Indication Alerts Intercept Drug Name Confusion Errors during Computerized Entry of Medication Orders
نویسندگان
چکیده
BACKGROUND Confusion between similar drug names is a common cause of potentially harmful medication errors. Interventions to prevent these errors at the point of prescribing have had limited success. The purpose of this study is to measure whether indication alerts at the time of computerized physician order entry (CPOE) can intercept drug name confusion errors. METHODS AND FINDINGS A retrospective observational study of alerts provided to prescribers in a public, tertiary hospital and ambulatory practice with medication orders placed using CPOE. Consecutive patients seen from April 2006 through February 2012 were eligible if a clinician received an indication alert during ordering. A total of 54,499 unique patients were included. The computerized decision support system prompted prescribers to enter indications when certain medications were ordered without a coded indication in the electronic problem list. Alerts required prescribers either to ignore them by clicking OK, to place a problem in the problem list, or to cancel the order. Main outcome was the proportion of indication alerts resulting in the interception of drug name confusion errors. Error interception was determined using an algorithm to identify instances in which an alert triggered, the initial medication order was not completed, and the same prescriber ordered a similar-sounding medication on the same patient within 5 minutes. Similarity was defined using standard text similarity measures. Two clinicians performed chart review of all cases to determine whether the first, non-completed medication order had a documented or non-documented, plausible indication for use. If either reviewer found a plausible indication, the case was not considered an error. We analyzed 127,458 alerts and identified 176 intercepted drug name confusion errors, an interception rate of 0.14±.01%. CONCLUSIONS Indication alerts intercepted 1.4 drug name confusion errors per 1000 alerts. Institutions with CPOE should consider using indication prompts to intercept drug name confusion errors.
منابع مشابه
Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)
OBJECTIVE To determine whether indication-based computer order entry alerts intercept wrong-patient medication errors. MATERIALS AND METHODS At an academic medical center serving inpatients and outpatients, we developed and implemented a clinical decision support system to prompt clinicians for indications when certain medications were ordered without an appropriately coded indication on the ...
متن کاملDecision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System: A systematic approach to decrease alerts.
OBJECTIVE We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts. DESIGN Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy aler...
متن کاملDecision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System
Objective: We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts. Design: Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy aler...
متن کاملA trial of inpatient indication based prescribing during computerized order entry with medications commonly used off-label.
BACKGROUND Requiring indications for inpatient medication orders may improve the quality of prescribing and allow for easier placement of diagnoses on the problem list. Indications for inpatient medication orders are also required by some regulators. OBJECTIVE This study assessed a clinical decision support (CDS) system designed to obtain indications and document problems during inpatient com...
متن کاملResponse to medication dosing alerts for pediatric inpatients using a computerized provider order entry system.
OBJECTIVE Medication dosing errors are of particular concern in hospitalized children. Avoidance of such errors is essential to quality improvement and patient safety. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) have the potential to reduce medication errors. The objective of this study was to evaluate provider response to the dosing alerts in a CPOE sy...
متن کامل