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Ross Koppel

Publications and source records attributed to Ross Koppel.

6 recordsLinked to original sources
PubMed2005

What do we know about medication errors made via a CPOE system versus those made via handwritten orders?

This commentary on the article by Shulman et al. examines what we understand by 'medication errors', what we mean by 'computerized physician order entry (CPOE) systems', how we measure errors, and what types of errors we are 'reducing' with CPOE systems. As the research of Shulman and colleagues highlights, much of the existing research on CPOE systems does not differentiate among: types of medication errors; consequential versus inconsequential medication errors; CPOE systems that include/exclude formal decision support packages; and the extent to which decision support information is implicitly presented to physicians via the CPOE system, for example, pull down menus with dosages. I discuss these issues and their implications for the evaluation of CPOE systems and of other emerging healthcare technologies.

Clinical Pharmacy Information Systems↗
PubMed2005

Role of computerized physician order entry systems in facilitating medication errors.

CONTEXT: Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE. OBJECTIVE: To identify and quantify the role of CPOE in facilitating prescription error risks. DESIGN, SETTING, AND PARTICIPANTS: We performed a qualitative and quantitative study of house staff interaction with a CPOE system at a tertiary-care teaching hospital (2002-2004). We surveyed house staff (N = 261; 88% of CPOE users); conducted 5 focus groups and 32 intensive one-on-one interviews with house staff, information technology leaders, pharmacy leaders, attending physicians, and nurses; shadowed house staff and nurses; and observed them using CPOE. Participants included house staff, nurses, and hospital leaders. MAIN OUTCOME MEASURE: Examples of medication errors caused or exacerbated by the CPOE system. RESULTS: We found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients' medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction. CONCLUSIONS: In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.

Clinical Pharmacy Information Systems↗
PubMed2005

Medication safety in older adults: home-based practice patterns.

OBJECTIVES: To identify the current state of medication-taking practices of community-dwelling older adults on high-risk medications. DESIGN: Telephone survey of older adults filling prescriptions for warfarin, digoxin, or phenytoin from May 2, 2002, through June 30, 2003. SETTING: The Pennsylvania Pharmacy Assistance Contract for the Elderly (PACE) Program, a state-run program providing prescription drug coverage for poor older adults. PARTICIPANTS: PACE members. MEASUREMENTS: Patients self-reported sources of information on current medications as well as home-based practices for organizing medication regimens. RESULTS: Four thousand nine hundred fifty-five PACE members were interviewed. Thirty-two percent of the sample reported that they had not received any specific instructions about their medications, 35% reported that they received instructions from their primary care provider, and 46% indicated they received them from a pharmacist. Fifty-four percent of participants indicated that they used a pillbox for organizing their medications. Older adults prescribed warfarin were more likely to report receiving instructions than those prescribed digoxin or phenytoin. CONCLUSION: A substantial proportion of older adults on high-risk medications do not recall receiving instructions for the use of their medications and do not take advantage of existing systems for organizing medication regimens. Improved patient education and delivery of medication organization systems are immediate opportunities to potentially reduce the risk of medication errors in older people.

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PubMed2005

Computerized physician order entry systems: the right prescription?

Policymakers increasingly urge the use of information technology to improve the quality and efficiency of health care. In particular, computerized physician order entry (CPOE) is emphasized for its ability to reduce prescribing errors inherent in paper-based systems. This Issue Brief summarizes research that sounds a cautionary note about the potential for computerized systems to facilitate medication errors, as well as reduce them.

Clinical Pharmacy Information Systems↗