Table 1.

Key themes, associated issues and recommendations

Main error facilitator	Key themes	Specific issues	Recommendations
System related	Computer screen display	Incomplete display3,26,27 Navigation between multiple screens11,28 Confusing data labels26	All medications (oral, intravenous, etc.) and all statuses (active and discontinued, etc.) should be clearly displayed in one area if possible The naming of data labels should be unambiguous Post-implementation testing is crucial to identify any issues Consistent use of color and design throughout the system
System related	Drop-down menus and auto-population	Miss-selection errors:3,11,28–33 Similar named medications or patients located next to each other Orders listed above or below the intended order Delays in the system response time and the consequent use of “multiple clicks” Scrolling onto the wrong order Erroneous suggestions of medications, doses, or patients33–35	Avoid overly long lists of patient’s names or medications Distinction between “look-alike-sound-alike” medications using tall man lettering, color or bold font Indication based CDS alerts Improved sensitivity and specificity of CDS functions
System related	Wording	Confusion between the system’s wording and user’s interpretation of that meaning26,30 Unnecessary “trailing zeros” i.e., 0020.000 mg instead of 20 mg36	Pre and post-evaluation of user’s normal workflow and practice to ensure user-informed design Enable local customization according to local practice and terminology
System related and user related	Default settings	User related Failure to change suggested default settings3,29,32,35 Lack of knowledge about default settings26 System related Orders hidden within pre-defined order sentences and order sets29	User education and training about complex prescribing functions and challenges that may be encountered with using the system Development of more sophisticated, patient specific predefined order sentences and order sets
System related	Non-intuitive ordering or information transmission	Lack of standardized terminology33,36–38 Interoperability issues33,41	Facilitate local customization to incorporate local terminology Consistent use of key terms between systems Addressing interoperability issues between standalone systems, particularly at the transmission of information stage
System related	Repeat prescriptions and automated processes	Repetition of previously corrected errors31,33,41 Reduced visibility of computerized errors31	Introduce additional checks into the prescribing process User training and education about the risks of using workarounds
User related	User’s work processes	Batch order entry40,42 Users working under another colleague’s log-in40,43	User education and training about the risks of using workarounds
System related and user related	CDS systems	User related Lack of knowledge about the CDS checks that are being performed39 System related Inconsistent and insufficient use of CDS to safeguard against errors27,39 Poor CDS design43 Erroneous suggestions due to issues with, CDS sensitivity, specificity, and accuracy of information34,39	Education and training about the systems functions (and lack of) Use of CDS, where a clinical need has been identified Refining the sensitivity and specificity of CDS

Abbreviations: CDS: Clinical Decision Support.