Understanding technology-related prescribing errors for system optimisation: the Technology-Related Error Mechanism (TREM) classification

ObjectivesTechnology-related prescribing errors curtail the positive impacts of computerised provider order entry (CPOE) on medication safety. Understanding how technology-related errors occur can inform CPOE optimisation. Previously, we developed a classification of the underlying mechanisms of technology-related errors using prescribing error data from two adult hospitals. Our objective was to update the classification using paediatric prescribing error data, and to assess the reliability with which reviewers could independently apply the classification. Materials and MethodsUsing data on 1696 prescribing errors identified by chart review in 2016 and 2017 at a tertiary paediatric hospital, we identified errors that were technology-related. These errors were investigated to classify their underlying mechanisms using our previously developed classification, and new categories were added based on the data. A two-step process was used to identify and classify technology-related errors involving review of the error in the CPOE and simulating the error in the CPOE testing environment. ResultsThe Technology-Related Error Mechanism (TREM) classification comprises seven categories and 19 subcategories. The seven categories are: 1) errors due to incorrect system configuration or system malfunction, 2) prescribing on the wrong patient record, 3) selection errors, 4) construction errors, 5) editing errors, 6) errors that occur when using workflows that differ from a paper-based system 7) contributing factor: use of hybrid systems. ConclusionTechnology-related errors remain a critical issue for CPOE. The updated TREM classification provides a systematic means of assessing and monitoring technology-related errors to inform and prioritise system improvements, and has now been updated for the paediatric setting. What is already known on this topicO_LITechnology-related errors occur frequently in computerised provider order entry (CPOE). C_LIO_LITechnology-related errors can be addressed by CPOE modifications; however, an understanding of how the errors occurred is required. C_LI What this study addsO_LIThis study presents a method for classifying how technology-related errors occur, the Technology-Related Error Mechanism (TREM) classification. C_LI How this study might affect research, practice or policyO_LIUsing the TREM classification can aid system managers in identifying areas for CPOE optimisation to deliver improved patient safety outcomes. C_LI