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dc.contributor.authorAbraham, Joanna
dc.contributor.authorKannampallil, Thomas, G.
dc.contributor.authorJarman, Alan
dc.contributor.authorSharma, Shivy
dc.contributor.authorRash-Foanio, Christine
dc.contributor.authorSchiff, Gordon, D.
dc.contributor.authorGalanter, William, L.
dc.date.accessioned2018-06-25T17:01:46Z
dc.date.available2018-06-25T17:01:46Z
dc.date.issued2017-07-11
dc.identifier.issn2044-5415
dc.identifier.other10.1136/bmjqs-2017-006606
dc.identifier.urihttp://hdl.handle.net/10027/22400
dc.descriptionCopyright @ BMJ Publishing Groupen_US
dc.description.abstractObjective:Medication voiding is a computerised provider order entry (CPOE)-based discontinuation mechanism that allows clinicians to identify erroneous medication orders. We investigated the accuracy of voiding as an indicator of clinician identification and interception of a medication ordering error, and investigated reasons and root contributors for medication ordering errors. Method: Using voided orders identified with a void alert, we conducted interviews with ordering and voiding clinicians, followed by patient chart reviews. A structured coding framework was used to qualitatively analyse the reasons for medication ordering errors. We also compared clinician-CPOE-selected (at time of voiding), clinician-reported (interview) and chart review-based reasons for voiding. Results: We conducted follow-up interviews on 101 voided orders. The positive predictive value (PPV) of voided orders that were medication ordering errors was 93.1% (95% CI 88.1% to 98.1%, n=94). Using chart review-based reasons as the gold standard, we found that clinician-CPOE-selected reasons were less reflective (PPV=70.2%, 95% CI 61.0% to 79.4%) than clinician-reported (interview) (PPV=86.1%, 95%CI 78.2% to 94.1%) reasons for medication ordering errors. Duplicate (n=44) and improperly composed (n=41) ordering errors were common, often caused by predefined order sets and data entry issues. A striking finding was the use of intentional violations as a mechanism to notify and seek ordering assistance from pharmacy service. Nearly half of the medication ordering errors were voided by pharmacists. Discussion: We demonstrated that voided orders effectively captured medication ordering errors. The mismatch between clinician-CPOE-selected and the chart review-based reasons for error emphasises the need for developing standardised operational descriptions for medication ordering errors. Such standardisation can help in accurately identifying, tracking, managing and sharing erroneous orders and their root contributors between healthcare institutions, and with patient safety organisations.en_US
dc.language.isoen_USen_US
dc.publisherBMJ Publishing Groupen_US
dc.subjectMedication errorsen_US
dc.subjectpatient safetyen_US
dc.subjectCPOEen_US
dc.subjectmedication order voidingen_US
dc.titleReasons for computerised provider order entry (CPOE)-based inpatient medication ordering errors: an observational study of voided ordersen_US
dc.typeArticleen_US
dc.identifier.citationAbraham, J., Kannampallil, T. G., Jarman, A., Sharma, S., Rash, C., Schiff, G. and Galanter, W. Reasons for computerised provider order entry (CPOE)-based inpatient medication ordering errors: An observational study of voided orders. BMJ Quality and Safety. 2018. 27(4): 299-307. 10.1136/bmjqs-2017-006606.en_US


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