J Am Med Inform Assoc - The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals.

Tópicos

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Resumo

JECTIVES: To compare the manifestations, mechanisms, and rates of system-related errors associated with two electronic prescribing systems (e-PS). To determine if the rate of system-related prescribing errors is greater than the rate of errors prevented.METHODS: Audit of 629 inpatient admissions at two hospitals in Sydney, Australia using the CSC MedChart and Cerner Millennium e-PS. System related errors were classified by manifestation (eg, wrong dose), mechanism, and severity. A mechanism typology comprised errors made: selecting items from drop-down menus; constructing orders; editing orders; or failing to complete new e-PS tasks. Proportions and rates of errors by manifestation, mechanism, and e-PS were calculated.RESULTS: 42.4% (n=493) of 1164 prescribing errors were system-related (78/100 admissions). This result did not differ by e-PS (MedChart 42.6% (95% CI 39.1 to 46.1); Cerner 41.9% (37.1 to 46.8)). For 13.4% (n=66) of system-related errors there was evidence that the error was detected prior to study audit. 27.4% (n=135) of system-related errors manifested as timing errors and 22.5% (n=111) wrong drug strength errors. Selection errors accounted for 43.4% (34.2/100 admissions), editing errors 21.1% (16.5/100 admissions), and failure to complete new e-PS tasks 32.0% (32.0/100 admissions). MedChart generated more selection errors (OR=4.17; p=0.00002) but fewer new task failures (OR=0.37; p=0.003) relative to the Cerner e-PS. The two systems prevented significantly more errors than they generated (220/100 admissions (95% CI 180 to 261) vs 78 (95% CI 66 to 91)).CONCLUSIONS: System-related errors are frequent, yet few are detected. e-PS require new tasks of prescribers, creating additional cognitive load and error opportunities. Dual classification, by manifestation and mechanism, allowed identification of design features which increase risk and potential solutions. e-PS designs with fewer drop-down menu selections may reduce error risk.

Resumo Limpo

jectiv compar manifest mechan rate systemrel error associ two electron prescrib system ep determin rate systemrel prescrib error greater rate error preventedmethod audit inpati admiss two hospit sydney australia use csc medchart cerner millennium ep system relat error classifi manifest eg wrong dose mechan sever mechan typolog compris error made select item dropdown menus construct order edit order fail complet new ep task proport rate error manifest mechan ep calculatedresult n prescrib error systemrel admiss result differ ep medchart ci cerner n systemrel error evid error detect prior studi audit n systemrel error manifest time error n wrong drug strength error select error account admiss edit error admiss failur complet new ep task admiss medchart generat select error p fewer new task failur p relat cerner ep two system prevent signific error generat admiss ci vs ci conclus systemrel error frequent yet detect ep requir new task prescrib creat addit cognit load error opportun dual classif manifest mechan allow identif design featur increas risk potenti solut ep design fewer dropdown menu select may reduc error risk

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