Computerized Physician Order Entry (CPOE) Systems: Debate Over CPOE Increasing Risk of Some Medication Errors, Not Lowering Risk of Drug Mistakes

Posted By on December 19, 2013

Last Update: 01/27/16

CPOE Patient Management Systems Do Not Stop Medication Errors

For several years now, there’s been a lot of discussion over the implementation of the computerized physician order entry (CPOE) systems in the United States as a means of increasing patient safety from the dangers of medication errors along with other health care mistakes. However, it’s not at all clear that CPOE works like magic to remove or negate the potential for drug mistakes or medication errors in hospitals, drug stores, clinics, pharmacies, etc.  There are some who challenge the use of CPOEs by saying these systems cause errors and mistakes to be made, not decreasing the risk of medication errors and drug mistakes.

What is CPOE?

Computerized Provider Order Entry involves computers and computer technology; it is a system where doctors’ prescriptions, instructions and diagnoses, etc., are all placed into computer databases where the information can be accessed and shared by the doctor, staff, any nurses or caretakers at a hospital or nursing care facility, as well as the local pharmacy or lab. CPOE is argued as a health care advancement because it speeds up the care given to the patient by faster communication between various health care providers, as well as decreasing the likelihood of medication errors for the patient.

From the National Institute of Health:

…Computerized physician order entry (CPOE) is a promising technology that allows physicians to enter orders into a computer instead of handwriting them. Because CPOE fundamentally changes the ordering process, it can substantially decrease the overuse, underuse, and misuse of health care services. Studies have documented that CPOE can decrease costs, shorten length of stay, decrease medical errors, and improve compliance with several types of guidelines. … Computerized physician order entry is a relatively new technology, and there is no consensus on the best approaches to many of the challenges it presents. This technology can yield many significant benefits and is an important platform for future changes to the health care system….

In sum, CPOE is a patient care management system designed to provide information about the patient and their health care needs to all sorts of health care providers through the use of a shared database file(s).

CPOE and Medication Errors and Drug Mistakes

Proponents of computerization of patient records argue that CPOE helps to prevent medication errors and drug mistakes. Reducing the risk of medication errors or drug mistakes through the use of Computerized Provider Order Management does make sense if the error comes from a badly written prescription on a doctor’s prescription pad or illegible instructions on a medical chart. It’s easier to read something typed on a screen than some scribble on a piece of paper.

One recent study published in the Journal of the American Medical Infomatics Association reported that medication errors and drug mistakes “… can cut drug errors in half, and could avoid more than 17 million adverse incidents annually.” That’s a tremendous help to patients who might otherwise have suffered serious injury or death due to a medication error or drug dosage mistake.

However, this patient management software system is also the cause and reason for other kinds of medication errors and drug dosage mistakes, others argue. Oregon Health and Science University is researching the “unintended consequences” of implementing CPOE systems in hospitals.

The reality is that there are still medication errors resulting in adverse drug events in U.S. hospitals that have implemented and are using a CPOE system. What is going on?

The federal government is looking into this quandry and so far its findings include:

1. Decision support in overriding alerts isn’t reducing harm from medication errors (the CPOE alerts are often overriden by prescribers – see image above); and
2. Lots of medication errors happen when the drugs are either being dispensed to be given to the patient or when the patient is actually being given the medication, and neither one of these situations is impacted by what is recorded on the CPOE database.

Accordingly, while many are working toward implementation of computerized patient management systems in the United States, the risk of medication errors and drug mistakes isn’t going away so much as medication errors and drug mistakes may simply be happening in different ways.

What Should You Do Now?

A good piece of advice if you have been harmed by a medication error, is to at least speak with an experienced personal injury lawyer before you file a claim to learn about some of the issues that can arise with these claims, including the type of evidence needed to prove a claim and the type and amount of damages you can recover. Most personal injury lawyers, like Alan Sackrin, will offer a free initial consultation (over the phone or in person) to answer your questions.

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