11.7% medication error rate in e-prescribing


11.7% medication error rate in e-prescribing


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.

In the majority of cases (60.7%), the errors were omissions of drug dose, duration, and frequency.

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


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