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Critique of the Week

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

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  1. 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

  2. Critique of the Week • Problem Statement: • To identify and quantify the role of CPOE in facilitating prescription error risks.

  3. Critique of the Week • Hypothesis • None • Significance • Examples of medication errors caused or exacerbated by the CPOE system

  4. Critique of the Week • Method of Data Collection • Qualitative • Intensive One on One Interviews • Focus Groups • Expert Interviews • Shadowing and Observation • Quantitative • Survey

  5. 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

  6. Critique of the Week • Level of Study • Descriptive • Survey • Focus Groups • Expert Interviews • Intensive one-on-one House Staff Interviews • Shadowing and Observation

  7. Critique of the Week • Framework • Ex post facto • Longitudinal

  8. Critique of the Week • No variables • No Operational definitions • No research design

  9. Critique of the Week • Missing Components • Pilot Study • Statistics (except demographic type) • Operational Definitions

  10. Critique of the Week(Missing Components, cont’d) • Weak Methodology • Sampling • Group Assignment • Design and Sequence • Copy of Data Collection Instrument • Raw Data

  11. 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

  12. 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

  13. Critique of the Week • Sample Selection • Not Discussed in Article • Group Assignments Not discussed (seems to be convenience sample)

  14. Critique of the Week • Survey Questionnaire is not Included • Interview Questionnaire in not Included • Focus Group Dialogue is not Included

  15. Critique of the Week • Results obtained not separable from interpretation of results

  16. Role of CPOE entry systems in facilitating medication errors JAMA, March 9, 2005 Vol.293, No. 10 p.1197

  17. Role of CPOE entry systems in facilitating medication errors JAMA, March 9, 2005-Vol.293, No. 10

  18. Critique of the Week • Future Study • Recommendations Studies of advantages and disadvantages of CPOE • Concentrate on organizational factors

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