e-Prescriptions as Error-Prone as Paper Scripts

A new study reports that the error rate with computer-generated prescriptions in physician offices roughly matches that for paper scripts--about 1 in 10.

Researchers at Massachusetts General Hospital (MGH; Boston, USA) and Harvard Medical School (Boston, MA, USA) conducted a retrospective cohort study of 3,850 computer-generated prescriptions received by a commercial outpatient pharmacy chain in Florida, Massachusetts, and Arizona over 4 weeks in 2008. A clinician panel reviewed the prescriptions using a method to identify and classify medication errors. Primary outcomes were the incidence of medication errors; potential adverse drug events, defined as errors with potential for harm; and rate of prescribing errors by error type and by prescribing system.

The results showed that 452 (11.7%) of the prescriptions contained 466 total errors, of which 163 (35%) were considered potential adverse drug events. Error rates varied by computerized prescribing system, from a low 5.1% to a high 37.5%. The most common error was omitted information (60.7% of all errors). The overall results indicated that 11.7% contained at least one error, of which a third had potential for harm; the researchers stressed that this is consistent with the literature on manual handwritten prescription error rates. The number, type, and severity of errors varied by the computerized prescribing system used, suggesting that some systems may be better at preventing errors than others. The study was published online on June 29, 2011, in the Journal of the American Medical Informatics Association.

“Software improvements could eliminate the vast majority of these mistakes. E-prescribing programs can incorporate so-called forcing functions that would prevent physicians from completing a prescription unless they enter required information, including complete drug names and proper abbreviations,” concluded lead author Karen Nanji, MD, MPH, of the MGH, and colleagues. “Likewise, decision-support tools can issue alerts about a wrong drug dose or frequency. However, physicians may rebel against e-prescribing software if anti-error safeguards make it too slow or annoying to use.”

Related Links:
Massachusetts General Hospital
Harvard Medical School