Qual Saf Health Care 16:279-284 doi:10.1136/qshc.2006.019497
  • Error management

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

  1. Bryony Dean Franklin1,
  2. Kara O’Grady1,
  3. Parastou Donyai2,
  4. Ann Jacklin1,
  5. Nick Barber3
  1. 1Centre for Medicines Safety and Service Quality, Pharmacy Department, Hammersmith Hospitals NHS Trust, The School of Pharmacy, University of London, London, UK
  2. 2Department of Pharmacy, Kingston University, Surrey, UK
  3. 3Department of Practice and Policy, The School of Pharmacy, University of London, London, UK
  1. Correspondence to:
 Professor B D Franklin
 Department of Pharmacy, Hammersmith Hospital, Du Cane Road, London,W12 0HS, UK; bdean{at}
  • Accepted 27 January 2007


Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time.

Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward.

Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system.

Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks.

Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test).

Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.


  • Funding: The research was funded by MDG Medical and the Department of Health’s Patient Safety Research Programme.

  • Competing interests: The authors’ work was independent of MDG Medical.

  • The grant from MDG Medical was unrestricted and they did not contribute to study design, data collection, analysis or interpretation of the data, nor to report writing or the decision to submit for publication.