Impact of computerized provider order entry system on medication prescribing errors in hospital wards: a comparative study.

Abstract

Introduction: Medication errors are a major concern in healthcare, threatening patient safety and increasing costs. These errors can occur at various stages, from prescribing to dispensing and administration. Among these, prescribing errors are particularly critical as they occur at the initial step of medication use process and can propagate downstream, potentially leading to adverse events. Computerized provider order entry (CPOE) systems, with integrated clinical decision support tools offer significant benefits over handwritten prescriptions including enhanced legibility, prescription completeness, standardization, a comprehensive audit trail and real-time alerts and reminders to assist prescribers during the prescribing process. This study aims to evaluate the effectiveness of a CPOE system with clinical decision support features in reducing prescribing errors across the hospital. It compares the rates and error types between electronic and handwritten prescriptions over different time periods following the CPOE implementation.

Materials and methods: This retrospective comparative analysis examines inpatient prescription data collected from the same hospital wards during three distinct periods: 1st January to 31st March 2023 (59,663 handwritten prescriptions), 1st October to 31st December 2023 (43,363 electronic prescriptions at 3 months post-CPOE implementation) and 1st January to 31st March 2024 (44,317 electronic prescriptions at 6 months post-CPOE implementation). The CPOE system was implemented in July 2023.

Results: The CPOE system significantly reduced medication prescribing errors (3 months post-CPOE: n=832, 1.92%; 6 months post-CPOE: n=617, 1.39%) compared to handwritten prescriptions (n=3532, 5.92%). The odds of errors occurring 3 months and 6 months post-CPOE implementation were 65% and 75% lower, respectively, than during the handwritten phase [Odds Ratio (OR), 0.35; 95% Confidence Interval (CI), 0.32 - 0.38] and [OR, 0.25; 95% CI, 0.23 - 0.28]. Potential error sources associated with handwritten prescriptions, such as illegible prescriptions, non-standard abbreviations and incomplete prescriptions, were entirely eliminated with CPOE adoption. Significant differences in error types were observed between handwritten and electronic prescriptions (p<0.001). However, errors related to incorrect dosage, frequency and unit of measurement increased under the CPOE system compared to handwritten prescriptions (p<0.001). A significant reduction in odds occurred with wrong unit of measurement [OR, 0.61; 95% CI, 0.52 - 0.72) followed by frequency errors [OR, 0.58; 95% CI, 0.47 - 0.73) from the 3 months to 6 months post-CPOE implementation. Non-significant reductions or increments in odds were observed for other error types including wrong dosage, wrong route, wrong form, wrong strength and wrong or inappropriate drugs between the two 3-month post-CPOE periods.

Conclusion: The implementation of the CPOE system has significantly minimized the factors contributing to medication prescribing errors associated with handwritten prescriptions. However, the CPOE-related errors can still occur and may persist or change over time. To further improve prescribing safety, it is essential to address the factors contributing to these errors and periodically assess them to minimize the gap. Future studies should explore additional aspects of medication safety such as prescriber knowledge, types of medicines prescribed, long term error patterns and contextual factors including disease complexity across clinical settings, particularly with the integration of advanced clinical decision support tools.