Implementation of Computerized Physician Order Entry (CPOE) System to Reduce the Inpatients' Medication Near Miss Rate

摘要

In Taipei Medical University affiliated Wan Fang Hospital, the evolution of inpatient order entry was classified into three stages as the hand-writing stage, partial CPOE (scissors and glue) stage, and full CPOE (bankbook style) stage respectively. Medication-related error is by far the most common adverse events. It might be caused by different steps such as prescribing, dispensing, administering, monitoring and managing medications. CPOE is an important tool for prescribing. In the first and second stages of inpatients' CPOE, clinicians were facing sizable near miss rate of medications. Most near misses of inpatient orders didn't cause medical injuries or economic costs in our hospital. Yet it's a warning sign to push us to come up with an innovative way to make improvements towards this aspect Due to poor understanding of physicians' handwriting, the medical transcription clerks might key in wrong medications and cause medication near miss. In scissors and glue stages, it's not an outright CPOE system, handwriting of medication orders was allowed. During the first two stages, the near miss rate of medication error was substantially high as 2.19%. Therefore, we ask the physicians who were in charge of the inpatients to use the bankbook style CPOE to prescribe medications. We compare the near miss rates of inpatient medication orders which were regularly monitored in three different stages of our inpatient CPOE. Since Jan 1st 2007, bankbook style CPOE was implemented in our hospital; all physicians were asked to use this system to prescribe inpatient medication orders. The near miss rates before and after the implementation of bankbook style CPOE was 2.19% and 0.25% respectively. This CPOE system helped to reduce near miss rate of inpatient medication error.