Medication errors and adverse drug events in hospitalised patients; methodological issues and computerised intervention

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Part I of this thesis focuses on the methodological aspects of medication errors and adverse drug events:
- in chapter 2 the focus is on the assessment of the relation between medication errors and adverse drug events. In this chapter we evaluate the agreement on assessing preventable adverse drug events between different professionals, i.e. physicians and pharmacists.
- in chapter 3 the relation between different subtypes of medication errors and patient harm is assessed in depth. We address which type of medication errors is mostly related to adverse drug events and is therefore most relevant from a clinical perspective.
- in chapter 4 we assess whether the determinants of medication errors not related to any patient harm are the same as medication errors related to patient harm.

Part 2 focuses on CPOE/CDSS in relation to medication safety:
- chapter 5 discusses the effect of the introduction of CPOE/CDSS on the incidence medication errors and preventable adverse drug events in two Dutch hospitals. We distinghuish the effect on different types of medication errors and preventable adverse drug events.
- in chapter 6 we focused on the different forms of decision support during electronic prescribing. We compare two computerised systems (a basic CDSS within a CPOE and a set of clinical rules) with medication review to answer the question to what extent patients at risk for medication related harm as identified by the two computerised systems actually have a medication error as identified by medication review.
-Because the effectiveness of the CPOE/CDSS system in reducing medication errors depends also on the use of CPOE/CDSS by health care professionals, we surveyed the expectations and experiences with the system of physicians and nurses. These results are shown in chapter 7.
- Currently, in most Dutch hospitals, CPOE/CDSS is already used or will be implemented in the coming future. It is important to know what should be extra invested to increase medication safety by using CPOE/CDSS. Chapter 8 aims to evaluate the balance between the effects and costs of CPOE/CDSS compared to the paper-based system.

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