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Electronic tools could substantially reduce medication errors in primary care

Around 1.5 million preventable adverse drug events are estimated to occur each year in the United States. However, little is known about the types and consequences of medication errors in primary care settings, where at least 3.5 billion medication prescriptions are written each year. A new study found that 57 percent of medication errors made in family physicians' offices could have been prevented by electronic medical records or computerized physician order entry.

Researchers analyzed the type, severity, and potential preventability of medication errors and their associated adverse drug events reported by more than 440 family physicians and staff from 52 practices. Of the 194 reported medication errors, 70 percent were prescribing errors, 10 percent were medication administration errors, 10 percent were documentation errors, and 3 percent were monitoring errors. Overall, 16 percent of the errors resulted in temporary harm (an adverse drug event).

The two most commonly reported medication errors were related to medication dose and selection, followed by the actual prescription itself and communication issues. The most common reasons for these error types included incorrect dose, incorrect drug selection, patient contraindications to the prescribed drug, communications problems with the pharmacy, and insufficient information on the prescription.

The researchers estimated that more than half of the medication errors could have been prevented by electronic medical records and computerized physician order entry. Physicians were thought to be primarily responsible for most (62 percent) of the errors, followed by nurses (11 percent), other clinic staff (7 percent), pharmacists (6 percent), and patients (4 percent).

Pharmacists prevented nearly half of those errors that did not reach the patient. The medications most frequently associated with errors were analgesics, antibiotics, cardiovascular drugs (for hypertension or hyperlipidemia), and endocrine drugs (oral antidiabetics, insulin, estrogen/progesterone, and levothyroxine).

The data for this study came from two error reporting studies conducted in 2000 by the American Academy of Family Physicians National Research Network and the Robert Graham Center supported by the Agency for Healthcare Research and Quality (HS11584 and HS14552).

See "Medication errors reported by U.S. family physicians and their office staff," by Grace M. Kuo, Pharm.D., Robert L. Phillips, M.D., Deborah Graham, M.S.P.H., and John M. Hickner, M.D., in Quality and Safety in Health Care 17, pp. 286-290.

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