ePrescribing reduces clinical errors

Commercial ePrescribing systems are able to reduce prescribing errors by up to 66 per cent, a University of NSW study has found.

Researchers studied prescribing errors both before and after the introduction of iSoft's MedChart and Cerner's Millennium PowerOrders ePrescribing systems in two Australian teaching hospitals.

The study involved a medication chart audit of 3291 admissions, before and after the systems were installed, and compared error rates.

They found that procedural prescribing error rates such as unclear and incomplete prescribing orders fell by more than 90 per cent, while the most serious prescribing errors declined by 44 per cent.

In Hospital A, the Cerner Millennium ePrescribing system was implemented on a geriatric ward, with three other wards – one geriatric, one renal/vascular and one respiratory – acting as controls.

In Hospital B, the iSoft MedChart system was implemented on two wards – one psychiatric and the other cardiology – with the researchers comparing before and after error rates.

“The use of the system resulted in a decline in errors at Hospital A from 6.25 per admission to 2.12 and at Hospital B from 3.62 to 1.46,” the researchers, led by Professor Johanna Westbrook of UNSW’s Australian Institute of Health Innovation, reported.

“This decrease was driven by a large reduction in unclear, illegal, and incomplete orders.”

Data was collected from daily reviews of all inpatient medication charts by three pharmacists independent from the hospitals for at least two months pre- and post-intervention.

The study found that of the pre-intervention admissions, there were an average 5.8 prescribing errors per admission, the majority of which were procedural ( unclear, incomplete, or illegible orders) and the rest comprising clinical errors, such as the wrong strength, dose, frequency or wrong drug, as well as drug-drug interactions or allergies.

Total error rates fell significantly in each intervention ward following ePrescribing system implementation, driven by a marked reduction in procedural errors.

There were some problems with the systems, particularly in terms of decision support, the researchers found. One problem was that even if decision support was available, it was observed during ward rounds that senior clinicians were seen to instruct junior clinicians to enter the orders, and thus alerts were not seen by the decision-makers.

However, the study provides persuasive evidence of the value of commercial ePrescribing systems to significantly and substantially reduce a range of prescribing errors, Professor Westbrook said.

“Most of this technology was developed in the US with the big medical centres designing their own customised systems,” she said.

“Hospitals in Australia can’t afford to do that, so they’re taking commercial off-the-shelf systems. We set out to see whether these systems are as effective as the home-grown ones.”

She said more research was required to ensure the new technologies were both effective and safe. Despite the significant improvements, the study found that the new technology – which demands changes in doctor, nurse and pharmacists’ work practices – also introduced new errors.

“ePrescribing systems can be very effective, but we need to monitor them closely,” she said. “They can unwittingly introduce system-related errors such as a clinician accidentally selecting the wrong drug name from a drop down menu.

“Systems are most useful when they provide user support to guide clinicians in their decision making. The systems we examined had very limited decision support and thus we would anticipate that, with support added over time, even greater reductions in medication errors can be achieved.”

The research findings appear this month in PLoS Medicine.

Posted in Australian eHealth


0 # Greg Twyford 2012-02-04 16:44
In both In-Patient Environments and in Primary Care both serious and trivial prescribing errors are frequently prevented from impacting on patient well-being through either the auspices of the staff who administer the medication, or the pharmacy supplying the order. This may not be reflected in a medication chart audit.

I don't have a sense that this issue has been factored in, or acknowledged, and how these existing safety mechanisms operate in either e-prescribing or hand-written order environments. E-Prescribing may just be preventing trivial errors that are corrected, either informally or formally, anyway.

Can a clinical outcome improvement, or adverse incident rate reduction be demonstrated yet from E-Prescribing?

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