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  6. 6 Institute for the Study of Science, University of Edinburgh, Edinburgh, UK
  7. 7 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  8. 8 Institute of Clinical Sciences, University of Birmingham Medical School, Birmingham, UK
  1. Correspondence to Professor Jamie J Coleman, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK; j.j.coleman{at}bham.ac.uk

Abstract

Background In this UK study, we investigated the impact of computerised physician order entry (CPOE) and clinical decision support (CDS) implementation on the rate of 78 high-risk prescribing errors amenable to CDS.

Methods We conducted a preintervention/postintervention study in three acute hospitals in England. A predefined list of prescribing errors was incorporated into an audit tool. At each site, approximately 4000 prescriptions were reviewed both pre-CPOE and 6 months post-CPOE implementation. The number of opportunities for error and the number of errors that occurred were collated. Error rates were then calculated and compared between periods, as well as by the level of CDS.

Results The prescriptions of 1244 patients were audited pre-CPOE and 1178 post-CPOE implementation. A total of 28 526 prescriptions were reviewed, with 21 138 opportunities for error identified based on 78 defined errors. Across the three sites, for those prescriptions where opportunities for error were identified, the error rate was found to reduce significantly post-CPOE implementation, from 5.0% to 4.0% (P<0.001). CDS implementation by error type was found to differ significantly between sites, ranging from 0% to 88% across clinical contraindication, dose/frequency, drug interactions and other error types (P<0.001). Overall, 43/78 (55%) of the errors had some degree of CDS implemented in at least one of the hospitals.

Conclusions Implementation of CPOE with CDS was associated with clinically important reductions in the rate of high-risk prescribing errors. Given the pre-post design, these findings however need to be interpreted with caution. The occurrence of errors was found to be highly dependent on the level of restriction of CDS presented to the prescriber, with the effect that different configurations of the same CPOE system can produce very different results.

  • decision support, computerized
  • decision support, clinical
  • hospital medicine
  • medication safety

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjqs-2017-007135

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    Footnotes

    • Contributors SKP, AnS, SS, JC and AzS designed the study. SKP and SS acquired the data. SKP, JH, SS, JC, AS and AJG performed the analysis. All authors were involved in the interpretation of the data. All authors were involved in the revisions and approval of the final manuscript for publication. All authors contributed to the writing of the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This work was funded by the National Institute for Health Research (NIHR). This article presents independent research funded by the NIHR under its Programme Grants for Applied Research Programme (reference number RP-PG-1209-10099).

    • Competing interests None declared

    • Ethics approval This work was classed as a service evaluation by an NHS research ethics committee and gained institutional review board permission from the university. We obtained all necessary organisational approvals from each of the hospital research and development departments prior to starting this work.

    • Provenance and peer review Not commissioned; externally peer reviewed.