Format

Send to

Choose Destination
J Am Med Inform Assoc. 2017 Mar 1;24(2):432-440. doi: 10.1093/jamia/ocw119.

A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care.

Author information

1
Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK.
2
Newcastle upon Tyne hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, UK.
3
School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX, USA.
4
Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
5
Health Education KSS Pharmacy, Downsmere Building, Princess Royal Hospital, West Sussex, UK.
6
The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
7
Harvard Medical School, Harvard University, Boston, MA, USA.
8
Harvard School of Public Health, Harvard University, Boston, MA, USA.

Abstract

Objective:

To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems.

Materials and Methods:

We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken.

Results:

A total of 1185 publications were identified, of which 34 were included in the review. We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users' work processes, and clinical decision support systems. Displaying an incomplete list of a patient's medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments. Users' misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors.

Discussion and Conclusions:

Human factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users' workflow expectations.

KEYWORDS:

alerts; clinical decision support; computerized provider order entry; decision-making; medication errors; patient safety

PMID:
27582471
DOI:
10.1093/jamia/ocw119
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center