Medication administration discrepancies persist despite electronic ordering.

Area of Science:

• Health Informatics
• Patient Safety
• Clinical Pharmacy

Background:

• Up to 38% of inpatient medication errors occur during administration.
• Computerized provider order entry (CPOE) systems improve prescribing but not administration accuracy.
• Timing discrepancies in medication administration remain a significant patient safety concern.

Purpose of the Study:

• To determine the extent to which computerized provider order entry (CPOE) medication orders align with actual medication administration times.
• To quantify medication administration discrepancies in an inpatient setting with CPOE.

Main Methods:

• Retrospective chart audits of adult patients at an academic hospital.
• Analysis of historical CPOE log files (1999-2003) and manual chart reviews.
• Evaluation of dose omissions, lag times, dose errors, and nursing schedule shifts.

Main Results:

• Dose omissions occurred in 12.6% of administration opportunities.
• Median lag time between ordered and actual administration was 27 minutes.
• Nurses shifted medication schedules for 10.7% of recurring orders, with identified reasons for discrepancies.

Conclusions:

• Inpatient medication administration does not consistently adhere to CPOE orders.
• Significant discrepancies in timing and omissions persist despite CPOE implementation.
• Addressing urgency, order duplication, and safe schedule shifting is crucial for improving medication administration safety.