Effects of computerized physician order entry on prescribing practices

Background: Computerized order entry systems have the potential to prevent errors, to improve quality of care, and to reduce costs by providing feedba ck and suggestions to the physician as each order is entered. This study as sesses the impact of an inpatient computerized physician order entry system on prescribing practices. Methods: A time series analysis was performed at an urban academic medical center at which all adult inpatient orders are entered through a computeriz ed system. When physicians enter drug orders, the computer displays drug us e guidelines, offers relevant alternatives, and suggests appropriate doses and frequencies. Result: For medication selection, use of a computerized guideline resulted in a change in use of the recommended drug (nizatidine) from 15.6% of all h istamine(2)-blocker orders to 81.3% (P<.001). implementation of dose select ion menus resulted in a decrease in the SD of drug doses by 11% (P<.001). The proportion of doses that exceeded the recommended maximum decreased fro m 2.1% before order entry to 0.6% afterward (P<.001). Display of a recommen ded frequency for ondansetron hydrochloride administration resulted in an i ncrease in the use of the approved frequency from 6% of all ondansetron ord ers to 75% (P<.001). The use of subcutaneous heparin sodium to prevent thro mbosis in patients at bed rest increased from 24% to 47% when the computer suggested this option (P<.001). All these changes persisted at 1- and 2-yea r follow-up analyses. Conclusion: Computerized physician order entry is a powerful and effective tool for improving physician prescribing practices.