Outpatient prescribing errors and the impact of computerized prescribing
- 162 Downloads
BACKGROUND: Medication errors are common among inpatients and many are preventable with computerized prescribing. Relatively little is known about outpatient prescribing errors or the impact of computerized prescribing in this setting.
OBJECTIVE: To assess the rates, types, and severity of outpatient prescribing errors and understand the potential impact of computerized prescribing.
DESIGN: Prospective cohort study in 4 adult primary care practices in Boston using prescription review, patient survey, and chart review to identify medication errors, potential adverse drug events (ADEs) and preventable ADEs.
PARTICIPANTS: Outpatients over age 18 who received a prescription from 24 participating physicians.
RESULTS: We screened 1879 prescriptions from 1202 patients, and completed 661 surveys (response rate 55%). Of the prescriptions, 143 (7.6%; 95% confidence interval (CI) 6.4% to 8.8%) contained a prescribing error. Three errors led to preventable ADEs and 62 (43%; 3% of all prescriptions) had potential for patient injury (potential ADEs); I was potentially life-threatening (2%) and 15 were serious (24%). Errors in frequency (n=77, 54%) and dose (n=26, 18%) were common. The rates of medication errors and potential ADEs were not significantly different at basic computerized prescribing sites (4.3% vs 11.0%, P=.31; 2.6% vs 4.0%, P=.16) compared to handwritten sites. Advanced checks (including dose and frequency checking) could have prevented 95% of potential ADEs.
CONCLUSIONS: Prescribing errors occurred in 7.6% of outpatient prescriptions and many could have harmed patients. Basic computerized prescribing systems may not be adequate to reduce errors. More advanced systems with dose and frequency checking are likely needed to prevent potentially harmful errors.
Key Wordsmedication error electronic prescribing ambulatory care
Unable to display preview. Download preview PDF.
- 3.Meyer TA. Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions. Am J Health Syst Pharm. 2000;57(suppl 4):4–22.Google Scholar
- 8.Davis K, Schoenbaum SC, Collins KS, Tenney K, Hughes DL, Audet AJ. Room for improvement: patients report on the quality of their health care. Available at: http://www.cmwf.org. Accessed November 1, 2003.Google Scholar
- 16.IMS Health, National Prescription Audit™ Plus 7/2003, All Channels, July 2002 through June 2003.Google Scholar
- 17.Helmreich RL, Merritt AC. Culture at Work in Aviation and Medicine: National, Organizational and Professional Influences. Brookfield, VT: Ashgate; 1998.Google Scholar
- 19.Rabinowitz E. Will palm-size computers make electronic prescribing happen? Manage Care. 1999;8:59–61.Google Scholar
- 20.Gallup poll. Computerisation in GP practices in England and Wales: 1993 survey. NHS Management Executive 1993.Google Scholar
- 21.Harris Interactive. Poll: Americans prefer direct prescribing connectivity between physicians, pharmacists. Available at: http://www.surescript.com/aug10.htm. Accessed November 1, 2003.Google Scholar
- 22.Barrett MJ, Holmes BJ, McAulay SE Forrester Research. Electronic medical records: a buyer’s guide for small physician practices. California HealthCare Foundation 2003. Available at: http://www.chcf.org. Accessed November 1, 2003.Google Scholar