Impact of Vendor Computerized Physician Order Entry in Community Hospitals Leung AA, et al.
Online Appendices
Appendix Table A. Number and rates of incidents pre- and post-implementation of computerized physician order entry systems for each hospital site
Incident† / Total no. (%) / Rate / 100 admissions (95% CI) † / p-value‡All sites* / Site 1 / Site 2 / Site 3 / Site 4 / Site 5
Pre / Post / Pre / Post / Pre / Post / Pre / Post / Pre / Post / Pre / Post / Pre / Post
ADEs / 146 (21.3) / 187 (23.3) / 14.6 (12.4, 17.1) / 18.7 (16.1, 21.5) / 19.5 (14.0, 26.3) / 26.5 (20.0, 34.3) / 11.0 (7.0, 16.3) / 8.0
(4.7, 12.6) / 15.5 (10.7, 21.6) / 23.5 (17.4, 30.8) / 14.5 (9.8, 20.4) / 25.5 (19.1, 33.2) / 12.5 (8.2, 18.1) / 10.0 (6.2, 15.0) / 0.03
Preventable / 106 (72.6) / 70 (37.4) / 10.6 (8.7, 12.7) / 7.0 (5.5, 8.8) / 14.0 (9.4, 19.8) / 11.5
(7.4, 16.9) / 9.0
(5.5, 13.8) / 4.0
(1.9, 7.5) / 11.0
(7.0, 16.3) / 8.0
(4.7, 12.6) / 10.5 (6.6, 15.6) / 9.0
(5.5, 13.8) / 8.5
(5.1, 13.2) / 2.5 (0.90, 5.4) / <0.01
Non-preventable / 40 (27.4) / 117 (62.6) / 4.0 (2.9, 5.4) / 11.7 (9.7, 14.0) / 5.5 (2.9, 9.4) / 15.0
(10.3, 21.0) / 2.0 (0.62, 4.6) / 4.0
(1.9, 7.5) / 4.5
(2.2, 8.1) / 15.5 (10.7, 21.6) / 4.0
(1.8, 7.4) / 16.5 (11.5, 22.8) / 4.0
(1.8, 7.4) / 7.5
(4.3, 12.0) / <0.01
Potential ADEs / 444 (64.9) / 575 (72.1) / 44.4 (40.4, 48.9) / 57.5 (52.9, 62.3) / 45.0 (36.3, 54.9) / 97.5 (84.4, 111.83) / 20.0 (14.4, 26.9) / 52.0 (42.6, 62.6) / 74.5 (63.2, 87.1) / 33.0 (25.7, 41.6) / 48.5 (39.5, 58.8) / 30.0 (23.1, 38.2) / 34.0 (26.5, 42.7) / 75.0 (63.6, 87.7) / <0.01
Intercepted / 46 (10.4) / 79 (13.7) / 4.6 (3.4, 6.1) / 7.9 (6.3, 9.8) / 6.0 (3.2, 10.1) / 17.0 (11.9, 23.4) / 0.5 (0.03, 2.2) / 12.5 (8.2, 18.1) / 6.0
(3.2, 10.1) / 5.0
(2.5, 8.8) / 5.5
(2.9, 9.4) / 2.5 (0.90, 5.4) / 5.0
(2.5, 8.8) / 2.5 (0.90, 5.4) / <0.01
Non-intercepted / 398 (89.6) / 496 (86.3) / 39.8 (36.0, 43.8) / 49.6 (45.4, 54.1) / 39.0 (31.0, 48.3) / 80.5 (68.7, 93.6) / 19.5 (14.0, 26.3) / 39.5 (31.4, 48.9) / 68.5 (57.7, 80.6) / 28.0
(21.3, 36.0) / 43.0 (34.5, 52.7) / 27.5 (20.9, 35.4) / 29.0 (22.3, 37.1) / 72.5 (61.3, 84.9) / <0.01
* Weighted average over all 5 sites. † CI = confidence interval. ‡ p-value among all sites. ADE = adverse drug event.
Appendix Table B. Adverse drug events by drug class
Pre-CPOE / Post-CPOE / p-value (for drug class) / Pre-CPOE / Post-CPOE / p-value (for drug class)
Cardiovascular / 30
(3.0) / 20
(2.0) / 0.16 / 3
(0.3) / 27
(2.7) / <0.001 / Amiodarone, Atenolol, Bumetanide, Carvedilol, Clonidine, Clopidogrel, Digoxin, Diltiazem, Enalapril, Furosemide, Hydrochlorothiazide, Isosorbide mononitrate, Labetalol, Lisinopril, Metolazone, Metoprolol, Nitroglycerin, Propranolol, Sotalol, Spironolactone, Torsemide, Valsartan
Diuretics / 11
(1.1) / 8
(0.8) / 1
(0.1) / 11
(1.1)
Beta-blockers / 11
(1.1) / 8
(0.8) / 1
(0.1) / 8
(0.8)
ACE-inhibitors / ARBs / 4
(0.4) / - / - / 2
(0.2)
Antiarrhythmic / 3
(0.3) / 3
(0.3) / 1
(0.1) / 4
(0.4)
Antiplatelet / 1
(0.1) / - / - / 1
(0.1)
Vasodilator / - / - / - / 1
(0.1)
Other / - / 1
(0.1) / - / -
Analgesics / 17
(1.7) / 15
(1.5) / 0.73 / 8
(0.8) / 36
(3.6) / <0.001 / Acetaminophen and combination pills containing acetaminophen: Darvocetâ (propoxyphene and acetaminophen), Fioricetâ (butalbital, acetaminophen, and caffeine), Percocetâ (oxycodone and acetaminophen), Vicodinâ (hydrocodone and acetaminophen); Aspirin, Bupivacaine, Dilaudid, Fetanyl, Hydrocodone, Hydromorphone, Meperidine, Methadone, Morphine, Oxycodone, Tramadol
Narcotic / 16
(1.6) / 14
(1.4) / 8
(0.8) / 35
(3.5)
Non-narcotic / 1
(0.1) / 1
(0.1) / - / 1 (0.1)
Antibiotics / 17
(1.7) / 5
(0.5) / 0.02 / 16
(1.6) / 24
(2.4) / 0.21 / Amoxicillin, Amoxicillin and clavulanate, Ampicillin, Ampicillin and sulbactam, Azithromcyin, Cefazolin, Cefepime, Cefoxitin, Ceftazidime, Ceftriaxone, Ciprofloxacin, Clindamycin, Doxycycline, Ertapenem, Gentamicin, Levofloxacin, Linezolid, Metronidazole Moxifloxacin, Silver sulfadiazine, Trimethoprim-sulfamethoxazole, Vancomycin
Anticoagulants / 13
(1.3) / 7
(0.7) / 0.19 / 4
(0.4) / 8
(0.8) / 0.26 / Enoxaparin, Fondaparinux, Heparin, Warfarin
Antiviral / - / - / - / - / 1
(0.1) / - / Acyclovir
Neurotropic Drugs / 10
(0.1) / 6
(0.6) / 0.33 / 5
(0.5) / 3
(0.3) / 0.48 / Alprazolam, Carbamazepine, Carbidopa-levodopa, Clonazepam, Chlordiazepoxide, Chlorpromazine, Donepezil, Fosphenytoin, Haloperidol, Imipramine, Lorazapam, Memantine, Olanzapine, Risperidone, Sertraline, Topiramate, Zolpidem
Sedatives / 7
(0.7) / 3
(0.3) / 1
(0.1) / -
Antipsychotics / 2
(0.2) / 1
(0.1) / 1
(0.1) / 1
(0.1)
Anticonvulsants / - / 1
(0.1) / 2
(0.2) / -
Antidepressants / 1
(0.1) / 1
(0.1) / - / -
Dementia drugs / - / - / 1
(0.1) / 1
(0.1)
Other / - / - / - / 1
(0.1)
Diabetes / 4
(0.4) / 8
(0.8) / 0.26 / 1
(0.1) / 5
(0.5) / 0.14 / Glyburide, Insulin (aspart, glargine, lispro, NPH, regular), Metformin, Pioglitazone, Rosiglitazone
Oral Antidiabetics / 2
(0.2) / 1
(0.1) / - / 2
(0.2)
Insulin / 2
(0.2) / 7
(0.7) / 1
(0.1) / 3 (0.3)
Other Drugs / 15
(1.5) / 9
(0.9) / 0.23 / 3
(0.3) / 13
(1.3) / 0.02 / Albuterol (salbutamol), Allopurinol, Cyclobenzaprine, Docusate, Fenofibrate, Guaifenesin, Intravenous radio-opaque contrast, Ipratropium, Lactulose, Levothyroxine, Magnesium sulfate, Methylprednisolone,Nicotine, Octreotide, Pantoprazole, Potassium chloride, Prednisone, Propofol, Sodium chloride (normal saline), Sodium polystyrene sulfonate, Senna, Sildenafil, Theophylline
Electrolytes/IV fluid / 5
(0.5) / 2
(0.2) / - / -
Steroids / 3
(0.3) / 2
(0.2) / 1
(0.1) / 4
(0.4)
Anesthetics / - / 1
(0.1) / - / 2
(0.2)
Bronchodilators / 2
(0.2) / - / - / 1
(0.1)
Gastrointestinal drugs / 2
(0.2) / 1
(0.1) / - / 1
(0.1)
Laboratory/X-Ray agents / - / - / 2
(0.2) / -
Thyroid agents / 1
(0.1) / - / - / -
Other / 2
(0.2) / 3
(0.4) / - / 5
(0.5)
Total / 106
(10.6) / 70
(7.0) / 0.007 / 40
(4.0) / 117
(11.7) / <0.001
* Events are counted as one case per patient per drug. One patient may have several adverse drug events (ADEs). ACE = angiotensin-converting enzyme. ARB = angiotensin II receptor blocker