Electronic prescribing with clinical decision support reduces medication errors in community-based practices
Research Activities, September 2010, No. 361
Physicians in community-based office practices dramatically reduce their rate of prescribing errors when using a Web-based electronic prescribing (e-prescribing) system with clinical decision support, according to a new study. The researchers found that physicians who switched from paper prescribing to e-prescribing ("adopters") reduced their error rate nearly sevenfold, from 42.5 to 6.6 per 100 prescriptions by the end of 1 year. For physicians in practices who continued to use paper prescriptions ("nonadopters"), errors remained high at 1 year (37.3 per 100 prescriptions). The use of e-prescribing eliminated all illegibility errors among adopters, going from 87.6 legibility errors per 100 prescriptions at baseline to none at 1 year.
The e-prescribing system included clinical decision support that made dosing recommendations and checked for drug-allergy interactions, drug-drug interactions, and duplicate therapies. Errors judged to be preventable by the clinical decision support software included errors in a medicine's dose, strength, frequency, directions, amount to be dispensed, and length of treatment.
The researchers studied 12 adult primary care practices located in a predominantly rural and suburban region of upstate New York. The practices all used paper prescriptions at the beginning of the study. Six practices adopted e-prescribing while another six practices continued to use paper prescribing during the study. Preventable adverse drug events (ADEs) are best detected through patient surveys. Future studies involving larger numbers of providers should include such surveys to analyze the impact of e-prescribing on rates of preventable ADEs, the researchers suggest. Their study was funded in part by the Agency for Healthcare Research and Quality (HS16316).
More details are in "Electronic prescribing improves medication safety in community-based office practices," by Rainu Kaushal, M.D., M.P.H., Lisa M. Kern, M.D., M.P.H., Yolanda Barr�n, M.S., and others in the June 2010 Journal of General Internal Medicine 25(6), pp. 350-356.