Evaluation of Errors When Using e-Prescribing

San Antonio—While electronic prescribing (e-prescribing) has been widely recommended for its ability to reduce medication errors, especially transcription errors; however, according to recent study literature, the rates of e-prescribing errors in ambulatory clinics varies widely from 5.1% to 37.5%. A recent study sought to examine the prevalence of unintended discrepancies for e-prescribing.

This study was presented by Daniel Lomelin, BS, and colleagues at the NASP meeting during a poster session titled From Physician Intent to the Pharmacy Label: Prevalence and Description of Discrepancies from a Cross-Sectional Evaluation of Electronic Prescriptions.

This retrospective, cross-sectional study of 3 ambulatory care clinic-community pharmacy pairs identified approximately 200 new prescriptions written at the participating clinics. Two of the clinics were for adult care and 1 was a pediatric facility—one was a family medicine clinic with an affiliated pharmacy, another was a family medicine clinic with an independent pharmacy, and the last was a pediatric clinic with an independent pharmacy. A total of 602 prescriptions written by 33 prescribers were evaluated in the study.

Data collected from each prescription included patient gender, patient birth year, drug name, drug dose, route of treatment administration, directions for use, additional instructions, drug dosage form, and quantity dispensed.

The researchers identified these discrepancies by comparing prescriber intent documented in the patient’s chart to what was entered into the clinic’s e-prescribing software. This was then compared to what was actually dispensed by the pharmacy per the prescription label.

For the family medicine clinic with an affiliated pharmacy cohort, 150 patients were included and 191 prescriptions were evaluated; 38% of the patients were male and 16 prescribers were included in this cohort.

For the family medicine clinic with an independent pharmacy cohort, 179 patients were included and 212 prescriptions were evaluated; 39% of the patients were male and 10 prescribers were included in this group.

For the pediatric clinic with an independent pharmacy cohort, 151 patients were included and 199 prescriptions were evaluated; 56% of the patients were male and 7 prescribers were included in this cohort.

For the 3 clinics (a family medicine clinic with an affiliated pharmacy, a family medicine clinic with an independent pharmacy, and a pediatric clinic with an independent pharmacy) the discrepancy rate between the prescriber’s note and the e-prescription was 1.7%, 0.6%, and 3.9%, respectively. The discrepancy rate between the e-prescription and the prescription label at the pharmacy was 4.2%, 0.9%, and 1.5%, respectively.

The most common discrepancy the researchers came across was a difference between directions for administration.

The researchers found the most discrepancies stemmed from “nonstandard” dosage forms when prescribers did not have appropriately structured list options to choose from.

The researchers identified that the e-prescribing software may need to be revised to accommodate different options for drug directions. For example, the study authors indicated that customization of e-prescribing software that gives providers the option to select “refer to additional instructions” as an option, rather than be forced to populate a field with an incorrect option, may lead to less discrepancies and prescribing errors. Additional studies are need to further examine the discrepancies between the e-prescription and the pharmacy label, according to the study authors.