Inpatient CPOE, med reconciliation results disappointing

Computerizing prescription order entry and medication reconciliation doesn't necessarily improve those processes as much as we'd like to think, according to two presentations at the midyear meeting of the American Society of Health-System Pharmacists.

Ramadas Balasubramanian of the Carolinas Medical Center-Pineville in Charlotte, N.C., and colleagues reported the facility experienced a 29.2 percent increase in medication dispensation errors with implementation of a CPOE system.

The new system was added when the hospital grew from 119 beds to 210 and the pharmacy began 24-hour operations. Afterward, the pharmacy dispensed 57 percent more doses, but its error rate grew, too, reported MedPage Today. The errors were categorized as drug omission, administration at the wrong time, unauthorized drug, wrong dose, and wrong form of dose.

Instances of unauthorized drug dispensation and improper dose decreased with use of the CPOE, but drug omission and administration at the wrong time were responsible for the increase. The authors blamed the system's inflexibility for the increase in errors. For instance, the CPOE set a time cutoff. If medication were ordered five minutes later, rather than going out with the morning administration round, it would not be administered until evening unless a special alert was sent to the nursing staff.

Jill Covyeou of Ferris State University in Big Rapids, Mich., and colleagues compared handwritten medication reconciliation charts and electronic charts. Overall accuracy was 51 percent in the handwritten charts and 63 percent in the electronic charts. Missing dates were the biggest problem with both types of charts.

The electronic system reduced the number of errors in the categories of missing information on dose frequency, missing dosage, and medication allergies when compared with handwritten charts.

They said pairing e-prescribing with electronic medical records would improve accuracy more than e-prescribing alone.

Hospitals that gave their pharmacists a lead role in medication reconciliation experienced fewer errors, a previous presentation at the conference this week concluded. Richard Mioni, of Chicago's Little Company of Mary Hospital and Health Care Centers (LCMH), reported that accuracy jumped from 32.3 percent to 94.2 percent after pharmacists took responsibility for assembling patient medication histories.

Meanwhile, a study published at the Journal of Medical Internet Research found that secure messaging can be an aid to medication reconciliation and workflow at primary care clinics because staff, rather than doctors, can handle many of patients' questions.

To learn more:
- find the article