Healthcare News & Insights

Reduce medication errors with CPOE

ThinkstockPhotos-123467068While hospitals have boosted patient safety overall, one big problem still persists: medication errors. They’re the most common mistakes made in hospitals, and they can have deadly consequences. A computerized physician order entry (CPOE) system can cut back on these errors – but only if it’s efficient. 

A new report by the Leapfrog Group examines just how effective CPOE systems are in helping clinicians avoid medication errors, which occur in 3.8 million inpatient admissions each year and raise healthcare costs by $16.4 billion. The vast majority of these errors occur due to manual ordering and transcribing, which is why CPOE can help cut back on these problems.

More and more hospitals are using CPOE systems, according to the Leapfrog Group’s report. In 2014, over 1,330 hospitals reported they were using computerized order entry, which is more than triple the number of hospitals that reported using one in 2010.

Meeting standards

But it’s not enough to have a CPOE system. Clinicians must use it consistently and regularly when ordering medication, replacing manual orders entirely. And the system also needs to flag potential errors for clinicians.

The Leapfrog Group has a standard that hospitals should meet to ensure their CPOE systems are effective, and it consists of two main goals:

  1. At least 75% of medication orders in all inpatient units must be ordered with the computerized entry system.
  2. The hospital must test the system to make sure that it alerts clinicians to at least 50% of common, serious medication and prescription errors before they harm patients.

This year, almost 60% of hospitals examined in the report met this standard with their CPOE systems.

Put systems to test

The Leapfrog Group has its own test hospitals can use to see if their systems properly alert them of problems with patient medication. The CPOE Evaluation tool was developed by several leading researchers and funded by the Agency for Healthcare Research and Quality (AHRQ) – and it’s the only test available for CPOE systems in U.S. hospitals.

By downloading a file containing info about several test patients and test medication orders, hospitals can see how their CPOE system responds when it tries to process those test orders. Results are scored based on how well the system alerts clinicians to potential medication conflicts.

Many hospitals reviewed in the report put their own CPOE systems to the test. In fact, the Leapfrog evaluation tool was used 1,249 times last year – a 30% increase over 2013’s numbers.

While many errors were flagged during testing, a significant portion went unnoticed. In 2014, 36% of orders with any type of issue with the medication prescribed didn’t trigger an alert from the computer system, and 14% of potentially fatal medication errors weren’t flagged at all.

From this information, it’s clear: Using a computerized order entry system is an excellent step toward ensuring patient safety in hospitals, but it’s not enough on its own. Any system that a hospital implements must be regularly reviewed and tested to make sure it’s appropriately alerting clinicians of potential errors.

Hospitals can visit the Leapfrog Group’s website and use its free evaluation tool to make sure their hospital’s system stands up to the test.

Why CPOE is worthwhile

Although the numbers are increasing, most hospitals still aren’t using CPOE systems. Many facilities cite cost as a major barrier, since customizing a system to meet a hospital’s individual needs can get expensive. It’s also time consuming, requiring additional training for physicians, clinical staff and pharmacists.

But in most cases, it’s worth the effort, and information from the Leapfrog Group shows why that’s the case.

Example: Brigham and Women’s Hospital implemented its own customized CPOE system. The initial cost was $1.9 million, and the facility spends an additional $500,000 annually to maintain it. However, the hospital’s saved between $5 and $10 million each year since it started using the system.

Besides the cost savings, it also reduced medication errors dramatically. In fact, one study at Brigham and Women’s showed that CPOE reduced error rates by 55%. A subsequent study at the facility showed even more promising results – serious medication errors had fallen by 88%.

The sharp reductions in error rates were entirely due to the CPOE system’s internal structure for medication orders and the automatic checks it performed on medications.

Other facilities who have implemented a CPOE system have reported significant decreases in:

  • Patient length of stay, and
  • Pharmacy, radiology and lab turnaround times.

What your hospital can do

The multiple benefits of CPOE can outweigh the initial costs – especially in an environment where hospitals are increasingly subject to financial penalties for negative patient outcomes.

Your facility may want to explore whether you can customize your electronic health records (EHR) system to include CPOE, if it doesn’t have those capabilities already. Not only will it help improve patient safety at your hospital, it’s also a key measure hospitals must meet with the meaningful use program for EHRs.

If you already have a CPOE system, it’s key to test it regularly to ensure it’s working properly and is compliant with current safety standards for prescribing medications, which will help your facility meet meaningful use requirements.

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