Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices. Clinical-Practice Context


Over at least two decades, concerns have grown about the prevalence and impact of medication errors. It is estimated that more than 1 million serious medication errors occur annually in the United States, contributing to 7,000 annual medication-error-related deaths (Kuperman, Bobb, et al., 2007). On average, a medication error is estimated to add $2,000 to the cost of hospitalization. These numbers suggest that medication errors account for roughly $7.5 billion a year nationwide in hospital costs alone (Leapfrog Group, 2008). Medication (prescribing) errors occur for many reasons. Traditionally, physicians have relied on paper-based, handwritten prescribing, followed by the actions of nurses, pharmacists, and others who administer medications. Prescribing errors are introduced when physicians accidentally prescribe the wrong drug or the wrong dose, overlook drug-drug interactions, fail to note patient allergies, or provide orders with illegible handwriting. While most of these errors are caught and corrected before they can harm patients, those that reach patients can have devastating consequences. Medication errors are also associated with wasteful spending, including payments for the wrong medications, and substantial costs for treatment of severe adverse events.

CPOE has been proposed as a way to reduce medication errors. The first CPOE system (called a “medical information system”) was developed by Lockheed Corporation and implemented at El Camino Hospital in Mountain View, Calif., in 1971. In the decades following implementation of this prototype system, CPOE has evolved considerably. For example, early systems could handle prescriptions but not refills. Although CPOE systems became substantially more sophisticated and embedded as potentially usable applications within hospital information systems, only a handful of hospitals actually implemented CPOE during the 1980s (e.g., Wishard Memorial Hospital in Indianapolis, Ind., and LDS Hospital in Salt Lake City, Utah).

Skepticism about the utility of these systems, their costs, the costs of installation and training, and the willingness of providers to use them were frequently stated reasons for not implementing CPOE. Hospital executives may also have sensed that better technology would be developed in a short time and would render any acquisition and installation obsolete.

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