An unintended consequence of electronic prescriptions: Prevalence and impact of internal discrepancies

Harvard Medical School, Boston, Massachusetts, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 07/2010; 17(4):472-6. DOI: 10.1136/jamia.2010.003335
Source: PubMed


Many e-prescribing systems allow for both structured and free-text fields in prescriptions, making possible internal discrepancies. This study reviewed 2914 electronic prescriptions that contained free-text fields. Internal discrepancies were found in 16.1% of the prescriptions. Most (83.8%) of the discrepancies could potentially lead to adverse events and many (16.8%) to severe adverse events, involving a hospital admission or death. Discrepancies in doses, routes or complex regimens were most likely to have a potential for a severe event (p=0.0001). Discrepancies between structured and free-text fields in electronic prescriptions are common and can cause patient harm. Improvements in electronic medical record design are necessary to minimize the risk of discrepancies and resulting adverse events.

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    • "From the studies assessed in this review, it appears that observational studies give us most insight into potential causes of adverse events or potential for patient harm. User-interface, faulty programming and erroneous information in the CDSS application were problems that lead to erroneous prescribing [67,74]. Adverse events were found to be concordant with non-adherence to CDSS suggestions [77]. "
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    ABSTRACT: The objective was to find evidence to substantiate assertions that electronic applications for medication management in ambulatory care (electronic prescribing, clinical decision support (CDSS), electronic health record, and computer generated paper prescriptions), while intended to reduce prescribing errors, can themselves result in errors that might harm patients or increase risks to patient safety. Because a scoping search for adverse events in randomized controlled trials (RCTs) yielded few relevant results, we systematically searched nine databases, including MEDLINE, EMBASE, and The Cochrane Database of Systematic Reviews for systematic reviews and studies of a wide variety of designs that reported on implementation of the interventions. Studies that had safety and adverse events as outcomes, monitored for them, reported anecdotally adverse events or other events that might indicate a threat to patient safety were included. We found no systematic reviews that examined adverse events or patient harm caused by organizational interventions. Of the 4056 titles and abstracts screened, 176 full-text articles were assessed for inclusion. Sixty-one studies with appropriate interventions, settings and participants but without patient safety, adverse event outcomes or monitoring for risks were excluded, along with 77 other non-eligible studies. Eighteen randomised controlled trials (RCTs), 5 non-randomised controlled trials (non-R, CTs) and 15 observational studies were included. The most common electronic intervention studied was CDSS and the most frequent clinical area was cardio-vascular, including anti-coagulants. No RCTS or non-R,CTS reported adverse event. Adverse events reported in observational studies occurred less frequently after implementation of CDSS. One RCT and one observational study reported an increase in problematic prescriptions with electronic prescribing CONCLUSIONS: The safety implications of electronic medication management in ambulatory care have not been established with results from studies found in this systematic review. Only a minority of studies that investigated these interventions included threats to patients' safety as outcomes or monitored for adverse events. It is therefore not surprising that we found little evidence to substantiate fears of new risks to patient safety with their implementation. More research is needed to focus on the draw-backs and negative outcomes that implementation of these interventions might introduce.
    BMC Medical Informatics and Decision Making 12/2013; 13(1):133. DOI:10.1186/1472-6947-13-133 · 1.83 Impact Factor
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    • "These studies offer limited evidence on how the electronic medication chart can support the collaborative process of medication management that spans multiple organisations [72] [77] [78]. Recent studies in healthcare contexts like hospitals and ambulatory care have identified unintended adverse consequences and a high incidence of errors related to electronic systems [79] [80] [81]. The prime reasons for adverse effects of electronic systems include their lack of alignment with the collaborative team based processes they intend to support [80] [82] [83]. "
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