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J Am Med Inform Assoc. 1999;6:313-321. DOI .
© 1999 American Medical Informatics Association

Research Paper

The Impact of Computerized Physician Order Entry on Medication Error Prevention

David W. Bates, MD, MSc1,2, Jonathan M. Teich, MD, PhD1,2, Joshua Lee, MD1, Diane Seger, RPh1,2, Gilad J. Kuperman, MD, PhD1,2, Nell Ma'Luf1, Deborah Boyle1 and Lucian Leape, MD3

1 Brigham and Women's Hospital and Harvard Medical School.
2 Partners Information Systems.
3 Harvard School of Public Health, Boston, Massachusetts.

Corresdpondence and reprints: David W. Bates, MD, MSc, Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. e-mail: <dwbates{at}bics.bwh.harvard.edu >.

Received for publication: 12/07/98; accepted for publication: 02/26/99.

Background: Medication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events.

Objective: To evaluate the impact of computerized physician order entry (POE) with decision support in reducing the number of medication errors.

Design: Prospective time series analysis, with four periods.

Setting and participants: All patients admitted to three medical units were studied for seven to ten-week periods in four different years. The baseline period was before implementation of POE, and the remaining three were after. Sophistication of POE increased with each successive period.

Intervention: Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings.

Main outcome measure: Medication errors, excluding missed dose errors.

Results: During the study, the non-missed-dose medication error rate fell 81 percent, from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period (P < 0.0001). Non-intercepted serious medication errors (those with the potential to cause injury) fell 86 percent from baseline to period 3, the final period (P = 0.0003). Large differences were seen for all main types of medication errors: dose errors, frequency errors, route errors, substitution errors, and allergies. For example, in the baseline period there were ten allergy errors, but only two in the following three periods combined (P < 0.0001).

Conclusions: Computerized POE substantially decreased the rate of non-missed-dose medication errors. A major reduction in errors was achieved with the initial version of the system, and further reductions were found with addition of decision support features.




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R. A. Miller, R. M. Gardner, K. B. Johnson, and G. Hripcsak
Clinical Decision Support and Electronic Prescribing Systems: A Time for Responsible Thought and Action
J. Am. Med. Inform. Assoc., July 1, 2005; 12(4): 403 - 409.
[Full Text] [PDF]

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 Qual Saf Health CareHome page
M M Cohen, N L Kimmel, M K Benage, M J Cox, N Sanders, D Spence, and J Chen
Medication safety program reduces adverse drug events in a community hospital
Qual. Saf. Health Care, June 1, 2005; 14(3): 169 - 174.
[Abstract] [Full Text] [PDF]

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 J Oncol Pharm PractHome page
A. S. Fabia, E. C. Rodrigo, A. A. Mari, D. A. Cubells, and N V. Jimenez Torres
Pharmaceutical validation as a process of improving the quality of antineoplastic treatment
Journal of Oncology Pharmacy Practice, June 1, 2005; 11(2): 45 - 50.
[Abstract] [PDF]

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 Journal of Health Politics, Policy and LawHome page
M. M. Mello, C. N. Kelly, and T. A. Brennan
Fostering Rational Regulation of Patient Safety
Journal of Health Politics Policy and Law, June 1, 2005; 30(3): 375 - 426.
[Abstract] [PDF]

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 JAMAHome page
L. L. Leape and D. M. Berwick
Five Years After To Err Is Human: What Have We Learned?
JAMA, May 18, 2005; 293(19): 2384 - 2390.
[Abstract] [Full Text] [PDF]

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 J. Am. Med. Inform. Assoc.Home page
C. J. Wang, R. S. Marken, R. C. Meili, J. B. Straus, A. B. Landman, and D. S. Bell
Functional Characteristics of Commercial Ambulatory Electronic Prescribing Systems: A Field Study
J. Am. Med. Inform. Assoc., May 1, 2005; 12(3): 346 - 356.
[Abstract] [Full Text] [PDF]

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 BMJHome page
K. Kawamoto, C. A Houlihan, E A. Balas, and D. F Lobach
Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success
BMJ, April 2, 2005; 330(7494): 765.
[Abstract] [Full Text] [PDF]

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 Qual Saf Health CareHome page
M Husch, C Sullivan, D Rooney, C Barnard, M Fotis, J Clarke, and G Noskin
Insights from the sharp end of intravenous medication errors: implications for infusion pump technology
Qual. Saf. Health Care, April 1, 2005; 14(2): 80 - 86.
[Abstract] [Full Text] [PDF]

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 Qual Saf Health CareHome page
M Weiner, T E Stump, C M Callahan, J N Lewis, and C J McDonald
Pursuing integration of performance measures into electronic medical records: beta-adrenergic receptor antagonist medications
Qual. Saf. Health Care, April 1, 2005; 14(2): 99 - 106.
[Abstract] [Full Text] [PDF]

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 Am J Health Syst PharmHome page
D. C. Spencer, A. Leininger, R. Daniels, R. P. Granko, and R. R. Coeytaux
Effect of a computerized prescriber-order-entry system on reported medication errors
Am. J. Health Syst. Pharm., February 15, 2005; 62(4): 416 - 419.
[Full Text] [PDF]

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 J. Am. Med. Inform. Assoc.Home page
R. L. Ohsfeldt, M. M. Ward, J. E. Schneider, M. Jaana, T. R. Miller, Y. Lei, and D. S. Wakefield
Implementation of Hospital Computerized Physician Order Entry Systems in a Rural State: Feasibility and Financial Impact
J. Am. Med. Inform. Assoc., January 1, 2005; 12(1): 20 - 27.
[Abstract] [Full Text] [PDF]

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 ASH Education BookHome page
W. H. Dzik
Technology for Enhanced Transfusion Safety
Hematology, January 1, 2005; 2005(1): 476 - 482.
[Abstract] [Full Text] [PDF]

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 Qual Saf Health CareHome page
N Barber
Designing information technology to support prescribing decision making
Qual. Saf. Health Care, December 1, 2004; 13(6): 450 - 454.
[Abstract] [Full Text] [PDF]

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 J. Am. Med. Inform. Assoc.Home page
T. C. Hsieh, G. J. Kuperman, T. Jaggi, P. Hojnowski-Diaz, J. Fiskio, D. H. Williams, D. W. Bates, and T. K. Gandhi
Characteristics and Consequences of Drug Allergy Alert Overrides in a Computerized Physician Order Entry System
J. Am. Med. Inform. Assoc., November 1, 2004; 11(6): 482 - 491.
[Abstract] [Full Text] [PDF]

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 Psychiatr. Serv.Home page
M. H. Trivedi, J. K. Kern, B. D. Grannemann, K. Z. Altshuler, and P. Sunderajan
A Computerized Clinical Decision Support System as a Means of Implementing Depression Guidelines
Psychiatr Serv, August 1, 2004; 55(8): 879 - 885.
[Abstract] [Full Text] [PDF]

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 ANN INTERN MEDHome page
C. L. Roumie, E. L. Grogan, W. Falbe, J. Awad, T. Speroff, R. S. Dittus, and T. A. Elasy
A Three-Part Intervention To Change the Use of Hormone Replacement Therapy in Response to New Evidence
Ann Intern Med, July 20, 2004; 141(2): 118 - 125.
[Abstract] [Full Text] [PDF]

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 J. Am. Med. Inform. Assoc.Home page
P. J. Embi, T. R. Yackel, J. R. Logan, J. L. Bowen, T. G. Cooney, and P. N. Gorman
Impacts of Computerized Physician Documentation in a Teaching Hospital: Perceptions of Faculty and Resident Physicians
J. Am. Med. Inform. Assoc., July 1, 2004; 11(4): 300 - 309.
[Abstract] [Full Text] [PDF]

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 J. Am. Med. Inform. Assoc.Home page
J. S. Sellman, D. Decarolis, A. Schullo-Feulner, D. B. Nelson, and G. A. Filice
Information Resources Used in Antimicrobial Prescribing
J. Am. Med. Inform. Assoc., July 1, 2004; 11(4): 281 - 284.
[Abstract] [Full Text] [PDF]

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 The Annals of PharmacotherapyHome page
T. Morera, G. Gervasini, J. A Carrillo, and J. Benitez
Using a Computerized Drug Prescription Screening System to Trace Drug Interactions in an Outpatient Setting
Ann. Pharmacother., July 1, 2004; 38(7): 1301 - 1306.
[Abstract] [Full Text] [PDF]

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 CMAJHome page
P. P. Choi, A. Day, and E. Etchells
Gaps in the care of patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease
Can. Med. Assoc. J., April 27, 2004; 170(9): 1409 - 1413.
[Abstract] [Full Text] [PDF]

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 Arch Intern MedHome page
A. Bobb, K. Gleason, M. Husch, J. Feinglass, P. R. Yarnold, and G. A. Noskin
The Epidemiology of Prescribing Errors: The Potential Impact of Computerized Prescriber Order Entry
Arch Intern Med, April 12, 2004; 164(7): 785 - 792.
[Abstract] [Full Text] [PDF]

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 J. Am. Med. Inform. Assoc.Home page
R. G. Berger and J.P. Kichak
Computerized Physician Order Entry: Helpful or Harmful?
J. Am. Med. Inform. Assoc., March 1, 2004; 11(2): 100 - 103.
[Abstract] [Full Text] [PDF]

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 J. Am. Med. Inform. Assoc.Home page
M. Bhosle and S. S. Sansgiry
Computerized Physician Order Entry Systems: Is the Pharmacist's Role Justified?
J. Am. Med. Inform. Assoc., March 1, 2004; 11(2): 125 - 126.
[Full Text] [PDF]

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 PediatricsHome page
A. E. Carroll, P. Tarczy-Hornoch, E. O'Reilly, and D. A. Christakis
The Effect of Point-of-Care Personal Digital Assistant Use on Resident Documentation Discrepancies
Pediatrics, March 1, 2004; 113(3): 450 - 454.
[Abstract] [Full Text] [PDF]

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 Arch Intern MedHome page
R. Kaushal, K. G. Shojania, and D. W. Bates
The Safety of Computer-Based Medication Systems--Reply
Arch Intern Med, February 9, 2004; 164(3): 340 - 340.
[Full Text] [PDF]

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 J. Am. Med. Inform. Assoc.Home page
D. S. Bell, S. Cretin, R. S. Marken, and A. B. Landman
A Conceptual Framework for Evaluating Outpatient Electronic Prescribing Systems Based on Their Functional Capabilities
J. Am. Med. Inform. Assoc., January 1, 2004; 11(1): 60 - 70.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
A. L. Potts, F. E. Barr, D. F. Gregory, L. Wright, and N. R. Patel
Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit
Pediatrics, January 1, 2004; 113(1): 59 - 63.
[Abstract] [Full Text] [PDF]

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 Qual Saf Health CareHome page
N Barber, M Rawlins, and B Dean Franklin
Reducing prescribing error: competence, control, and culture
Qual. Saf. Health Care, December 1, 2003; 12(90001): i29 - 32.
[Abstract] [Full Text] [PDF]


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