Prescribing errors and adverse drug reaction documentation before and after implementation of e‐prescribing using the Enterprise Patient Administration System

Abstract

Background Medication errors are a leading cause of harm to patients in hospital that can be decreased by electronic medication management systems. Aims This study determined the effects of electronic prescribing using the Enterprise Patient Administration System (EPAS) on prescribing errors and adverse drug reaction (ADR) documentation in South Australian public hospitals. Methods A prospective structured medication chart audit was conducted before (in 2012) and after the implementation (in Dec 2014) of EPAS, comparing the paper‐based National Inpatient Medication Chart (NIMC) with prescribing. All inpatients were eligible for inclusion in the study. Prescribing order errors were determined by the percentage of medication orders that had unclear, illegal or unsafe prescriptions. The quality of ADR documentation was assessed by the percentage of patients with correct documentation. Results The total number of prescribing errors before and after the implementation of EPAS was 67.7 and 2.8 per 100 orders, respectively. The frequency of prescribing order errors due to unclear, illegal and unsafe prescriptions decreased to almost zero with EPAS. Prescriptions classified as unsafe due to incorrect dose, route of administration or dosing frequency decreased from 5.8% to 0.03% of medication orders before versus after EPAS implementation (p < 0.0001). Completed ADR documentation was similar between the paper‐based NIMC and EPAS, but the percentage of patients with ADR alerts who required them was 100% in EPAS compared with 27% on the NIMC (p < 0.0001). Conclusions E‐prescribing using EPAS significantly decreased prescribing errors and increased ADR alerts. Continued implementation of electronic medication management systems is an important approach to improve medication safety.

The impact of health information technology on prescribing errors in hospitals: a systematic review and behaviour change technique analysis

“…Twenty studies focused on adults [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56], ten on a paediatric or neonatal population [57][58][59][60][61][62][63][64][65][66], and five included a mixed population [67][68][69][70][71] (see Table 1). Ten studies were based in the US [37,41,42,48,54,57,58,64,67,70], eight in the UK [39,45,49,50,53,…”

“…Using the Black et al [6] taxonomy, 21 of the studies were CPOE systems and 14 ePrescribing systems. Where there was an overlap between the characteristics of a CPOE system and an ePrescribing system, as in the HIT described by Al-Sarawi et al [38], the described characteristics as well as the authors' terminology were considered in order to categorise the HIT.…”

“…A variety of CDS was present in 18 CPOE systems, ranging from allergy and drug-drug interaction alerts to therapeutic duplication alerts, weight-based dosing, and renal function dosing [39-43, 46, 48, 50, 52, 54-58, 61, 62, 64, 70]. In contrast with CPOE systems, just three ePrescribing systems used alert-based CDS [38,60,68].…”

“…In three studies, the individual OR was not significant. Three commercial ePrescribing systems used alert-based CDS: Al-Sarawi et al [38], Hodgkinson et al [68], and Jani et al [60] reported reductions in prescribing errors, with OR of 0.01 [95% CI 0.01-0.02], 0.01 [0.01-0.02], and 0.48 [0.30-0.76], respectively. The median OR for ePrescribing studies with CDS was 0.01 (IQR 0.01-0.48, 3 studies).…”

“…Selection errors [45,49,60,68] and duplicate errors [38,47,60] were the TGE most frequently identified. Due to the simpler nature of some ePrescribing systems, free-text errors were possible [67].…”