Study: Use of drop-down menus triggers e-prescribing errors

An Australian audit of e-prescribing systems at two major hospitals found that selection of items from drop-down menus triggered the greatest number of system-related errors. The study—published online in the Journal of the American Medical Informatics Association on May 30—also discovered a high frequency of errors when prescribers were asked to edit information within the system or perform new tasks not previously required.

In all, after reviewing 629 admissions at two Sydney hospitals that used the CSC MedChart and Cerner Millennium e-prescribing systems, researchers discovered 1,164 prescribing errors. Of those, 493 were systems-related with evidence that the hospitals had detected only 13.4 percent of these mistakes prior to the study audit, according to Johanna Westbrook, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney and colleagues.

“However, only 2.2 percent were serious errors. A unique aspect of our study is that we are able to show that both e-prescribing prevented many more prescribing errors than they created at the study hospitals, providing some confidence of the overall benefit e-prescribing for patient safety. However, system-related errors significantly reduced the overall effectiveness of e-prescribing,” Westbook et al wrote.

The study looked at the use of Cerner Millennium PowerOrders, in which prescribers utilize a drop-down menu of predefined order sequences—include the drug, strength, dose and form—and CSC MedChart, which uses long-hand prescribing, as drug, strength, dose, etc. are entered individually following the selection of a drug product.

The researchers found that the MedChart e-prescribing design, which provided greater opportunities for selection errors, generated these at a rate four times higher than the Cerner e-prescribing system. “This suggests that e-prescribing designed with fewer opportunities for selection errors, that is, by guiding users to select from pre-defined order sentences, may be beneficial,” according to the study.

Errors caused by editing accounted for 21 percent of systems-related errors, a similar level with each e-prescribing system. However, editing errors using MedChart stemmed from wrong timing errors and Cerner errors occurred when prescribers edited predefined order sequences.

“Doctors who use these systems on a day-to-day basis should be aware of design features and tasks associated with increased risk of generating system-related prescribing errors,” according to the authors.

The entire study is accessible here.