A Strategy to Overcome Under-Reporting Issues of Voluntary Medication Error Reporting System: Computerized Prescriber Order Entry as an Example

Medical error reporting systems have been in place for decades, with the hope that the collected reports would help us understand the nature of errors and prevent similar errors from occurring in the future. Among the various types of reporting systems, a voluntary system leaves the decision about whether to report a detected error or not to healthcare providers. Naturally, not every detected error has been reported, and we call such a phenomenon under-reporting. The level of under-reporting varies across reporters and organizations, which has prohibited us from analyzing the data and utilizing the results with satisfactory validity. The current study tried to show how to overcome this issue, using the effectiveness of a computerized prescriber order entry (CPOE) system as an example. Since CPOE is designed to catch the prescribing error, we first calculated the ratio between the odds of prescribing error reaching the patient and that of administering errors seemingly unrelated to the prescribing phase. We then compared this ratio between hospitals with CPOE and without CPOE. With this methodology, combined with adding a random intercept to control for hospital-level clustering of medication errors, we could effectively handle the varying degrees of reporting levels across hospitals, achieving a solid comparison of the effectiveness of CPOE between hospitals with and without CPOE. The final results showed that the odds of an error being caught before reaching the patient was 4.63 times higher in the prescribing phase of the medication use process among hospitals using CPOE than among hospitals without CPOE. We believe the methodology used in this study can be applied to many other topics in patient safety studies using data from voluntary medical error reports.