11.7% Medication Error Rate In E-Prescribing
Editor's ChoiceAcademic Journal
Main Category: IT / Internet / E-mail
Also Included In: Primary Care / General Practice
Article Date: 03 Jul 2011 - 0:00 PDT
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| Article Opinions: | 6 posts |
The chances of mistakes occurring in prescriptions sent electronically are no lower than in those written out by hand, a researcher from Massachusetts General Hospital in Boston wrote in the Journal of American Medical Information Association. This will be a disappointment for health reform experts and policymakers who assured that E-prescribing would have fewer medication errors, as well as saving the government billions of dollars.
Author Karen Nanji, M.D. explained that new technology does not in itself eliminate the risk of medication errors.
In 2008, Nanji and team evaluated 3,850 electronic prescriptions from three pharmacy chain outlets in Florida, Massachusetts, and Arizona over a four-week period. They all came from outpatient computerized prescribing systems at non-hospital doctors' offices. The prescriptions were checked for medical errors by a clinical panel. They also determined whether any of the errors could potentially harm patients.
11.7% of all the prescriptions had some kind of mistake. Four percent of them had mistakes which could cause a significant or serious adverse event. The researchers added that this is no better than the error rate found in handwritten prescriptions.
The researchers do not know whether the errors were corrected by the pharmacist or whether they led to an adverse event.
A computerized prescribing system requires that comprehensive functionality and proper processes are in place, otherwise medication errors remain high, they added.
17.3% of all the errors were found in E-prescriptions for anti-infectives. E-prescriptions for nervous system medications came second, and then respiratory drugs. Nervous system, cardiovascular and anti-infective medications had the highest number of errors linked to possible adverse events. An example of an error with potential for an adverse event was dosage omission.
According to Surescripts, last year approximately 190,000 doctors in the USA were e-prescribing - transmitting prescriptions directly to a pharmacy computer. Physicians who electronically prescribe (e-prescribe) have been receiving hundreds of millions of dollars from the federal government in Medicare bonuses.
The vast majority of these mistakes could be eliminated if software were improved. Forcing functions could be put into the programs that would make it impossible for the doctor to complete the prescription without entering required information.
The authors warn that any additions to computer programs must not be done at the expense of speed and efficiency - put simply, they must not slow things down.
Programs had error rates that varied from 5.1% to 37.5%.
"Errors associated with outpatient computerized prescribing systems"
Karen C Nanji, Jeffrey M Rothschild, Claudia Salzberg, Carol A Keohane, Katherine Zigmont, Jim Devita, Tejal K Gandhi, Anuj K Dalal, David W Bates, Eric G Poon
JAMIA doi:10.1136/amiajnl-2011-000205
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
MLA
23 Feb. 2012. <http://www.medicalnewstoday.com/articles/230296.php>
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Visitor Opinions In Chronological Order (6)
Blame the Pharmacy
posted by BrickellPrincess on 2 Jul 2011 at 5:17 pmThe pharmacy is to blame. I have personally had two e-prescriptions filled incorrectly at the same CVS pharmacy. Needless to say, I no longer go to CVS. But in both instances it was the pharmacist who dispensed the wrong medication not the e-prescribing system!
E-precriptions
posted by John on 3 Jul 2011 at 1:10 amAs a recently retired pharmacist I find this error rate to be surprisingly low based on my own experience. I have found that much of the problem involves office staff, not the physician.
The wrong software
posted by Michael on 3 Jul 2011 at 5:31 amWhat a stupid study. I work in a facility with a system that will not let you prescribe the medication until you put in the dosage and frequency. The rate was widely variable in this study, likely due to this difference. So really, rate should actually be about 4%.( in fact, my emr system also checks of the dose is standard, and if there are any contraindications to warn about.) So lets not give e-prescriptions a bad name because of such an easily fixable error.
All Depends On The Software
posted by Ash on 5 Jul 2011 at 9:21 amAs a chronically ill patients who takes a lot of meds, but who is still a computer geek despite it all, I have to say that it all depends on the software. My PCP uses a software program that requires the strength & quantity & number of refills be filled in, allows her to pick from what meds are covered by my insurance, submit prior authorizations quickly & easily on the ones not normally covered, and requires her to select the illness being treated the first time she orders a particular medication - thereby reducing the risk of prescribing the wrong medication. Not only does it do all that, but it also checks for drug interactions & double prescribing.
I've seen her enter dozens of prescriptions doing this, never had an incorrect one, and it's all a fast & streamlined process.
3,850???
posted by Steve on 5 Jul 2011 at 7:00 pmThis study is complete junk.
It was performed nearly 3 years ago in 2008.
The sampling set is such a small number that I find it difficult to give the results any credence. Dr Nanji should be embarrassed to publish such a weak study with her name on it.
How many different prescribers were reviewed?
How many prescriber eprescibing systems were reviewed?
How many pharmacy eprescribing systems were reviewed?
With only 3850 rx's I bet not many!
In comparison, what is the rate of error on paper prescriptions?
In addition, the article completely misses advancements being made like the current use of Representative NDCs and the imminent use of RxNorm to navigate the various drug compendia, as well as strong EMR adoption with advanced features like DUR checking (including dosage checks).
What does the article propose? That we remain in the dark ages of the paper world? I love how the media eats up any negative news.
E-Prescribing is most certainly a solid success story and continues to provide safer, more auditable prescribing.
Electronic Prescribing
posted by Electronic Prescribing on 2 Aug 2011 at 9:44 amI would have to agree with John- as a pharmacist, you often find that human error is just as if not more faulty than the electronic program.
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