Patient Safety and Quality

1 in 10 computer-generated prescriptions include at least one error

In the ambulatory care setting, medication errors and adverse drug events (ADEs) are common. The use of electronic prescribing systems is one way to reduce these errors and events. However, computer-generated prescriptions can introduce new errors, and some systems are better than others. A new study finds that 1 in 10 computer-generated prescriptions contain at least 1 error.
The researchers conclude that implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful use does not decrease medication errors. They looked at 3,850 computer-generated prescriptions received during a 4-week period by a commercial pharmacy chain with stores in 3 States (Arizona, Florida, and Massachusetts). A panel of independent reviewers examined each prescription for errors. If an error was identified, it was classified by type. Any error having the potential for harm was considered a potential ADE.
A total of 452 prescriptions (11.7 percent) had one or more of 466 errors. Of these errors, 163 (35 percent) were classified as potential ADEs. The rate of prescriptions containing ADEs was 4.2 percent. More than half (58.3 percent) of these ADEs were significant, although none were life-threatening. Errors were most often found with anti-infective prescriptions (40.3 percent), followed by nervous-system drugs and respiratory-system drugs. Nervous-system drugs, however, had the highest rate for potential ADEs (27 percent), followed by cardiovascular drugs, and anti-infectives. Error rates varied widely from 5.1 percent to 37.5 percent among the various computerized systems. Omitted information was the most common cause for errors (60.7 percent) and ADEs (50.9 percent).
The researchers suggest that both computer-based and provider-based interventions are needed to reduce errors associated with computer-generated prescriptions. These include specific drug-decision support, calculators, careful vendor and system selection, and extensive training beyond what the vendor offers. The study was supported in part by the Agency for Healthcare Research and Quality (HS16970).
See "Errors associated with outpatient computerized prescribing systems," by Karen C. Nanji, M.D., M.P.H., Jeffrey M. Rothschild, M.D., M.P.H., Claudia Salzberg, M.S., and others in the Journal of the American Medical Informatics Association 18, pp. 767-773, 2011.