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."
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