study switching to e prescriptions increases risk of medication errors

With the recent trend toward e-medicine, there has been an assumption that electronic medical records, and especially electronic-format prescriptions, would cut down on medical errors. The stereotype that doctors have terrible handwriting isn’t baseless, and many have speculated that numerous prescription errors might be caused by nurses’ and pharmacists’ inability to read some doctors’ illegible prescription orders. With electronic prescriptions, many observers expected the rate of medication errors to decrease rapidly.

A recent study published in the Journal of General Internal Medicine paints a different picture, unfortunately. The study reviewed prescription errors at an academic-affiliated ambulatory clinic before, during and a year after its switch to e-prescriptions. The researchers found that, despite the support tools provided, the rate of prescription errors actually increased, at least during the first 12 weeks of implementation.

The good news is that the overall error rate did drop substantially a year after the new e-prescription system was implemented — from 36 percent of all prescriptions resulting in a nursing or pharmacy error to 12 percent. Of course, a 12 percent error rate is still unacceptably high.

Incorrect abbreviations and coding were the most common e-prescription errors

The most common problem caused by the e-prescription system was that doctors would use improper abbreviations or codes that were misinterpreted by pharmacies. With time, the rate of abbreviation errors dropped from 24 percent to 6 percent.

Beyond that specific type of transcription error, however, the initial picture was more dismal. The frequency of errors associated with incorrect or incomplete directions, improper dosages and incorrect dose frequency increased during the first 12 weeks that the program was implemented.

The study’s authors were surprised to learn that even doctors who were experienced with other e-prescription software were confused by the new system.

“We thought it would be more of a seamless transition because people were already accustomed to sitting in front of a computer…but each electronic system has its nuances,” said one of the study’s co-authors, Rainu Kaushal, MD, MPH a quality and medical informatics professor at Weill Cornell Medical College.

The study’s authors indicated that better, more focused training is necessary. Physicians need to be trained on how to use the systems and on the potential dangers when they are not used correctly. Physicians interviewed generally did not believe that e-prescription systems could impact safety. Furthermore, many became frustrated with the constant alert messages sent by the software and started to routinely override those alerts.

Despite these results, Dr. Kaushal believes that the patient safety improvements expected from e-prescription systems will eventually materialize. However, every patient deserves quality care, even when their doctors are learning a new computer system. Prescription errors can be deadly, and it is essential for doctors, nurses, pharmacists and health care facilities to insist on accurate, appropriate prescription orders in every case.

Source: American Medical News, “Upgrading e-prescribing system can bump up error risk,” Pamela Lewis Dolan, June 13, 2011

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