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More refining sought for computerized physician order entry systems

A study found that a CPOE drastically sliced times on doctor order delivery but introduced medication errors in a surgical setting.

By Pamela Lewis Dolan — Posted June 5, 2009

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Implementing a computerized physician order entry system helped improve efficiencies at the Mayo Clinic in Scottsdale/Phoenix, Ariz., but did not reduce medication errors. In some cases, the system actually helped create errors, according to a study by Mayo physicians published in the May Journal of the American College of Surgeons (link).

According to the study, "Impact of a Computerized Physician Order-Entry System," Mayo's system, installed in stages from May 2007 through April 2008, reduced the time it took for a physician order to be received by a nurse from 41.2 minutes to 27 seconds. This improved process not only allowed patients to get needed medication or tests quicker but also allowed the hospital to reduce staff by 19.6%, saving $445,500.

While previous studies have shown that CPOEs decrease medication errors in the hospital setting, the Mayo study looked at those numbers in the inpatient surgical setting. Due to the standard order sets associated with surgical procedures and the variable nature of orders associated with general medical care, errors are usually lower in the surgical setting. That did not happen in Mayo's case.

During the six months before CPOE implementation, 15 medication errors occurred in the course of 6,815 surgical procedures. During the first six months after the launch, 10 errors occurred in 5,963 surgical procedures. During the second six months after implementation, 13 errors were reported in 6,106 surgical procedures.

Study co-author William M. Stone, MD, a vascular surgeon at Mayo, said that although the system helped reduce some errors, it actually helped create others. This canceled out the reductions.

"That did surprise us a little bit," Dr. Stone said. He said the ability to toggle between two patients on the computer made it possible for medication to be ordered for the wrong patient. He believes studies such as this will help system developers solve some of the glitches that allow these errors to occur.

Overall, Dr. Stone said, the study was helpful. "It made us aware that we have some work to do and that, even though sometimes we implement these things and we think it's going to be a positive influence, we have to find out why it didn't achieve exactly what we wanted it to. And we are doing some things to try to eliminate some of the problems that it may have created to offset the gains."

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