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Electronic Prescribing Within an Electronic Health Record Reduces Ambulatory Prescribing Errors

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Abstract:

Background: Health policy forces are promoting the adoption of interoperable electronic health records (EHRs) with electronic prescribing (e-prescribing). Despite the promise of EHRs with e-prescribing to improve medication safety in ambulatory care settings—where most prescribing occurs and where errors are common—few studies have demonstrated its effectiveness. A study was conducted to assess the effect of an e-prescribing system with clinical decision support, including checks for drug allergies and drug–drug interactions, that was integrated within an EHR on rates of ambulatory prescribing errors.

Methods: In a prospective study using a nonrandomized, pre–post design with concurrent controls, 6 providers who used a commercial e-prescribing system were compared with 15 providers who remained paper-based from September 2005 through July 2008. Prescribing errors were identified by a standardized prescription and chart review.

Results: Some 2,432 paper prescriptions at baseline and 2,079 prescriptions at one year were analyzed. Error rates for e-prescribing adopters decreased 1.5-fold—from 26.0 errors per 100 prescriptions at baseline (95% confidence interval [CI], 17.4–38.9) to 16.0 errors per 100 prescriptions at one year (95% CI, 12.7–20.2; p = .09). Error rates remained unchanged for nonadopters (37.3 per 100 prescriptions at baseline, 95% CI, 27.6–50.2, versus 38.4 per 100 prescriptions at one year, 95% CI 27.4–53.9; p = .54). Error rates for e-prescribing adopters were significantly lower than for nonadopters at one year (p < .001). Illegibility errors were high at baseline and eliminated by e-prescribing.

Conclusions: The preliminary findings from this small group of providers suggest that e-prescribing systems may decrease ambulatory prescribing errors, which are occurring at high rates among community-based providers.

Document Type: Research Article

Publication date: October 1, 2011

More about this publication?
  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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