Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department

Abstract

IntroductionMedication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%–38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.MethodsWe conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period.ResultsOverall, E-prescriptions included fewer prescription errors as compared to HW-prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001), missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001) and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02).ConclusionA basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

Quality of medical prescriptions in diabetes and hypertension management in Kerala and its associated factors

“…Many studies have also shown that use of electronic prescribing systems in hospitals can help to reduce prescription errors. This may improve the quality of prescriptions as well as quality of care [26,27], but this requires sufficient funding and extensive training of doctors on the usage of electronic system. Factors such as age of doctors, years of experience, number of patients consulted per day, location of hospitals, and type of hospitals showed no significant association after adjusting for the confounders.…”

A Systematic Review on the Strategies and Techniques for Decreasing Prescribing Errors

“…The implementation of CPOE in the prescribing process and their impact on minimizing the prescribing errors in the hospital settings is largely discussed in a substantial number of studies in the literature.It was clear that it significantly resulted in improving the prescribing process and the treatment plan. [9][10][11][12][13][14][15][16][17][18][19][20][21] These studies addressed different tools in the application of CPOE. For instance, Amato et al reviewed a convenience sample of 10 CPOE systems at 6 sites were evaluated.…”

“…The rates of 14 different errors were calculated and compared between the pre-and post-intervention period. 11 On the other hand the CPOE strategy was widely used in the oncology practice especially when prescribing the cytotoxic chemotherapies and the supportive treatment. For example, Elsaid et al reported the development of chemotherapy regimen-specific prescribing templates.…”

“…The use of CPOE completely eliminated problems and errors related to missing patient identifiers and data, and erroneous dose calculations. [9][10][11][12][13][14][15][16][17][18][19][20][21] However, other studies have identified problems related to the involvement of CPOE and clinical decision support (CDS), including the navigation between multiple screens, the confusion of data labels,miss-selection errors, erroneous suggestions of medications and doses. 22,23 In addition to other errors including, non-intuitive ordering or information transmission, Lack of standardized terminology, interoperability issue, duplicate prescriptions, and repetition of previously corrected errors, reduced visibility of computerized errors.…”

“…22,23 In addition to other errors including, non-intuitive ordering or information transmission, Lack of standardized terminology, interoperability issue, duplicate prescriptions, and repetition of previously corrected errors, reduced visibility of computerized errors. 11,22 Also, it can lead to a lack of knowledge about the CDS checks that are being performed,inconsistent and insufficient use of CDS to safeguard against errors. [22][23][24][25] II-Education strategy: The implementation of an educational intervention, is a simple and low-cost strategy that could produce a significant reduction of the prescription error rate.…”