Thursday, June 03, 2010

Should we take the P out of CPOE?

Maybe according to this study:

To investigate whether a collaborative order entry method consisting of nurse order entry (NOE) followed by physician verification and countersignature is as effective as a strictly physician order entry (POE) method in reducing nonintercepted dose and frequency medication errors in the neonatal ward of an Iranian teaching hospital...

Medication prescribing for 158 neonates was studied. The rate of nonintercepted medication errors during the NOE period was 40% lower than during the POE period (rate ratio 0.60; 95% confidence interval [CI] .50, .71; P less than .001). During the POE period, 80% of nonintercepted errors occurred at the prescription stage, while during the NOE period, 60% of nonintercepted errors occurred in that stage. Prescription errors decreased from 10.3% during the POE period to 4.6% during the NOE period (P less than .001), and the number of warnings with which physicians complied increased from 44% to 68% respectively (P less than .001). Meanwhile, transcription errors showed a nonsignificant increase from the POE period to the NOE period. The median error per patient was reduced from 2 during the POE period to 0 during the NOE period (P= .005). Underdose and curtailed and prolonged interval errors were significantly reduced from the POE period to the NOE period. The rate of nonintercepted overdose errors remained constant between the two periods. However, the severity of overdose errors was lower in the NOE period (P = .02).

As explained in the body of the paper the NOE phase was similar to traditional paper based physician orders.

It is widely claimed that CPOE enhances patient safety by taking people (and consequently opportunities for error) out of the loop down stream. That's a popular canard and evidence, as provided by this paper, suggests otherwise. Those extra people downstream just may be a layer of safety!

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