Business Research

Amr Mohamed Ibrahim Mohamed

GOV (10)
Group (A)
Supervised by: Prof. Dr. Ashraf EL Safty
Jan 2022

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Table of content:
Table of figures………………………………………………………………...3
List of abbreviations…………………………………………………….……3
Abstract………………………………………………………………………..4
Problem definition…………………………………………………………….4
Stakeholder analysis…………………………………………………………..5
Management functions………………………………………………………..8
Business functions……………………………………………………………..8
Industry………………………………………………………………………..10
Macroenvironment……………………………………………………………12
Literature review……………………………………………………………...16
Theoretical framework………………………………………………………..21
Hypothetical statement………………………………………………………..23
References………………………………………………………………………24

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Table of figures:
Figure (1) : Business anatomy model-9 Elements (ElSafty,2020).
Figure (2) : Organization structure of Ministry Of Health And Population (Khalid
A.,2013).
Figure (3) :Conceptual Model.
Figure (4) : Research paper theoretical framework.

List of Abbreviations:
CPOE Computerized Physician Order Entry
HPOE Handwriting Physician Order Entry
ICU Intensive Care Unit
SDS Sustainable Development Strategy
IMF International Monetary Fund

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 Title:
The impact of computerized physician order entry on medication errors in ICU
unit in Kafr Shokr Hospital

Abstract:
Even though most medication errors have minimal potential for harm, they still add
a lot of unnecessary work to hospitals' workloads (David w.Bates, 1999). A small
percentage do have the potential to harm, and some do result in avoidable
pharmacological side effects (David w.Bates, 1999).
Studies showed a strong impact for digitalization on reducing medication errors.
There are many forms of digitalization. In our study we will focus only on one type
of digitalization, namely computerized physician order entry(CPOE). The main
objective of the study is to detect the impact of applying computerized physician
medical orders on medication errors for critically ill patients in ICU unit in
comparison to the currently used hand writing physician order entry(HPOE).

Problem definition:
Medical errors are very common, and may lead to serious harm to patients.
Medical errors may lead to missed medication doses or mistakes in medication
doses, duration, route of administration or giving totally different medications. All
that mistakes may endanger patients health. In our attempt to minimize medication
errors, we will test the effect of conversion of handwriting medical record to
computerized medical records on the incidence of medication errors.
For a better understanding for the problem and the importance of the study we will
use the business anatomy model”9elements”(Elsafty,2020).

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 Figure 1 Business Anatomy Model - 9 Elements (Elsafty, 2020).

Stakeholder analysis:
Doctors: The main stakeholder who will play the main role in our study as they
will give the order and will perform the data entry on the system. During the
discussion with Our Doctors they encouraged the application of computerized
medical records as they hope that such application will lead to reduction in
occurrence of medication errors. But they predict that lack of training of the staff to
use such technology would affect its application besides, there would be resistance
to use such technology that may consume more time than the traditional hand
writing way, specially with large number of patients presented to the hospital at the
same time as in case of accidents.

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Nurses: who will be trained to deal with the system to respond to the given orders
by the doctors. Our nurses support the use of computerized medical records as they
expect that such use will clarify doctors orders regarding medication and that will
minimize medication errors. But also they linked the success of such application of
technology to adequate training of the system users.
Pharmacists: Who will prepare the doctors medications orders. Our pharmacists
support the use of the computerized medical records and expect that such records
will minimize medication errors. But they claimed that they may resist using the
technology if there is large number of patients admitted to the hospital at the same
time.
Technical support employees: will provide the support and maintenance to the
system. Our employees suggest that they can develop such system of computerized
medical records and can provide us with sufficient technical support. Also such
team will be responsible for staff training and giving logging in authorization to
patients data.
All patients admitted in the hospital during the study period.
Civil organizations: Will provide the fund to apply the system and provide the
supplies required for such system.
Specialized Medical centers Institute and Ministry of Health and Population :
That will give the approvals to apply such system and to conduct the study.

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Organization:
Kafr Shokr Hospital is a specialized hospital under the cover of Specialized
medical centers which is operating under supervision of Egyptian Ministry of
Health and Population. It is a governmental partially profit and partially non profit
organization as it deals with both types of patients , paid and non paid.

Organization structure:

Figure 2 Organization Structure of the Ministry of Health and Population(Khalid A.,2013)

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Management functions:
Planning: As planning is setting objectives, so, the main objective is to set an
integrated digital medical system that maximize patient safety.
The study will evaluate the role of applying computerized physician order entry on
minimizing the medication errors that would affect the patients.
Organizing: Is to allocate the resources with clearly defined role for each
managerial level, in addition to provide the equipment and infrastructure required
to apply such medical system and providing ways to fund the system.

Leading: Is to provide an elite medical service to the patients and reach the level of
excellence in the services we are providing.

Controlling: By measuring the actual performance with the expected performance.

Comparing the incidence rate of medication errors in both computerized and
handwriting physician medical orders.
Business function:
Product/service: Our core business is to provide health care services with high
quality and with maximum patient’s safety. According to Yasmin A. Mobasher
(2022), the main aim is to increase the duration of human life and to ensure the
health of society as a whole and of each individual person.
Currently, medical services are given in accordance with contributions made to the
health insurance fund. In order to emphasise the value of primary services as afilter
for the emergence of problems, primary health care is offered via public clinics. Cl
inics provide access to free drugs, outpatient and inpatient care (A.Mobasher,
2022).
Financing system : According to Yasmen A.Mobasher(2020)
74% of all medical expenses in Egypt are covered by the health insurance system.
The cooperative society and private insurances each contribute 6.8% and 5% of the
costs, respectively.

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Taxation makes up less than 3% of costs, however direct patient involvement in
costs makes up more than 13%. The quantity of financing for public hospitals is set
by the government.Global allocations that are based on the level of spending from
the prior year are used to fund public hospitals. Daily fees are charged for services.
Both public and private hospitals employ workers, and both pay them based on
documentation in the majority of cases.
HR: The performance of the healthcare industry can be significantly improved
with the help of human resources(Potcovaru & Gîrneaţă, 2015). According to
Yasmin A.Mobasher(2020),the human resources in Egypt is
represented by the medical or non-
medical personnel, which enables individualised or targeted health interventions
and is the health care system's most valuable resource just because of the
associated financial effort.In some regions of Egypt, the availability of medical
resources is much below the national average, and access to basic healthcare is
constrained.From this perspectiv, the rural environment continues to be the most
challenging (Rashad & Sharaf, 2015).
Marketing and sales: Is a very important aspect for health care services. Many
campaigns are carried out by the government to raise the health awareness and the
services provided by the health services. Also the government gave a special
attention to many initiatives for early detection of many diseases.
IT: According to Sustainable Development Strategy(SDS),Egypt vision
2030(2015) there is strong governmental attention for governance, digitalization
and the use of technology in all aspects of life.

Geography:
In this study we are focusing on a specific hospital ,Kafr Shokr Hospital that is
located in Kalyoubia governerate ,but it will give an idea about the governmental
hospitals in Egypt.

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Industry: Egyptian health sector:
In order to better and ensure the health and wellness of the Egyptian people, the
Egyptian healthcare system must overcome numerous obstacles.
The system must not only deal with diseases brought on by deprivation of basic
necessities and illiteracy, but also with newly emerging ailments and disorders
linked to a modern, urban lifestyle. Growing access to international communicatio
ns and trade is increasing thehopes for more and better care as well as cutting-
edge medical technologies.
According to Sustained Development Strategy (SDS) Egypt vision 2030 (2015),
we have the following goals:
Adopting inclusive healthcare coverage.
Improving the quality of healthcare service provision.
Enhancing preventive and health programs.
Improving health sector governance.
Decentralize health services provision.
Developing information and technological infrastructure to support health
care systems.
Developing human resource management in the health sector.
Developing the pharmaceutical sector.

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Health sector SWOT analysis: According to Yasmin A . Mobasher(2022):
Strength:
Everyone has equal access to medical care, so they can receive the necessary
treatments regardless of their socioeconomic standing or employment.
The doctors are state workers, and the funding is provided by regular taxes and
fees through the state budget.
The system, which ensures that practically the whole population has access to
comprehensive health services, was created on the principles of equity.
Need, not financial means, determines who gets medication.
Political will and the possibility of implementing plans at the level of the health
system being present in the system.

Weakness:
A lack of funding for medical institutions and an inadequately constructed
physical infrastructure.
Widespread access to high-quality medical care at the local level.
A lack of medical staff motivation.
The absence of an interconnected information network connecting all healthcare
providers and organizations with responsibility for health insurance.
The high prevalence of non-communicable chronic diseases and the inadequate
preventative strategies.
A lack of fundamental study on the risk factors for noncommunicable chronic
diseases.
OPPORTUNITIES:
The existence of health system investment projects.
Improving the competency of the healthcare system and the standard of medical
practice.

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Willingness of international organizations and donor nations to support the health
system financially and technically.
The abundance of non-governmental groups working in the health and medical-
social fields that might be tapped as resources for joint initiatives.
Threats:
Should continue favoring the metropolitan health system over the rural one.
The departure of workers from the healthcare industry.
A lack of managerial competence at the level of the health system.
The chance of communicable and non-communicable diseases spreading and
getting worse, which collectively result in significant human, societal, and
financial costs.

Micro environment:
Doctors, nurses, technicians, workers, employees, patients, government and civil
organizations.
Macro environment:
Political and legal: According to Uziyel(2021):
Since the Egyptian president and his government are anticipated to continue in
power and maintain stability between 2022 and 2030, the political situation in
Egypt is anticipated to remain peaceful until that time. The coronavirus (Covid19)
pandemic and the ensuing policy change have created socioeconomic uncertainty,
but the government will continue to deploy supportive economic measures to
reduce social tensions brought on by economic hardship.
The legal environment in Egypt has improved significantly over the past five years
in a variety of ways, particularly investment laws that support the launch of new
businesses and increase the ease of conducting business. Additionally, the

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government has begun to publish and monitor the adherence to governance
principles across the public and private sectors to protect all business stakeholders.
Additionally, the health sector is given specific attention through a number of presi
dential initiatives, as well as through the management of this sector and its
digitalization.

Technological: According to SDS, Egypt vision 2030(2015) and Ministry of

Communication and Information Technology official web site:
By creating a Digital Egypt, the ICT 2030 plan assists in attaining the goals of
Egypt's Vision 2030.
These goals include strengthening the ICT infrastructure, promoting digital
inclusion, achieving the shift to a knowledgebased economy, supporting innovation
, boosting capacities, combating corruption, ensuring cybersecurity, and advancing
Egypt's standing on the regional and global stages.
The fundamentals for converting Egypt into a digital society are laid out in the
comprehensive vision and strategy known as "Digital Egypt."
The three primary pillars of the "Digital Egypt" strategy are digital transformation,
digital skills and jobs, and digital innovation.
These three pillars are supported by the legislative framework and the digital
infrastructure, which are both crucial foundations.

Demographic:
Egypt has a population of 104 million people, with growing rate of 1.94 %,

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Economic policy: According to Uziyel(2021):
The shortterm objectives of Egyptian policy will be to deal with the pandemic's eco
nomic effects. Large infrastructure investments in sectors like transportation and de
salination will be the focus of this, which aims to enhance aggregate demand and i
mprove longer-term productive capacity.
After concluding a US$12 billion programme in 2019, Egypt will continue to have
a close partnership with the IMF. It tapped US$2.8 billionfrom the Fund's
coronavirus rapid financing initiative and agreed a further 12-month, US$5.2bn
standby arrangement (SBA), the second tranche of which was released in late
December, and which is likely to be fully disbursed within the timeframe. Other
multilateral agencies will also disburse funds to Egypt,including funding to support
small and medium-sized enterprises following the pandemic and to sustain
infrastructure projects.
Priority will be given to structural and regulatory reforms to increase Egypt's
appeal to foreign investors and to the private sector at home, along with a gradual
transition to more sustainable state finances.

Fiscal policy: According to Uziyel(2021):

The budgetary fallout from the pandemic remains intense in 2020/21 and beyond.
Modest growth in economic activity, reformed tax thresholds and tax breaks aimed
at boosting disposable incomes and supporting businesses will dampen revenue
collection, but the government has taken some measures to offset this, including
the surcharge on salaried employees for 2020/21, which has helped to boost the tax
take overall. The government will increase transfer payments to the poorest, as
well as public-sector wages and pensions, to limit political discontent, adding to
the fiscal burden. Value-added tax (VAT) earnings, which generate almost half
oftax revenue, will recover, with a small rate increase from 14% likely in the
middle of the forecast period. The government will leave the corporate tax rate
unchanged at 22.5% early in the forecast period to encourage a recovery in
investment, raising it marginally later in the forecast period as it seeks to manage
the public finances. It is expected that the fiscal deficit to peak at 8.5% of GDP in

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2020/21, given the drag on revenue of weak GDP growth and ongoing pandemic
mitigation measures.
The deficit will then narrow, but fiscal rationalization will slow in 2023/24, owing
to election-related spending ahead of the presidential poll. The deficit will average
7% of GDP a year in 2021/22-2024/25.
Funding the deficit will involve domestic borrowing and tapping multilateral and
bilateral sources in the early years of the forecast period, topped up with more
costly sovereign bond issuance, driving public debt up to a peak of 116.8% of GDP
at end-2020/21.
Time:
The study will be applied to all patients admitted to the ICU for one month starting
from applying CPOE system.
Major question:
What is the impact of computerized physician order entry (CPOE) on medication
errors?

Minor questions:
Would the availability of trained staff affect medication errors?
I claim that the availability of trained staff will reduce medication errors.
Would the staff resistance to apply the technology affect mediation errors?
I claim that resistance to apply the technology will increase medication errors

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Conceptual Mode

CPOE
Medication errors
training

resistance

Figure 3 conceptual model prepared by the researcher

Literature review:
Key words: medication errors, computerized physician medical orders, trained
staff, resistance, digitalization.
According to Tatyana (2007), medication error is a very common problem and the
aim of the study was to compare between computerized and handwriting physician
medical orders in relation to the percentage of occurrence of medication errors
(Tatyana, 2007). The study found that application of computerized physician
medical orders is very promising in reducing the incidence of medication errors
occurrence specially when combined with other forms of health care digitalization
(Tatyana, 2007).
According to Bates (1999),The study expressed how common medication error is
and although large portion of medication errors cause little harm to patients, yet,
some can cause great harm and more hospital work, besides, many of medication
errors are preventable. The aim of the study is to detect the impact of applying
computerized physician medical orders on medication errors. The study was
conducted to all patients admitted to the hospital in 7 to 10 weeks period in 4
different years. The study found a significant reduction in non missed dose
medication errors that was excluded from the study (bates, 1999). Also there was
more reduction in medication errors when other features were added as decision
support feature (bates, 1999).

As described by Walfstadt (2008), this study is a systematic review to the studies

that evaluated the impact of application of computerized physician medical orders
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and clinical decision support on medication errors, namely adverse drug events.
This systematic review found that only few trials evaluated such impact and further
studies are needed to evaluate such impact (Walfstadt, 2008)
As described by King (2003), it is a retrospective cohort study in a tertiary
pediatric hospital aiming to assess the impact of applying computerized physician
medical orders on medication errors and adverse drug events. It compared the
incidence of medication errors occurrence in wards using computerized physician
medical orders to wards using handwriting medical orders. King (2003) mentioned
that the study found a significant reduction in rate of medication errors but not the
adverse drug events in wards using computerized physician medical order.
A.Longhurst (2010) conducted a cohort study that did not evaluate the impact of
applying of computerized physician medical orders on medication errors but aimed
to evaluate the application of computerized physician medical orders on mortality
rates in an academic children hospital. The study found that application of
computerized physician medical orders led to statistically significant reduction in
mortality rates in academic children hospital (A.Longhurst, 2010).
As pediatric and ICU patients are at high risk of medication errors, such study was
done to evaluate the impact of computerized medical records on medication
prescription errors, adverse drug events, and mortality in pediatric and neonatal
care units and also in adult ICU (Rosse, 2009). The study found marked reduction
in medication errors with application of computerized medical records
(Rosse, 2009).
Radley(2013)statedthathospital medication mistakes are frequent, costly, and even
hazardous to patients.
Radley(2013)wanted to evaluate the reduction in medication errors in
hospitals that can be attributed to electronic prescription via computerized
provider order entry (CPOE) systems. The study found significant reduction in
medication prescription errors attributed to the application of computerized
medical records (Radley, 2013).

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It has been established that computerised provider order entry (CPOE) improves
patient safety by minimizing medication errors and associated adverse drug events
(ADEs) (Devine, 2010).
Davine(2010)statedthatThe majority of studies confirming these benefits have been
undertaken in inpatient settings, while fewer have been conducted in ambulatory
settings.
The purpose of this study was to assess the impact of a basic, ambulatory CPOE
system on medication mistakes and related ADEs (Devine, 2010). The study found
that applying computerized medical records lead to significant reduction not only
in inpatients setting but also in outpatients setting (Devine, 2010).

Colpaert(2006)statedthatFrequent medication errors in the intensive care unit (ICU

) result in patientmorbidity and mortality, an extended period of time in the ICU,

and large additional expenses.Thestudy examined whether the implementation of a

computerised ICU system decreased the frequency and severity of medication

prescription errors (MPEs) .

Colpaert(2006)proved in the study that there is significant reduction in
incidence and severity of medication prescription errors with the application of
computerized medical orders .
A.Verdi(2007)conducted this study to determine the effect of Computerized
medication orders and decision support system
on (1) the incidence of errors in ordering resuscitation (CPR) drugs and
(2) the time required to print out the order form in a paediatric intensive care unit
(PICD).
The study found complete elimination in medication errors and marked reduction
in the time needed for prescriping medications with such applications (A.Verdi,
2007).
Mohammad khammarnia(2007) stated that Computerized physician medical order
software is one technique to lower medical errors related to doctor's orders. This
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study compared prescription errors across two groups before and after a hospital
used computerized medication orders (Mohammad Khammarnia, 2017).
The study found that generally, the application of computerized physician medical
orders reduce the medication errors (Mohammad Khammarnia, 2017).
Another study reviewed 13 papers published between 1998 and 2007, and found 9
papers out of the 13 demonstrated significant reduction in medication errors with
application on medication orders, Few studies examined changes in error severity,
but minor errors were most often reported as decreasing (Margaret H.Reckmann,
2009).Also according to Margaret H.Reckmann (2009), further studies with larger
samples from different sites are required.
According to Virginie Korb(2017), medication errors are unavoidable totally, and
even with the usage of CPOE there still chances for medication errors due to
weakness of available systems. The recognition of such medication errors will give
us the chance to improve such available systems.
According to the literature review by Zahra Niazkhani(2009) that was conducted to
review 51 publications between 1990 and 2007 to detect the advantages and
disadvantages of CPOE. The advantages were improving patients safety reducing
medication errors and the disadvantages were that CPOE were more time
consuming leading to more user resistance to apply the system and problematic
user-system interaction (Zahra Niazkhani, 2009).More studies are required to
detect the impact of CPOE usage (Zahra Niazkhani, 2009).
According to the systematic review conducted by Elske Ammenwerth (2008)
conducted to evaluate the impact of CPOE on medication errors found that many
literatures proved the importance of applying such system for improving patient
safety and reducing medication errors while some literatures showed some
medication errors or increased mortality with CPOE.
The application of CPOE in the form of computerized check list of pediatrics
medications in pediatric emergency unit significantly reduced the incidence of
medication errors (rian E. Sard, et al., 2008).
Although application of CPOE was not able to completely eliminate medication
errors yet, there was significant reduction in the number of problem- and error-
containing chemotherapy order (Barry R. Meisenberg, 2012).
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The use of computerised physician order entry (CPOE) has been demonstrated to
increase quality and decrease resource use, yet the majority of the data suggest
that CPOE requires more time to record orders. We chose to assess the CPOE syst
em's effect on physician time in the new environment because we had already put it
into place. We conducted a prospective study utilising a random reminder
mechanism to achieve this.The main findings were that although CPOE saved
them an additional 2% of time, interns spent 9.0% of their time ordering with it
compared to 2.1% before, resulting in a net difference of 5% of their overall time.
(Kirstin Shu, 2001).
Studies involving hospitalised patients—including those who are severely ill—
have shown that CPOE, particularly with decision support, improves a number of o
utcomes. Clinical indicators including fewer major prescription errors and better an
timicrobial care of critically ill patients, which leads to shorter stays, are examples
of these improved outcomes. In addition, CPOE has improved a number of process
outcomes, including higher adherence to evidencebased procedures, a decline in
Unindicated laboratory testing, and cost savings in pharmacotherapeutics
(JeffreyRothschild, 2004) .

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Theoretical framework:
Theoretical framework is the merge between the researcher belief that came from
the real life experience together with the detailed stakeholder analysis and was
presented previously as the conceptual model, and all the literatures that were
reviewed by the researcher.
Based on the above reviewed literatures, the application of CPOE was proved to
significantly reduce the medication errors for all patients admitted to hospital as
stated by Tatyana(2007), Rosse(2009) who conducted his study in ICU patients as
Colpaert(2006), Bates(1999), Radley(2013).
Also as stated by Devine (2010), the application CPOE proved to reduce
medication errors not only for patients admitted to hospitals but also for
outpatients.
Margaret H.Reckmann (2009), reviewed 13 papers from 1999-2007 and found 9
out of 13 papers proved the significant reduction in medication errors with
application Of CPOE.
Also Zahra Niazkhani(2009) reviewed 51 publications between 1990-2007 and
also proved the significant reduction of medication errors with application of
CPOE but also focused on user resistance due to more time consuming data entry
and lack of training.
All literatures reached a conclusion that further studies are required to further
evaluate the impact of CPOE on the incidence of medication errors as stated by
walfstadt (2008) and Margaret H. Reckmann (2009).
According to what is mentioned above, Rosse(2009) model and Colpaert (2006)
are very close to the researcher model and accordingly the study variables are:

Dependent variable: According to Uma Sekaran (2016) , the dependent variable is

defined as:
It's the researcher's job to determine the value of the dependent variable.
The purpose of research is to learn about the dependent variable, characterise it, an
d either explain its variability or make predictions about it.

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And so, the study dependent factor is medication errors.
Independent variable: As mentioned by Uma Sekaran (2016), independent
variable is defined as:
is one that has a positive or negative impact on the dependent variable.
In other words, the dependent variable is present when the independent variable is
present, and the dependent variable increases or decreases by a certain amount for
every unit that the independent variable increases.
And so, the study independent factor is the CPOE.
Moderating variable: As mentioned by Uma Sekaran (2006), moderating variable
is defined as:
is one that significantly affects the relation between the independent and dependent
variables. That is, the initial connection between the independent and dependent
variables is changed by the inclusion of a third variable (the moderating variable).
And so, the study moderating factor is training of users.
Mediating variable: As mentioned by Uma Sekaran (2016), mediating variable is
defined as:
is one that emerges between the point at which the independent variables begin to h
ave an impact on the dependent variable and the point at which their effects are felt
by it. Thus, the mediating variable has a temporal quality or time dimension.
And so the study mediating variable is resistance of users as it is linked to time
when there are large number of patients admitted to hospital at the same time.

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Hypothetical statement:
Alternative (1): H1A: There is a significant negative impact of applying CPOE on
medication errors. In other words, applying CPOE significantly reduces the
incidence of medication errors.
Null (1):H1 Ø: There is a negative relation between the application of CPOE and
the incidence of medication errors.
Alternative (2): H2A: There is a negative impact for training on CPOE and the
incidence of the medication errors. In other words, lack of training on the system
will increase the medication errors and vice versa.
Null (2): H2 Ø: There is a negative relation between the training of the system and
the incidence of medication errors.
Alternative (3): H3A: There is a positive impact between resistance to apply the
system and the incidence of medication errors.
Null (3): H3 Ø: There a positive relation between resistance to apply the system
and the incidence of medication errors.

training

Medication
CPOE errors

Resistance

Figure 4 Research paper theoretical framework prepared by the researcher

The purpose of this research design is descriptive analysis (Descriptive Research

Strategy), which is based on the selection of a specific model from a large body of
literature review models that contains relationships between the dependent and
independent variables as well as moderating and mediating variables, if they are

23
present, with a defined relation and direction. And so, the research design will use
two types of investigation techniques (Descriptive statistics) and
(Correlation/Inferential) to define the relation between the research variables.
The CPOE system will be applied in the ICU unit and the users will be well trained
and so the variables are controlled and so the research variables are contrived. The
research will use Field experiment as the study will take place in the hospital
namely in ICU unit that will be supplied with the system and training of the users.
The time horizon of the study will be (Multiple cross section) as the medication
errors will be counted for all patients in the ICU for one month starting from the
application of CPOE. So we will collect data from different persons. Also we may
use (longitudinal time horizon) as more than one medical error may occur to one
patient.

References
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A.Mobasher, Y. (2022). SWOT analysis of health system in Egypt. managment and economic review, 112-
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A.Verdi. (2007). Prevention of potential errors in resuscitation medications orders by means of a

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Alske Ammenwerth, P. s.-I. (2008). The Effect of Electronic Prescribing on Medication Errors and Adverse
Drug Events: A Systematic Review . Journal of the American Medical Informatics Association,
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Barry R. Meisenberg, M. ,.-C. (2012). Reduction in Chemotherapy Order Errors With Computerized
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bates, d. w. (1999). the impact of computerized physician order entry on medication errors prevention.
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