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Detection and prevention of prescriptions with excessive doses in electronic prescribing systems

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Introduction

Dose dependent adverse drug reactions are often caused by prescribing errors ignoring upper dose limits. Thus, computerised physician order entry incorporating maximum recommended therapeutic doses (MRTDs) might reduce prescriptions of excessive doses. We evaluated the suitability of MRTD information as published in the Summary of Product Characteristics (SPC) (MRTDSPC) or by the US Food and Drug Administration (MRTDFDA) and the value of Defined Daily Doses (DDD, World Health Organisation) as knowledge bases for an alerting system.

Methods

In a large set of critical-dose drugs (N = 140) we compared MRTDFDA and DDD values with the corresponding German MRTDSPC. We then retrospectively assessed a set of 633 electronically prescribed drugs (EPDs) issued at a university hospital and calculated prescription rates of excessive doses.

Results

MRTDFDA was similar to MRTDSPC in 37% (N = 140), higher in 32%, and lower in 31% of drugs. On average, available DDD values (N = 129) were 1.6 times lower than MRTDSPC, with 64% being lower, 33% similar, and 3% larger than MRTDSPC. Prescription rates of excessive doses according to MRTDFDA were 2.5-fold higher (6.1%) than according to MRTDSPC (2.5%) (p < 0.01). However, only one in four EPDs categorised as overdosed according to MRTDFDA exceeded MRTDSPC, and MRTDFDA values were available only for 67% of all assessed EPDs.

Conclusion

Our study revealed a remarkable number of prescriptions with doses exceeding approved limits. Their prevention appears feasible but the choice of an appropriate database for MRTDs is essential, and differences between available information sources are large.

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Acknowledgement

The work of H. Seidling was supported in part by the Chamber of Pharmacists Baden-Württemberg, A. Al Barmawi was supported by an unrestricted educational grant of Syria.

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Authors and Affiliations

  1. Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    H. M. Seidling, A. Al Barmawi, J. Kaltschmidt, T. Bertsche, M. G. Pruszydlo & W. E. Haefeli

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  1. H. M. Seidling
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  2. A. Al Barmawi
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  3. J. Kaltschmidt
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  4. T. Bertsche
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  5. M. G. Pruszydlo
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  6. W. E. Haefeli
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Corresponding author

Correspondence to W. E. Haefeli.

Additional information

H. M. Seidling and A. Al Barmawi contributed equally to the work.

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Seidling, H.M., Al Barmawi, A., Kaltschmidt, J. et al. Detection and prevention of prescriptions with excessive doses in electronic prescribing systems. Eur J Clin Pharmacol 63, 1185–1192 (2007). https://doi.org/10.1007/s00228-007-0370-9

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  • DOI: https://doi.org/10.1007/s00228-007-0370-9

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