Erroneous med orders 'sail through' CPOE systems

Nearly 80 percent of erroneous medication orders could be entered in computerized physician order entry (CPOE) systems, and more than half "sailed right through," with little or no difficulty or warnings, according to research published at BMJ Quality & Safety.

The researchers found 10,060 CPOE-related errors reported to the U.S. Pharmacopeia MEDMARX reporting system. They developed a taxonomy of those errors, then tried to replicate them on 13 CPOE systems at 16 sites.

Only 26.6 percent of erroneous orders generated specific warnings; of those, 69 percent were passive alerts, such as information displayed or easily overridden or ignored. Another 29 percent required workarounds, such as adjusting the dosage, but nonetheless, still could be entered, according to the research.

Leading CPOE-related errors included missing or erroneous label directions, wrong dose or strength, scheduling problems and delays in medication processing or administration due to confusing orders. In addition, despite the ease found in entering erroneous orders, systems that issue too many alerts also can lead to "alert fatigue," the authors noted. They urged finding the right balance to ensure patients are protected.

And while tighter regulation of electronic health records and CPOE poses one approach, improved post-market surveillance is another, they stated.

Making sure the problem of erroneous medication orders is fixed will only be more imperative as the CPOE market expands. The medication management market is expected to surpass $1.6 billion by 2019, according to Markets and Markets, a classification that includes CPOE systems, clinical decision support systems, inventory management tools and more. In addition, over the next five years, the CPOE entry market is set to grow from $938.4 million to more than $1.2 billion, according to a report from research firm MicroMarket Monitor.

However, despite the possibility of errors from using CPOE systems, many see the benefits of the tools.

Chris Snyder, a hospitalist and chief medical information officer at Peninsula Regional Medical Center in Salisbury, Maryland, said during a FierceHealthIT webinar last year that CPOE systems create a "funneled approach" to ordering.

"It turned out to be a huge stabilizer in the variability of ordering practices," Snyder said of its use at his hospital. "We weren't following guidelines ... and we weren't managing the protocols the way we should have been. ... It stopped us from creating errors with overprescribing."

To learn more:
- check out the research

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