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Critique of the Week. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. Koppel, R.; Metlay, J. Cohen, A; et all JAMA, March 9, 2005-Vol.293, No. 10. Linda W. Byrd. Critique of the Week. Problem Statement:
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Critique of the Week Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors Koppel, R.; Metlay, J. Cohen, A; et all JAMA, March 9, 2005-Vol.293, No. 10 Linda W. Byrd
Critique of the Week • Problem Statement: • To identify and quantify the role of CPOE in facilitating prescription error risks.
Critique of the Week • Hypothesis • None • Significance • Examples of medication errors caused or exacerbated by the CPOE system
Critique of the Week • Method of Data Collection • Qualitative • Intensive One on One Interviews • Focus Groups • Expert Interviews • Shadowing and Observation • Quantitative • Survey
Critique of the Week • Summary of Results • Authors found a widely used CPOE system facilitated 22 types of medication error risks • Identified and quantified error risks not previous considered • Findings offer opportunities for error reduction
Critique of the Week • Level of Study • Descriptive • Survey • Focus Groups • Expert Interviews • Intensive one-on-one House Staff Interviews • Shadowing and Observation
Critique of the Week • Framework • Ex post facto • Longitudinal
Critique of the Week • No variables • No Operational definitions • No research design
Critique of the Week • Missing Components • Pilot Study • Statistics (except demographic type) • Operational Definitions
Critique of the Week(Missing Components, cont’d) • Weak Methodology • Sampling • Group Assignment • Design and Sequence • Copy of Data Collection Instrument • Raw Data
Critique of the Week • No controls for effect of: • Potential Bias • Differences between subjects before study • Maturation within subjects • Variation in Administration • Effect of Mortality
Critique of the Week • Theoretical Population for Generalization • Research Conducted in One Hospital • The TDS CPOE system comprises 60% of Market • “May not be widely generalizable” due to customization features
Critique of the Week • Sample Selection • Not Discussed in Article • Group Assignments Not discussed (seems to be convenience sample)
Critique of the Week • Survey Questionnaire is not Included • Interview Questionnaire in not Included • Focus Group Dialogue is not Included
Critique of the Week • Results obtained not separable from interpretation of results
Role of CPOE entry systems in facilitating medication errors JAMA, March 9, 2005 Vol.293, No. 10 p.1197
Role of CPOE entry systems in facilitating medication errors JAMA, March 9, 2005-Vol.293, No. 10
Critique of the Week • Future Study • Recommendations Studies of advantages and disadvantages of CPOE • Concentrate on organizational factors