Study: E-prescribing reduces inpatient errors
Commercial electronic prescribing systems (e-prescribing) could substantially reduce prescribing error rates in hospital inpatients, according to a study published in this week's PLoS Medicine.
The study's authors, led by Johanna Westbrook, PhD, from the University of New South Wales in Sydney, studied the introduction of the Cerner Millennium e-prescribing system into one ward in one hospital (Hospital A), and used three other wards as controls. At another hospital, the authors compared the error rates on two wards before and after the introduction of the e-prescribing system iSoft MedChart.
The study looked at both procedural (e.g., incomplete, unclear medication orders) and clinical (e.g., wrong dose, wrong drug) orders, and rated the severity of the errors (minor to serious). The researchers found that on the three intervention wards where an e-prescribing system was implemented the procedural prescribing error rates fell by more than 90 percent.
The researchers found that serious clinical errors declined significantly (44 percent) on the three wards that used the e-prescribing system whereas the serious clinical error rate fell by 16.7 percent in control wards that did not get the system.
The overall rate of clinical errors (those rated as minor to serious combined) did not fall due to the fact that the e-prescribing systems unwittingly introduced some new types of errors called "system-related errors." These included, for example, when a prescriber accidentally selected the wrong drug from a drop-down menu item. These system-related errors accounted for 35 percent of errors occurring in the intervention wards.
The study has limitations, the authors admitted, such as the lack of randomization and lack of control wards in Hospital B. They concluded, however, "Implementation of these commercial e-prescribing systems resulted in significant reductions in prescribing error rates with a significant decline in serious errors observed."
The study indicated the need for ongoing improvements of e-prescribing systems, the authors wrote. "Importantly, the results highlight the need to continually monitor and refine the design of these systems to increase their capacity to improve both the safety and appropriateness of medication use in hospitals."
The study's authors, led by Johanna Westbrook, PhD, from the University of New South Wales in Sydney, studied the introduction of the Cerner Millennium e-prescribing system into one ward in one hospital (Hospital A), and used three other wards as controls. At another hospital, the authors compared the error rates on two wards before and after the introduction of the e-prescribing system iSoft MedChart.
The study looked at both procedural (e.g., incomplete, unclear medication orders) and clinical (e.g., wrong dose, wrong drug) orders, and rated the severity of the errors (minor to serious). The researchers found that on the three intervention wards where an e-prescribing system was implemented the procedural prescribing error rates fell by more than 90 percent.
The researchers found that serious clinical errors declined significantly (44 percent) on the three wards that used the e-prescribing system whereas the serious clinical error rate fell by 16.7 percent in control wards that did not get the system.
The overall rate of clinical errors (those rated as minor to serious combined) did not fall due to the fact that the e-prescribing systems unwittingly introduced some new types of errors called "system-related errors." These included, for example, when a prescriber accidentally selected the wrong drug from a drop-down menu item. These system-related errors accounted for 35 percent of errors occurring in the intervention wards.
The study has limitations, the authors admitted, such as the lack of randomization and lack of control wards in Hospital B. They concluded, however, "Implementation of these commercial e-prescribing systems resulted in significant reductions in prescribing error rates with a significant decline in serious errors observed."
The study indicated the need for ongoing improvements of e-prescribing systems, the authors wrote. "Importantly, the results highlight the need to continually monitor and refine the design of these systems to increase their capacity to improve both the safety and appropriateness of medication use in hospitals."
Beth Walsh,
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.