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Implementing a basic electronic prescribing system may reduce nonclinical prescribing errors

Illegibility, missing information, and wrong dose were the prescribing errors most frequently found during a pilot study of handwritten prescribing errors conducted in an internal medicine clinic that is part of a large health system.

In preparation for implementation of an electronic prescribing system, Emily Beth Devine, Pharm.D., M.B.A., of the University of Washington, and colleagues retrospectively reviewed 1,411 prescriptions that were handwritten during a 5-month timeframe to identify and characterize medication errors. The electronic prescribing system was then implemented in two stages: a basic system and then an advanced system with computerized decision support (CDS) capabilities. To identify errors, the researchers reviewed each handwritten prescription and the electronic health record. Nearly 28 percent of the prescriptions evaluated contained one or more errors.

Over 90 percent of the errors were potential errors and 79 percent were nonclinical errors (most often missing information); 21 percent were clinical errors. A total of 6.9 percent of errors reached the patient, 0.2 percent of errors caused patient harm (2 in every 1,000 prescriptions written that contained an error).

The authors suggest that implementing a basic electronic prescribing system may reduce nonclinical prescribing errors such as illegibility, missing information, and wrong dose, but that the addition of CDS alerts will be necessary to help reduce more severe clinical prescribing errors, such as contraindications due to drug-disease or drug-drug interactions.

The study was supported in part by the Agency for Healthcare Research and Quality (HS15319).

See "Characterization of prescribing errors in an internal medicine clinic," by Dr. Devine, Jennifer I. Wilson-Norton, M.B.A., Nathan M. Lawless, Ch.E., and others, in the May 15, 2007, American Journal of Health-Systems Pharmacy 64, pp. 1062-1070.

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