Int J Clin Pharm (2014) 36:1099–1100 DOI 10.1007/s11096-014-0028-5
LETTER TO THE EDITOR
Answer to the comment on ‘Potential medication errors associated with computer prescriber order entry’ E. Villaman˜a´n • M. Ruano • Y. Larrubia • T. Baumann • E. R. Armada • A. Herrero • ´ lvarez-Sala R. A
Received: 19 September 2014 / Accepted: 29 September 2014 / Published online: 28 October 2014 Ó Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014
Dear Editor, First, we would like to thank Fayaz-Bakhsh et al. for the comments related to our article that was published in your journal about electronic prescribing and medication errors [1]. We are in agreement about the importance of medication errors due to their negative effects on patients and their repercussions on the healthcare system. As is referenced in the letter, of the strategies directed to minimize errors, those that have demonstrated one of the best efficacy have been assisted CPOE and the development of prescription decision support. Nevertheless, this system, in our opinion, presents two important shortcomings: the introduction of new errors (as shown in our study) and the difficulty applying CPOE to special populations, such as pediatrics or critical patients. In accordance with the authors that you have referenced and along with the available evidence [2], CPOE has demonstrated a lower efficacy in reducing errors in pedi-
E. Villaman˜a´n (&) M. Ruano Y. Larrubia A. Herrero Pharmacy Department, La Paz University Hospital, Paseo de La Castellana 261, 28046 Madrid, Spain e-mail: [email protected] T. Baumann School of Pharmacy, University of Wisconsin – Madison, Madison, WI, USA E. R. Armada Cardiology Department, La Paz University Hospital, Madrid, Spain ´ lvarez-Sala R. A Pneumology Department, La Paz University Hospital, Madrid, Spain
atric patients compared to adults. There are risk factors specific to the pediatric population that may lead to medication errors. It has been seen that these generally occur in the prescribing phase and are due to incorrect unit conversions or incorrect dose calculations. In the pediatric population, it is common to make an error in the positioning of the decimal point, causing a tenfold change in dose. While in adults, medication errors related to dose calculations typically lead to a two-fold increase [3]. Thus, medication errors can more easily cause severe consequences in this vulnerable population. There is also the added inconvenience of the difficulty in adapting the CPOE programs, which are designed for adults, to the pediatric. In many cases, this is a complex process that causes many problems in hospitals that treat both adult and pediatric patients. Similarly, critical patients are another vulnerable population in which medication errors are caused by unit specific risk factors. The efficacy of CPOE is limited by the complexity and variability of each patient’s clinical case. The treatment of such patients requires continuous changes and the rapid implementation of the therapies may be hindered by the additional workflow of CPOE. This also introduces new errors from the use of this technology and fixed pharmaceutical management strategies, for example fluid-therapy [4]. These limitations make the use of these programs difficult in the critical care setting. For all these reasons, and in accordance with your letter, we also think that despite the value of the CPOE in increasing patient safety, such systems have two major drawbacks: the complexity to adapt them to specific patient populations and new errors related to this technology. It would be desirable that these programs include decision support specifically designed for different patient populations.
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References 1. Villaman˜a´n E, Larrubia Y, Ruano M, Ve´lez M, Armada E, Herrero ´ lvarezSala R. Potential medication errors associated with A, A computer prescriber order entry. Int J Clin Pharm. 2013;35: 577–83. 2. Conory S, Sweis D, Planner C, Yeung V, Collier J, Haines L, et al. Interventions to reduce dosing errors in children. A systematic review of the literature. Drug Saf. 2007;30:1111–25.
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Int J Clin Pharm (2014) 36:1099–1100 3. Lesar TS. Tenfold medication dose prescribing errors. Ann Phamacother. 2002;36:1833–9. 4. Armada ER, Villaman˜a´n E, Lo´pez de Sa´ E, Rosillo S, Rey JR, ´ lvarez-Sala R, Lo´pez-Sendo´n J. Computerized Testillano ML, A physician order entry in the cardiac intensive unit: effects on prescription error and workflow conditions. J Crit Care. 2014; 29:188–93.
LETTER TO THE EDITOR
Answer to the comment on ‘Potential medication errors associated with computer prescriber order entry’ E. Villaman˜a´n • M. Ruano • Y. Larrubia • T. Baumann • E. R. Armada • A. Herrero • ´ lvarez-Sala R. A
Received: 19 September 2014 / Accepted: 29 September 2014 / Published online: 28 October 2014 Ó Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014
Dear Editor, First, we would like to thank Fayaz-Bakhsh et al. for the comments related to our article that was published in your journal about electronic prescribing and medication errors [1]. We are in agreement about the importance of medication errors due to their negative effects on patients and their repercussions on the healthcare system. As is referenced in the letter, of the strategies directed to minimize errors, those that have demonstrated one of the best efficacy have been assisted CPOE and the development of prescription decision support. Nevertheless, this system, in our opinion, presents two important shortcomings: the introduction of new errors (as shown in our study) and the difficulty applying CPOE to special populations, such as pediatrics or critical patients. In accordance with the authors that you have referenced and along with the available evidence [2], CPOE has demonstrated a lower efficacy in reducing errors in pedi-
E. Villaman˜a´n (&) M. Ruano Y. Larrubia A. Herrero Pharmacy Department, La Paz University Hospital, Paseo de La Castellana 261, 28046 Madrid, Spain e-mail: [email protected] T. Baumann School of Pharmacy, University of Wisconsin – Madison, Madison, WI, USA E. R. Armada Cardiology Department, La Paz University Hospital, Madrid, Spain ´ lvarez-Sala R. A Pneumology Department, La Paz University Hospital, Madrid, Spain
atric patients compared to adults. There are risk factors specific to the pediatric population that may lead to medication errors. It has been seen that these generally occur in the prescribing phase and are due to incorrect unit conversions or incorrect dose calculations. In the pediatric population, it is common to make an error in the positioning of the decimal point, causing a tenfold change in dose. While in adults, medication errors related to dose calculations typically lead to a two-fold increase [3]. Thus, medication errors can more easily cause severe consequences in this vulnerable population. There is also the added inconvenience of the difficulty in adapting the CPOE programs, which are designed for adults, to the pediatric. In many cases, this is a complex process that causes many problems in hospitals that treat both adult and pediatric patients. Similarly, critical patients are another vulnerable population in which medication errors are caused by unit specific risk factors. The efficacy of CPOE is limited by the complexity and variability of each patient’s clinical case. The treatment of such patients requires continuous changes and the rapid implementation of the therapies may be hindered by the additional workflow of CPOE. This also introduces new errors from the use of this technology and fixed pharmaceutical management strategies, for example fluid-therapy [4]. These limitations make the use of these programs difficult in the critical care setting. For all these reasons, and in accordance with your letter, we also think that despite the value of the CPOE in increasing patient safety, such systems have two major drawbacks: the complexity to adapt them to specific patient populations and new errors related to this technology. It would be desirable that these programs include decision support specifically designed for different patient populations.
123
1100
References 1. Villaman˜a´n E, Larrubia Y, Ruano M, Ve´lez M, Armada E, Herrero ´ lvarezSala R. Potential medication errors associated with A, A computer prescriber order entry. Int J Clin Pharm. 2013;35: 577–83. 2. Conory S, Sweis D, Planner C, Yeung V, Collier J, Haines L, et al. Interventions to reduce dosing errors in children. A systematic review of the literature. Drug Saf. 2007;30:1111–25.
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Int J Clin Pharm (2014) 36:1099–1100 3. Lesar TS. Tenfold medication dose prescribing errors. Ann Phamacother. 2002;36:1833–9. 4. Armada ER, Villaman˜a´n E, Lo´pez de Sa´ E, Rosillo S, Rey JR, ´ lvarez-Sala R, Lo´pez-Sendo´n J. Computerized Testillano ML, A physician order entry in the cardiac intensive unit: effects on prescription error and workflow conditions. J Crit Care. 2014; 29:188–93.
