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Commercial electronic prescribing systems can reduce medication errors in hospital patients

PLOS

A study published in this week's PLoS Medicine shows that commercial electronic prescribing systems (commonly known as e-prescribing, in which prescribers use a computer to order medications for their patients through a system with the help of prompts, aids, and alerts) could substantially reduce prescribing error rates in hospital in-patients.

In the study, led by Professor Johanna Westbrook from the University of New South Wales in Sydney, Australia, the authors 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 over 90%.

The researchers found that serious clinical errors declined significantly by 44% on the three wards that used the e-prescribing system whereas the serious clinical error rate fell by 16.7% 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 accidently selected the wrong drug from a drop-down menu item. These system-related errors accounted for 35% of errors occurring in the intervention wards.

These findings are important as medication errors using hand-written scripts (for example, prescribing the wrong drug or giving a drug by the wrong route), frequently occur in health-care settings and are responsible for thousands of deaths every year.

The authors admit that the study has limitations, such as the lack of randomization and lack of control wards in Hospital B, but conclude: "Implementation of these commercial e-prescribing systems resulted in significant reductions in prescribing error rates with a significant decline in serious errors observed."

The authors note: "System-related errors require close attention as they are frequent, but are potentially remediable by system redesign and user training."

The authors add: "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."

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Funding: The research was funded by grants from the National Health and Medical Research Council (NHMRC) Program grant 568612 and Project grant 400929. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: WBR has in the past had shares, and acted as a consultant to give general advice on incident reporting to Patient Safety International (PSI), which was then bought by ISOFT, which in turn has been bought by Computing Services Corporation. He was a board member of PSI, which at that stage was, but is no longer, a subsidiary of the not-for-profit research organisation, the Australian Patient Safety Foundation (APSF), of which he has been and is President. RB spoke on "Electronic medication management and the Hospital pharmacist" at the Cerner Regional User Group meeting in 2010. This was at the request of her employer. She personally received no honorarium or fees from this speaking engagement. All other authors declared that no competing interests exist.

Citation: Westbrook JI, Reckmann M, Li L, Runciman WB, Burke R, et al. (2012) Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study. PLoS Med 9(1): e1001164. doi:10.1371/journal.pmed.1001164

CONTACT:
Johanna Westbrook
Director, Centre for Health Systems and Safety Research
Australian Institute of Health Innovation, Faculty of Medicine
University of New South Wales
Sydney
Australia
+61 2 9385 3856
+61 412 008 538 (mobile)
J.Westbrook@unsw.edu.au

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