Residents' numeric inputting error in computerized physician order entry prescription

Xue Wu; Changxu Wu; Kan Zhang; Dong Wei

doi:10.1016/j.ijmedinf.2016.01.002

Residents' numeric inputting error in computerized physician order entry prescription

Int J Med Inform. 2016 Apr:88:25-33. doi: 10.1016/j.ijmedinf.2016.01.002. Epub 2016 Jan 15.

Authors

Xue Wu¹, Changxu Wu², Kan Zhang³, Dong Wei⁴

Affiliations

¹ Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Peking University School of Nursing, Beijing, China.
² Department of Industrial and Systems Engineering, State University of New York (SUNY)-Buffalo, NY, USA. Electronic address: changxu.wu@gmail.com.
³ Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
⁴ General Surgery Department, Beijing Hospital, Beijing, China.

PMID: 26878759
DOI: 10.1016/j.ijmedinf.2016.01.002

Abstract

Background: Computerized physician order entry (CPOE) system with embedded clinical decision support (CDS) can significantly reduce certain types of prescription error. However, prescription errors still occur. Various factors such as the numeric inputting methods in human computer interaction (HCI) produce different error rates and types, but has received relatively little attention.

Objective: This study aimed to examine the effects of numeric inputting methods and urgency levels on numeric inputting errors of prescription, as well as categorize the types of errors.

Methods: Thirty residents participated in four prescribing tasks in which two factors were manipulated: numeric inputting methods (numeric row in the main keyboard vs. numeric keypad) and urgency levels (urgent situation vs. non-urgent situation). Multiple aspects of participants' prescribing behavior were measured in sober prescribing situations.

Results: The results revealed that in urgent situations, participants were prone to make mistakes when using the numeric row in the main keyboard. With control of performance in the sober prescribing situation, the effects of the input methods disappeared, and urgency was found to play a significant role in the generalized linear model. Most errors were either omission or substitution types, but the proportion of transposition and intrusion error types were significantly higher than that of the previous research. Among numbers 3, 8, and 9, which were the less common digits used in prescription, the error rate was higher, which was a great risk to patient safety.

Conclusions: Urgency played a more important role in CPOE numeric typing error-making than typing skills and typing habits. It was recommended that inputting with the numeric keypad had lower error rates in urgent situation. An alternative design could consider increasing the sensitivity of the keys with lower frequency of occurrence and decimals. To improve the usability of CPOE, numeric keyboard design and error detection could benefit from spatial incidence of errors found in this study.

Keywords: Computerized physician order entry; Numeric inputting; Prescription error.

MeSH terms

Adult
Decision Support Systems, Clinical / standards*
Drug Prescriptions / standards*
Female
Humans
Internship and Residency
Male
Medical Order Entry Systems / standards*
Medical Order Entry Systems / statistics & numerical data*
Medication Errors / prevention & control*
Numerical Analysis, Computer-Assisted*
Patient Safety
Physicians*
Young Adult