What is the impact of introducing inpatient electronic prescribing on prescribing errors? A naturalistic stepped wedge study in an English teaching hospital

Franklin, Bryony Dean; Puaar, Seetal

doi:10.1177/1460458219833112

Cited by 14 publications

(10 citation statements)

References 24 publications

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“…Whilst evidence shows a variation amongst prescribing systems in reducing errors, our results add to research that indicates there are fewer incomplete prescriptions with electronic prescribing systems [27]. This was specifically true where mandatory fields were required prior to a prescription being accepted by the system.…”

Section: Key Findingssupporting

confidence: 49%

“…Electronic prescribing systems are considered an important strategy in reducing medication errors including those involving insulin [10,24,25]. It is important to note however, that there is conflicting evidence within the literature internationally on the impact of electronic prescribing in reducing inpatient medication errors [26][27][28]. In 2019, a report from the Healthcare Safety Investigation Branch (HSIB) summarised that although the implementation of electronic prescribing is associated with a greater than 50% reduction in medication errors, different types of electronic prescribing and medicines administration (ePMA) systems are available, and this can lead to variation in how medicines are prescribed.…”

Section: Introductionmentioning

confidence: 99%

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A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Setra

Jani

2021

Pharmacy

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Accurate and complete prescriptions of insulin are crucial to prevent medication errors from occurring. Two core components for safe insulin prescriptions are the word ‘units’ being written in full for the dose, and clear documentation of the insulin device alongside the name. A retrospective review of annual audit data was conducted for insulin prescriptions to assess the impact of changes to the prescribing system within a secondary care setting, at five time points over a period of 7 years (2014 to 2020). The review points were based on when changes were made, from standardized paper charts with a dedicated section for insulin prescribing, to a standalone hospital wide electronic prescribing and medicines administration (ePMA) system, and finally an integrated electronic health record system (EHRS). The measured outcomes were compliance with recommended standards for documentation of ‘units’ in full, and inclusion of the insulin device as part of the prescription. Overall, an improvement was seen in both outcomes of interest. Device documentation improved incrementally with each system change—34% for paper charts, 23%–56% for standalone ePMA, and 100% for ePMA integrated within EHRS. Findings highlight that differences in ePMA systems may have varying impact on safe prescribing practices.

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Section: Key Findingssupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Setra

Jani

2021

Pharmacy

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“…The prescribing error rate of 3.3% found in this study falls in the range of other such studies done on in-patients wherein the error rate has been reported from 1.5% to 15%. 8,[14][15][16] The reported prescribing error rates in studies done on out-patients have been much higher i.e. 65% or greater.…”

Section: Discussionmentioning

confidence: 99%

A study on prescribing errors in in-patients of a corporate tertiary care hospital in North India

Rashed¹

2019

Int J Basic Clin Pharmacol

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Background: Prescribing errors are a subset of medication errors which have a potential for grave harm to the patient. Identification and acknowledgement of such errors can ameliorate much of this danger. Studies of prescribing errors are sparse in India. Such studies, whatever have been conducted, mainly focus on the out-patients or the patients on discharge. Hence, this study was undertaken to study the prescribing errors in prescriptions generated for patients admitted in wards of a corporate hospital in North India.Methods: The prescriptions for in-patients admitted in wards were analyzed for different types of prescribing errors in individual drug orders and prescription as a whole.Results: The prescribing error rate was found to be 3.3% in this study. Of all errors, errors leading to delays in patient care (i.e. Errors of prescription writing) (54.54%) and erroneous copying of the prescription to the drug chart by junior/ resident doctors (Transcription errors) (31.31%) were found to be the major causes of prescribing errors in this study. Of the former category, prescribing a wrong strength (24.24%) and illegible drug orders (12.12%) were the most numerous error subtypes. Errors leading to sub-optimal patient care (i.e. Errors of decision making) were least identified of which Therapeutic duplication (12.12%) was the most common subtype.Conclusions: The error rate found in this study is comparable to the data available from developed countries. However, there are significant differences in the occurrences of error subtypes found in this study as compared to the studies of the west.

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“…The paper by Dean Franklin and Puaar 20 describes the result of a stepped wedge study of the impact of introducing electronic prescribing on prescribing errors in one hospital with 20 wards. The study nicely demonstrates the importance of having a robust study design that allows a nuanced analysis of the effect of technology on process and outcome measures.…”

Section: The Contribution Of the Papers In This Special Issuementioning

confidence: 99%

Digital health and patient safety: Technology is not a magic wand

Sujan

Scott

Cresswell

2019

Health Informatics J

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The use of novel health information technology provides avenues for potentially significant patient benefit. However, it is also timely to take a step back and to consider whether the use of these technologies is safe – or more precisely what the current evidence for their safety is, and what kinds of evidence we should be looking for in order to create a convincing argument for patient safety. This special issue on patient safety includes eight papers that demonstrate an increasing focus on qualitative approaches and a growing recognition that the sociotechnical lens of examining health information technology–associated change is important. We encourage a balanced approach to technology adoption that embraces innovation, but nonetheless insists upon suitable concerns for safety and evaluation of outcomes.

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What is the impact of introducing inpatient electronic prescribing on prescribing errors? A naturalistic stepped wedge study in an English teaching hospital

Cited by 14 publications

References 24 publications

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

A study on prescribing errors in in-patients of a corporate tertiary care hospital in North India

Digital health and patient safety: Technology is not a magic wand

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