The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study
Abstract Background The medication process is complex and error-prone. To avoid medication errors, a medication order should fulfil certain criteria, such as good readability and comprehensiveness. In this context, a computerized physician order entry (CPOE) system can be helpful. This study aims to...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12911-021-01607-6 |
| _version_ | 1819109137661820928 |
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| author | Viktoria Jungreithmayr Andreas D. Meid Implementation Team Walter E. Haefeli Hanna M. Seidling |
| author_facet | Viktoria Jungreithmayr Andreas D. Meid Implementation Team Walter E. Haefeli Hanna M. Seidling |
| author_sort | Viktoria Jungreithmayr |
| collection | DOAJ |
| description | Abstract Background The medication process is complex and error-prone. To avoid medication errors, a medication order should fulfil certain criteria, such as good readability and comprehensiveness. In this context, a computerized physician order entry (CPOE) system can be helpful. This study aims to investigate the distinct effects on the quality of prescription documentation of a CPOE system implemented on general wards in a large tertiary care hospital. Methods In a retrospective analysis, the prescriptions of two groups of 160 patients each were evaluated, with data collected before and after the introduction of a CPOE system. According to nationally available recommendations on prescription documentation, it was assessed whether each prescription fulfilled the established 20 criteria for a safe, complete, and actionable prescription. The resulting fulfilment scores (prescription-Fscores) were compared between the pre-implementation and the post-implementation group and a multivariable analysis was performed to identify the effects of further covariates, i.e., the prescription category, the ward, and the number of concurrently prescribed drugs. Additionally, the fulfilment of the 20 criteria was assessed at an individual criterion-level (denoted criteria-Fscores). Results The overall mean prescription-Fscore increased from 57.4% ± 12.0% (n = 1850 prescriptions) before to 89.8% ± 7.2% (n = 1592 prescriptions) after the implementation (p < 0.001). At the level of individual criteria, criteria-Fscores significantly improved in most criteria (n = 14), with 6 criteria reaching a total score of 100% after CPOE implementation. Four criteria showed no statistically significant difference and in two criteria, criteria-Fscores deteriorated significantly. A multivariable analysis confirmed the large impact of the CPOE implementation on prescription-Fscores which was consistent when adjusting for the confounding potential of further covariates. Conclusions While the quality of prescription documentation generally increases with implementation of a CPOE system, certain criteria are difficult to fulfil even with the help of a CPOE system. This highlights the need to accompany a CPOE implementation with a thorough evaluation that can provide important information on possible improvements of the software, training needs of prescribers, or the necessity of modifying the underlying clinical processes. |
| first_indexed | 2024-12-22T03:21:03Z |
| format | Article |
| id | doaj.art-78e28588e5da49ee90399ae83bb4e24f |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-22T03:21:03Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-78e28588e5da49ee90399ae83bb4e24f2022-12-21T18:40:43ZengBMCBMC Medical Informatics and Decision Making1472-69472021-10-0121111210.1186/s12911-021-01607-6The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after studyViktoria Jungreithmayr0Andreas D. Meid1Implementation Team2Walter E. Haefeli3Hanna M. Seidling4Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University HospitalDepartment of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University HospitalHeidelberg University HospitalDepartment of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University HospitalDepartment of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University HospitalAbstract Background The medication process is complex and error-prone. To avoid medication errors, a medication order should fulfil certain criteria, such as good readability and comprehensiveness. In this context, a computerized physician order entry (CPOE) system can be helpful. This study aims to investigate the distinct effects on the quality of prescription documentation of a CPOE system implemented on general wards in a large tertiary care hospital. Methods In a retrospective analysis, the prescriptions of two groups of 160 patients each were evaluated, with data collected before and after the introduction of a CPOE system. According to nationally available recommendations on prescription documentation, it was assessed whether each prescription fulfilled the established 20 criteria for a safe, complete, and actionable prescription. The resulting fulfilment scores (prescription-Fscores) were compared between the pre-implementation and the post-implementation group and a multivariable analysis was performed to identify the effects of further covariates, i.e., the prescription category, the ward, and the number of concurrently prescribed drugs. Additionally, the fulfilment of the 20 criteria was assessed at an individual criterion-level (denoted criteria-Fscores). Results The overall mean prescription-Fscore increased from 57.4% ± 12.0% (n = 1850 prescriptions) before to 89.8% ± 7.2% (n = 1592 prescriptions) after the implementation (p < 0.001). At the level of individual criteria, criteria-Fscores significantly improved in most criteria (n = 14), with 6 criteria reaching a total score of 100% after CPOE implementation. Four criteria showed no statistically significant difference and in two criteria, criteria-Fscores deteriorated significantly. A multivariable analysis confirmed the large impact of the CPOE implementation on prescription-Fscores which was consistent when adjusting for the confounding potential of further covariates. Conclusions While the quality of prescription documentation generally increases with implementation of a CPOE system, certain criteria are difficult to fulfil even with the help of a CPOE system. This highlights the need to accompany a CPOE implementation with a thorough evaluation that can provide important information on possible improvements of the software, training needs of prescribers, or the necessity of modifying the underlying clinical processes.https://doi.org/10.1186/s12911-021-01607-6Computerized physician order entry systemEvaluation resultsMedication prescriptionDocumentation errors |
| spellingShingle | Viktoria Jungreithmayr Andreas D. Meid Implementation Team Walter E. Haefeli Hanna M. Seidling The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study BMC Medical Informatics and Decision Making Computerized physician order entry system Evaluation results Medication prescription Documentation errors |
| title | The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study |
| title_full | The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study |
| title_fullStr | The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study |
| title_full_unstemmed | The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study |
| title_short | The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study |
| title_sort | impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation a before and after study |
| topic | Computerized physician order entry system Evaluation results Medication prescription Documentation errors |
| url | https://doi.org/10.1186/s12911-021-01607-6 |
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