ONC report tackles EHR drug 'pick list' errors

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A new report from the ONC calls on vendors, providers and others to get involved in reducing “pick list” medication errors.

Vendors, providers and others all need to be involved in reducing “pick list” medication errors, according to a new report from the ONC.

The report, on the safe use of pick lists in ambulatory care settings, notes that pick lists, also known as drop-down menus, are “ubiquitous” features in every EHR and order entry system. While they save time and can reduce some errors, such as typographical mistakes stemming from sloppy physician handwriting, they have created new types of medication errors attributable to poor design, implementation and/or system configuration. The two general types of pick list errors are choosing the wrong patient record and choosing the wrong medication for a patient.

The report makes six recommendations to reduce these errors:

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  • Use specific design features to reduce wrong patient pick list errors, such as including photographs of patients in their records.
  • Use electronic prescribing common guidelines that focus on improving safety when developing pick lists.
  • Determine best practices for organization, design and configuration of pick lists.
  • Display a summary review screen before completing a medication order.
  • Provide easy-to-use “retract and reorder” functionality as well as functionality to track and identify potential design errors through the use of this information.
  • Provide patients with lists of their current medications.

The report includes supporting material, including self-assessments and best practices for providers, with examples. It also recommends more research in this area, such as managing interruptions during medication ordering, the use of clinical decision support tools to help with ordering, sharing diagnosis information with pharmacy staff and tracking errors.

“The resources, planning, and coordination required to implement each of these six recommendations may differ by type of stakeholder and by recommendation. Generally, however, implementation will require vendors, practice managers, information officers, and providers to work together to ensure that system functionality, training and organization policies, and end-user practices all align,” the report states.

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