Abstract
BACKGROUND: Medication errors are common among inpatients and many are preventable with computerized prescribing. Relatively little is known about outpatient prescribing errors or the impact of computerized prescribing in this setting.
OBJECTIVE: To assess the rates, types, and severity of outpatient prescribing errors and understand the potential impact of computerized prescribing.
DESIGN: Prospective cohort study in 4 adult primary care practices in Boston using prescription review, patient survey, and chart review to identify medication errors, potential adverse drug events (ADEs) and preventable ADEs.
PARTICIPANTS: Outpatients over age 18 who received a prescription from 24 participating physicians.
RESULTS: We screened 1879 prescriptions from 1202 patients, and completed 661 surveys (response rate 55%). Of the prescriptions, 143 (7.6%; 95% confidence interval (CI) 6.4% to 8.8%) contained a prescribing error. Three errors led to preventable ADEs and 62 (43%; 3% of all prescriptions) had potential for patient injury (potential ADEs); I was potentially life-threatening (2%) and 15 were serious (24%). Errors in frequency (n=77, 54%) and dose (n=26, 18%) were common. The rates of medication errors and potential ADEs were not significantly different at basic computerized prescribing sites (4.3% vs 11.0%, P=.31; 2.6% vs 4.0%, P=.16) compared to handwritten sites. Advanced checks (including dose and frequency checking) could have prevented 95% of potential ADEs.
CONCLUSIONS: Prescribing errors occurred in 7.6% of outpatient prescriptions and many could have harmed patients. Basic computerized prescribing systems may not be adequate to reduce errors. More advanced systems with dose and frequency checking are likely needed to prevent potentially harmful errors.
Similar content being viewed by others
References
Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape LL. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10:199–205.
Dean B, Schachter M, Vincent C, Barber N. Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Safety Health Care. 2002;11:340–4.
Meyer TA. Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions. Am J Health Syst Pharm. 2000;57(suppl 4):4–22.
Shaughnessy AF, Nickel RO. Prescription-writing patterns and errors in a family medicine residency program. J Fam Pract. 1989;29:290–5.
Hawksworth GM, Corlett AJ, Wright DJ, Chrystyn H. Clinical pharmacy interventions by community pharmacists during the dispensing process. Br J Clin Pharm. 1999;47:695–700.
Rupp MT, DeYoung M, Schondelmeyer SW. Prescribing problems and pharmacist interventions in community practice. Med Care. 1992;30:926–40.
Buurma H, de Smet PAGM, van den Hoff OP, Egberts ACG. Nature, frequency, and determinants of prescription modifications in Dutch community pharamacies. Br J Clin Pharmacol. 2001;52:85–91.
Davis K, Schoenbaum SC, Collins KS, Tenney K, Hughes DL, Audet AJ. Room for improvement: patients report on the quality of their health care. Available at: http://www.cmwf.org. Accessed November 1, 2003.
Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. New Engl J Med. 2003;348:1556–64.
Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280:1311–6.
Bates DW, O’Neil AC, Boyle D, et al. Potential identifiability and preventability of adverse events using information systems. J Am Med Inform Assoc. 1994;1:404–11.
Bates DW, Ebell M, Gotlieb E, Zapp J, Mullins HC. A proposal for electronic medical records in U.S. primary care. J Am Med Inform Assoc. 2003;10:1–10.
Rothschild JM, Lee TH, Bae T, Bates DW. Clinician use of a palmtop drug reference guide. J Am Med Inform Assoc. 2002;9:223–9.
Bates DW, Cullen D, Laird N, et al. Incidence of adverse drug events and potential adverse drug events: implications for prevention. JAMA. 1995;274:29–34.
Lesar TS, Briceland LL, Stein DS. Factors related to errors in medication prescribing. JAMA. 1997;277:312–7.
IMS Health, National Prescription Audit™ Plus 7/2003, All Channels, July 2002 through June 2003.
Helmreich RL, Merritt AC. Culture at Work in Aviation and Medicine: National, Organizational and Professional Influences. Brookfield, VT: Ashgate; 1998.
Schiff GD, Bates DW. Electronic point-of-care-prescribing: writing the “script”. Dis Manage Health Outcomes. 2000;7:297–304.
Rabinowitz E. Will palm-size computers make electronic prescribing happen? Manage Care. 1999;8:59–61.
Gallup poll. Computerisation in GP practices in England and Wales: 1993 survey. NHS Management Executive 1993.
Harris Interactive. Poll: Americans prefer direct prescribing connectivity between physicians, pharmacists. Available at: http://www.surescript.com/aug10.htm. Accessed November 1, 2003.
Barrett MJ, Holmes BJ, McAulay SE Forrester Research. Electronic medical records: a buyer’s guide for small physician practices. California HealthCare Foundation 2003. Available at: http://www.chcf.org. Accessed November 1, 2003.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have no conflicts of interest to report.
Rights and permissions
About this article
Cite this article
Gandhi, T.K., Weingart, S.N., Seger, A.C. et al. Outpatient prescribing errors and the impact of computerized prescribing. J GEN INTERN MED 20, 837–841 (2005). https://doi.org/10.1111/j.1525-1497.2005.0194.x
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2005.0194.x