Researching errors in computerized prescriber order entry (CPOE) in order to boost patient safety is the focus of a year-long research project to be conducted by the Center for Patient Safety Research and Practice at the Brigham and Women's Hospital and Harvard Medical School.
The center will partner with Quantros, Inc., a Silicon Valley-based software company that manages MEDMARX, the largest adverse drug event database in the world, to research errors that have been reported to be associated with CPOE. MEDMARX provides hospitals and health systems with an Internet-accessible database to track and trend adverse drug reactions and medication errors. Since its inception the database has collected more than 1.5 million medication errors from more than 800 hospitals and health systems.
Researchers from the Center for Patient Safety Research and the Quantros Patient Safety Center, a federally certified Patient Safety Organization at Quantros, will investigate about 200,000 MEDMARX records where CPOE was listed as a contributing factor.
"We owe it to the people who took the time to document these problems, and learn everything we can from them, not to mention the patients who have experienced problems. We owe it to them to help make sure that future patients don't experience similar problems," said Gordon Schiff, MD, the Center's associate director and principal investigator of the project.
The research project will focus on such topics as:
- Creating descriptive statistics to analyze the drugs, dosing issues, prescribing and dispensing issues, outcomes and other contributing factors identified by the reporters of CPOE-related errors;
- Extracting insights from report narratives to better understand the nature and mechanism of the reported CPOE-related errors and how better designed systems might have prevented them: and
- Developing and testing a new classification for CPOE-related errors and process failure modes to collect more useful data.
"The overriding goal is to better understand CPOE the technology that has been proven to improve medication safety and evaluate potential problems to make sure that we identify and uproot those problems in the best possible ways," said Schiff. "The overarching goal is to learn from the experiences of people out on the front lines who are using CPOE systems as to some of the potential problems so their efforts in reporting, which is a very important part of our patient safety infrastructure. The rich data from such reports needs to be aggregated across the hundreds of reporting hospitals and analyzed for recurring preventable factors that can be targeted for improving the technology and healthcare practices."
Investigators will also test vulnerability of leading CPOE systems. "Although use of CPOE reduces adverse drug events significantly, there is still room for improvement. This project is about understanding how to further improve CPOE by applying new knowledge from such studies," said Ali Rashidee, MD, Quantros director for safety and risk management and a principal investigator on the project.
"Our goal is that we use our safety data to understand and provide feedback for furthering point of care systems, such as CPOE systems, so they can be improved upon and made safer," added Sanjaya Kumar, MD, CEO and chief medical officer at Quantros.
The project is being funded by a grant from the National Patient Safety Foundation.
