Outpatient prescribing errors and the impact of computerized prescribing (original) (raw)

Abstract

BACKGROUND: Medication errors are common among inpatients and many are preventable with computerized prescribing. Relatively little is known about outpatient prescribing errors or the impact of computerized prescribing in this setting.

OBJECTIVE: To assess the rates, types, and severity of outpatient prescribing errors and understand the potential impact of computerized prescribing.

DESIGN: Prospective cohort study in 4 adult primary care practices in Boston using prescription review, patient survey, and chart review to identify medication errors, potential adverse drug events (ADEs) and preventable ADEs.

PARTICIPANTS: Outpatients over age 18 who received a prescription from 24 participating physicians.

RESULTS: We screened 1879 prescriptions from 1202 patients, and completed 661 surveys (response rate 55%). Of the prescriptions, 143 (7.6%; 95% confidence interval (CI) 6.4% to 8.8%) contained a prescribing error. Three errors led to preventable ADEs and 62 (43%; 3% of all prescriptions) had potential for patient injury (potential ADEs); I was potentially life-threatening (2%) and 15 were serious (24%). Errors in frequency (_n_=77, 54%) and dose (_n_=26, 18%) were common. The rates of medication errors and potential ADEs were not significantly different at basic computerized prescribing sites (4.3% vs 11.0%, _P_=.31; 2.6% vs 4.0%, _P_=.16) compared to handwritten sites. Advanced checks (including dose and frequency checking) could have prevented 95% of potential ADEs.

CONCLUSIONS: Prescribing errors occurred in 7.6% of outpatient prescriptions and many could have harmed patients. Basic computerized prescribing systems may not be adequate to reduce errors. More advanced systems with dose and frequency checking are likely needed to prevent potentially harmful errors.

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References

  1. Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape LL. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10:199–205.
    Article PubMed CAS Google Scholar
  2. Dean B, Schachter M, Vincent C, Barber N. Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Safety Health Care. 2002;11:340–4.
    Article CAS Google Scholar
  3. Meyer TA. Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions. Am J Health Syst Pharm. 2000;57(suppl 4):4–22.
    Google Scholar
  4. Shaughnessy AF, Nickel RO. Prescription-writing patterns and errors in a family medicine residency program. J Fam Pract. 1989;29:290–5.
    PubMed CAS Google Scholar
  5. Hawksworth GM, Corlett AJ, Wright DJ, Chrystyn H. Clinical pharmacy interventions by community pharmacists during the dispensing process. Br J Clin Pharm. 1999;47:695–700.
    Article CAS Google Scholar
  6. Rupp MT, DeYoung M, Schondelmeyer SW. Prescribing problems and pharmacist interventions in community practice. Med Care. 1992;30:926–40.
    Article PubMed CAS Google Scholar
  7. Buurma H, de Smet PAGM, van den Hoff OP, Egberts ACG. Nature, frequency, and determinants of prescription modifications in Dutch community pharamacies. Br J Clin Pharmacol. 2001;52:85–91.
    Article PubMed CAS Google Scholar
  8. Davis K, Schoenbaum SC, Collins KS, Tenney K, Hughes DL, Audet AJ. Room for improvement: patients report on the quality of their health care. Available at: http://www.cmwf.org. Accessed November 1, 2003.
  9. Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. New Engl J Med. 2003;348:1556–64.
    Article PubMed Google Scholar
  10. Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280:1311–6.
    Article PubMed CAS Google Scholar
  11. Bates DW, O’Neil AC, Boyle D, et al. Potential identifiability and preventability of adverse events using information systems. J Am Med Inform Assoc. 1994;1:404–11.
    PubMed CAS Google Scholar
  12. Bates DW, Ebell M, Gotlieb E, Zapp J, Mullins HC. A proposal for electronic medical records in U.S. primary care. J Am Med Inform Assoc. 2003;10:1–10.
    Article PubMed Google Scholar
  13. Rothschild JM, Lee TH, Bae T, Bates DW. Clinician use of a palmtop drug reference guide. J Am Med Inform Assoc. 2002;9:223–9.
    Article PubMed Google Scholar
  14. Bates DW, Cullen D, Laird N, et al. Incidence of adverse drug events and potential adverse drug events: implications for prevention. JAMA. 1995;274:29–34.
    Article PubMed CAS Google Scholar
  15. Lesar TS, Briceland LL, Stein DS. Factors related to errors in medication prescribing. JAMA. 1997;277:312–7.
    Article PubMed CAS Google Scholar
  16. IMS Health, National Prescription Audit™ Plus 7/2003, All Channels, July 2002 through June 2003.
  17. Helmreich RL, Merritt AC. Culture at Work in Aviation and Medicine: National, Organizational and Professional Influences. Brookfield, VT: Ashgate; 1998.
  18. Schiff GD, Bates DW. Electronic point-of-care-prescribing: writing the “script”. Dis Manage Health Outcomes. 2000;7:297–304.
    Article Google Scholar
  19. Rabinowitz E. Will palm-size computers make electronic prescribing happen? Manage Care. 1999;8:59–61.
    CAS Google Scholar
  20. Gallup poll. Computerisation in GP practices in England and Wales: 1993 survey. NHS Management Executive 1993.
  21. Harris Interactive. Poll: Americans prefer direct prescribing connectivity between physicians, pharmacists. Available at: http://www.surescript.com/aug10.htm. Accessed November 1, 2003.
  22. Barrett MJ, Holmes BJ, McAulay SE Forrester Research. Electronic medical records: a buyer’s guide for small physician practices. California HealthCare Foundation 2003. Available at: http://www.chcf.org. Accessed November 1, 2003.

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Authors and Affiliations

  1. Center for Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA
    Saul N. Weingart MD, PhD
  2. Harvard School of Public Health, Boston, MA, USA
    Lucian L. Leape MD
  3. Division of General Medicine, Brigham and Women’s Hospital, 1620 Tremont Street, 3rd floor, 02120, Boston, MA
    Tejal K. Gandhi MD, MPH, Andrew C. Seger Pharm D, Joshua Borus BA, Elisabeth Burdick MS, Eric G. Poon MD, MPH & David W. Bates MD, MSc

Authors

  1. Tejal K. Gandhi MD, MPH
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  2. Saul N. Weingart MD, PhD
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  3. Andrew C. Seger Pharm D
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  4. Joshua Borus BA
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  5. Elisabeth Burdick MS
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  6. Eric G. Poon MD, MPH
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  7. Lucian L. Leape MD
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  8. David W. Bates MD, MSc
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Corresponding author

Correspondence to Tejal K. Gandhi MD, MPH.

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The authors have no conflicts of interest to report.

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Gandhi, T.K., Weingart, S.N., Seger, A.C. et al. Outpatient prescribing errors and the impact of computerized prescribing.J GEN INTERN MED 20, 837–841 (2005). https://doi.org/10.1111/j.1525-1497.2005.0194.x

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