Error rates for computer-generated prescriptions vary significantly

About 1 in 10 computer-generated prescriptions includes at least 1 error, and one third of those has potential for harm, which is consistent with the error rate for paper-written prescriptions, according to a new study published online June 29 in the Journal of the American Medical Infomatics Association.

Over a 4-week period in 2008, researchers analyzed 3,850 computer-generated prescriptions received by a commercial outpatient pharmacy chain across three states to find the frequency, types, and causes of errors associated with outpatient computer-generated prescription. A clinician panel reviewed the prescriptions to identify and classify medication errors, as well as determined the error’s potential for harm and the severity of the harm. Primary outcomes included the incidence of medication errors; potential adverse drug events (ADE; errors with potential for harm); and rate of prescribing errors by type and system.

Researchers found 452 (11.7%) prescriptions that contained 466 total errors, and 163 (35%) were classified as potential ADEs. Of the potential ADEs, 95 (58.3%) were significant, 68 (41.7%) were serious, and none were life threatening. The 4 most common classes of drug containing medication errors were anti-infectives (40.3%), nervous-system drugs (13.9%), and respiratory system drugs (8.6%). Nervous system drugs, cardiovascular drugs, and anti-infectives were the classes most commonly associated with potential ADEs.

Researchers also found that error rates by computerized prescribing system varied from 5.1% to 37.5%, with the most common error, about 60%, being omitted information.

“Although we found an average error rate that is consistent with these studies, we found in addition that the number, type, and severity of prescribing errors varied significantly according to which computerized prescribing system was used, suggesting that either the system designs differed, for example, with a superior user interface or more advanced functionality; or implementation varied, since, for example, better clinician training may result in safer prescribing,” the authors wrote.

They reported several strategies to minimize errors associated with computer-generated prescriptions, including computer-based interventions and provider-based interventions. Computer-based interventions include forcing functions, specific drug decisions support, and calculators; while provider-based interventions may include rigorous vendor selection, aligned financial incentives, and strong training.

“To enable stakeholders to realize more of the potential benefits of computerized prescribing systems, vendors and healthcare providers may consider implementing several of the outlined computer-based and provider-based interventions, which combined have the potential to eliminate more than 80% of the errors,” the authors concluded.

This study was supported by a grant from the Agency for Healthcare Research and Quality (Rockville, Maryland) and in part by a grant from the Harvard Risk Management Foundation, Cambridge, Massachusetts.