Free-Text Computerized Provider Order Entry Orders Used as Workaround for Communicating Medication Information

• Type of Material: Article
• Authors: Swaminathan Kandaswamy, Emory University; Joanna Grimes, MedStar Health National Center for Human Factors in Healthcare; Daniel Hoffman, University of Maryland; Jenna Marquard, University of Minnesota; Raj M. Ratwani, MedStar Health National Center for Human Factors in Healthcare; Aaron Z. Hettinger, MedStar Health National Center for Human Factors in Healthcare
• Language: English
• Date: 2022-08-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/PTS.0000000000000948
• Title of Journal or Parent Work: JOURNAL OF PATIENT SAFETY
• Volume: 18
• Issue: 5
• Start Page: 430
• End Page: 434
• Grant/Funding Information: This manuscript was supported in part by grants numbers R01HS025136 and R21 HS024755 from the Agency for Healthcare Research and Quality.
• Keywords: IMPACT; electronic health records; workaround; ELECTRONIC HEALTH RECORD; Health Policy & Services; Health Care Sciences & Services; communication; Life Sciences & Biomedicine; Science & Technology; safety
• Research Categories: Health Sciences, Health Care Management; Mass Communications

Abstract

Objectives Medication information is frequently communicated via free-text computerized provider order entry (CPOE) orders in electronic health records. When such information is transmitted separately from a structured CPOE medication order, there is a significant risk of medication error. Although prior studies have described the frequency of using free-text CPOE orders for communicating medication information, there is a gap in understanding the nature of the medication information contained in the free-text CPOE orders. The aims of this study are to (1) identify the most common medication names communicated in free-text CPOE orders and their risk levels and (2) identify what actions physicians expect that nurses will complete when they place free-text CPOE orders, and (3) describe differences in these patterns across hospitals. Methods This study was a retrospective analysis of a sample of 26,524 free-text CPOE orders from 6 hospitals in the mid-Atlantic U.S. region. Results Free-text CPOE orders contained in the sample mentioned 193 medication names. Free-text CPOE orders were used frequently to communicate information about naloxone, heparin, flumazenil, and dextrose. Twenty-two percent of the free-text CPOE orders related to discontinuing medication(s), whereas 7% of the free-text CPOE orders relate to giving medication(s). There was high variation across hospitals both in the percentage of free-text CPOE orders mentioning medication information and in the proportion of those that referred to high-risk medications. Conclusions The prevalence of medication information in free-text CPOE orders may suggest specific communication challenges in respect to urgency, uncertainty, planning, and other aspects of communication and clinical needs. Understanding and addressing communication challenges around commonly mentioned medication names and actions, especially those that are high risk, can help reduce the risk of medication errors.