CPOE can avert 17.4M med errors annually, but uptake remains ‘modest’

Despite the effectiveness of computerized provider order entry (CPOE) systems at preventing medication errors, adoption and use in U.S. hospitals remain modest, according to a study in the March issue of the Journal of the American Medical Informatics Association.

The Institute of Medicine (IOM) estimates that, on average, hospitalized patients are subject to at least one medication error per day. The IOM also estimates that at least one-quarter of all medication-related injuries are preventable, and recommends e-prescribing through a CPOE system as one way to reduce medication errors and patient harm (JAMA 1990;263:2329-2334).

David C. Radley, PhD, MPH, health policy analyst at the Institute for Healthcare Improvement in Cambridge, Mass., and colleagues said their study’s objective was to derive a nationally representative estimate of medication error reduction in hospitals attributable to e-prescribing through CPOE systems.

The researchers conducted a systematic literature review and applied random-effects meta-analytic techniques to derive a summary estimate of the effect of CPOE on medication errors. This pooled estimate was combined with data from the 2006 American Society of Health-System Pharmacists annual survey, the 2007 American Hospital Association Annual Survey and the latter’s 2008 EHR Adoption Database supplement to estimate the percentage and absolute reduction in medication errors attributable to CPOE.

They found that processing a prescription drug order through a CPOE system decreases the likelihood of error on that order by 48 percent.

Given this effect size, and the degree of CPOE adoption and use in hospitals in 2008, the researchers estimated a 12.5 percent reduction in medication errors, or approximately 17.4 million medication errors averted in the U.S. in one year.

“Our findings suggest that CPOE can substantially reduce the frequency of medication errors in inpatient acute-care settings; however, it is unclear whether this translates into reduced harm for patients,” Radley et al colleagues.

Thus, the authors suggested that current U.S. government policies, such as the HITECH Act, to increase CPOE adoption and use will likely prevent millions of additional medication errors each year, but they acknowledged that further research is needed to better characterize links to patient harm.