ID re-entry helps reduce wrong-patient errors

Requiring providers to re-enter patient ID numbers in computerized physician order entry systems significantly reduced the number of wrong-patient orders in a study published by the Journal of the American Medical Informatics Association.

The New York-based researchers used a retract-and-reorder measurement tool to determine the reasons for wrong-patient orders, then set up a three-pronged study to look at two possible solutions compared with no intervention: a single-click confirmation of patient identity and requiring that the ID number be re-entered.

The one-year study comprised an estimated 5,246 wrong-patient orders that were quickly corrected. In phone interviews, 170 of 223 retract-and-reorder events were identified as wrong-patient orders. Providers were then asked whether the errors were the result of juxtaposition, interruption or other factors. And 23.8 percent of the events were not errors at all, but providers quickly changing their orders.

Of those deemed incorrect, however, single-click confirmation reduced errors by 16 percent, while requiring re-entry brought errors down by 41 percent.

"All hospitals that implement CPOE systems should consider measuring retract-and-reorder events to estimate the frequency of wrong-patient orders, and optimize their software to minimize these errors," the authors said.

With interruption cited as the leading cause of errors, though, it raises the question of how much that optimization could help.

The re-entry also added 6.6 seconds to the time required to place each order, which might lead to unforeseen errors in providers' busy day, the authors noted. And nurses made fewer errors than radiology and outpatient groups. The authors suggested for further study into the error rate among departments, which could be an important factor with the addition of lab and radiology orders to Meaningful Use Stage 2.

Though the errors in this study did not measure errors that reach the patient and cause harm, research has been mixed on CPOE systems' ability to detect adverse drug events. A Canadian study found systems lacking, while one from Brigham and Women's Hospital in Boston found CPOE systems effective in reducing drug-related injury.

Yet several studies have found that data quality in electronic health records remains a problem. Peter Witonsky, president and chief sales officer at health technology vendor iSirona, pointed to several reasons in a recent Healthcare IT News article, including poor typing, miscommunication, delays in entering information and latency in systems, which makes new information slow to appear.

To learn more:
- read the JAMIA abstract
- here's the Healthcare IT News article

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