Medication error rates fell substantially in two Australian hospitals after they introduced commercial electronic prescribing systems, according to a study published in PLoS Medicine. Although the use of these systems introduced new errors--as some U.S. studies have also shown--those additional mistakes were far outweighed by the increase in safety when the e-prescribing applications were used.
At one hospital, clinicians used the Cerner Millennium e-prescribing system in a geriatric ward. Three other wards served as controls. In the second hospital, the iSoft Medchart system was implemented in a psychiatric ward and a cardiology ward. The researchers compared the error rates before and after the introduction.
The use of the e-prescribing systems resulted in error reductions of 66.1 percent, 57.5 percent, and 60.5 percent in the three intervention wards. The control wards in the first hospital did not experience a significant decline in errors.
The researchers attributed the decrease in errors in the wards that used e-prescribing to "a large reduction in unclear, illegal and incomplete orders." Fewer mistakes in prescribing were responsible for a far smaller portion of the decline.
However, e-prescribing did lead to a significant drop in serious errors that could have resulted in death. Rates of serious errors were cut nearly in half, while serious errors in control wards fell only 17 percent.
System-related mistakes, such as picking the wrong medication from a drop-down box, accounted for more than a third of the errors in the intervention wards. But these were considered relatively minor in light of the overall error reduction.
It's hard to compare this study with similar U.S. trials, because hospitals in the U.S. use computerized physician order entry (CPOE), a system that includes both medication and test orders. But several studies of CPOE have shown that they can cause medical errors, while other studies have indicated that they can prevent mistakes from occurring.
Last November, the Institute of Medicine proposed that the federal government establish a panel to investigate patient deaths and serious injuries associated with health IT.
To learn more:
- read the PLoS study
- see a Medscape article on the study
- check out an InformationWeek Healthcare article on e-prescribing errors in hospitals