JAMIA: E-prescribing systems don't reduce common mistakes
Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors, according to research published online June 29 in the Journal of the American Medical Informatics Association.
Karen C. Nanji, MD, MPH, from the department of anesthesia, critical care and pain medicine at Massachusetts General Hospital in Boston, and colleagues sought to report the frequency, types and causes of errors associated with outpatient computer-generated prescriptions and to develop a framework to classify these errors to determine which strategies have the greatest potential for preventing them.
Using a retrospective study of 3,850 computer-generated prescriptions received by an outpatient pharmacy chain across three states over four weeks in 2008, a clinician panel reviewed the prescriptions to identify and classify medical errors.
Nanji and colleagues looked at the number of mistakes made and their potential to cause harm, as well as the frequency of particular mistakes and whether these were associated with one type of system.
Of the 3,850 prescriptions assessed, more than one in 10 contained a total of 466 errors. Of these, a third (163; 35 percent) were considered to be potentially harmful. “Error rates varied by computerized prescribing system, from 5.1 percent to 37.5 percent. The most common error was omitted information (60.7 percent of all errors),” the authors wrote.
Mistakes were classified as: "significant," but posing little serious threat to life, such as rash, headache or diarrhea; serious but not life threatening, such as low blood sugar, reduced heart rate and fainting; and life threatening if not treated, such as heart attack and respiratory failure.
Among the 163 potentially harmful errors, 58 percent were significant and 42 percent were serious. None was life threatening, according to the authors.
Four out of 10 medication errors involved anti-inflammatory drugs and antibiotics, and the most common types of drugs associated with errors were nervous system drugs (27 percent), cardiovascular drugs (13.5 percent) and anti-inflammatories/antibiotics (12.3 percent).
Options might include "forcing functions" which would not allow a prescription to be completed if certain information were missing; decision support systems, such as maximum dose checks; and calculators, the authors noted.
"Providers appear to be rapidly adopting EHR and computerized prescribing, and one of the major anticipated benefits is expected to be through medication-error reduction," the authors wrote. However, they concluded, "To enable stakeholders to realize more of the potential benefits of computerized prescribing systems, vendors and healthcare providers may consider implementing several of the outlined computer-based and provider-based interventions, which combined have the potential to eliminate more than 80 percent of the errors.”
Karen C. Nanji, MD, MPH, from the department of anesthesia, critical care and pain medicine at Massachusetts General Hospital in Boston, and colleagues sought to report the frequency, types and causes of errors associated with outpatient computer-generated prescriptions and to develop a framework to classify these errors to determine which strategies have the greatest potential for preventing them.
Using a retrospective study of 3,850 computer-generated prescriptions received by an outpatient pharmacy chain across three states over four weeks in 2008, a clinician panel reviewed the prescriptions to identify and classify medical errors.
Nanji and colleagues looked at the number of mistakes made and their potential to cause harm, as well as the frequency of particular mistakes and whether these were associated with one type of system.
Of the 3,850 prescriptions assessed, more than one in 10 contained a total of 466 errors. Of these, a third (163; 35 percent) were considered to be potentially harmful. “Error rates varied by computerized prescribing system, from 5.1 percent to 37.5 percent. The most common error was omitted information (60.7 percent of all errors),” the authors wrote.
Mistakes were classified as: "significant," but posing little serious threat to life, such as rash, headache or diarrhea; serious but not life threatening, such as low blood sugar, reduced heart rate and fainting; and life threatening if not treated, such as heart attack and respiratory failure.
Among the 163 potentially harmful errors, 58 percent were significant and 42 percent were serious. None was life threatening, according to the authors.
Four out of 10 medication errors involved anti-inflammatory drugs and antibiotics, and the most common types of drugs associated with errors were nervous system drugs (27 percent), cardiovascular drugs (13.5 percent) and anti-inflammatories/antibiotics (12.3 percent).
Options might include "forcing functions" which would not allow a prescription to be completed if certain information were missing; decision support systems, such as maximum dose checks; and calculators, the authors noted.
"Providers appear to be rapidly adopting EHR and computerized prescribing, and one of the major anticipated benefits is expected to be through medication-error reduction," the authors wrote. However, they concluded, "To enable stakeholders to realize more of the potential benefits of computerized prescribing systems, vendors and healthcare providers may consider implementing several of the outlined computer-based and provider-based interventions, which combined have the potential to eliminate more than 80 percent of the errors.”