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Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital
  1. Seetal Jheeta Puaar1,
  2. Bryony Dean Franklin1,2
  1. 1 Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
  1. Correspondence to Seetal Jheeta Puaar, Centre for Medication Safety and Service Quality Imperial College Healthcare NHS Trust, London, W6 8RF, UK; seetal.jheeta{at}


Background Few studies have applied a systems approach to understanding the causes of specific prescribing errors in the context of hospital electronic prescribing (EP). A comprehensive understanding of underlying causes is essential for developing effective interventions to improve prescribing safety. Our objectives were to explore prescribers’ perspectives of the causes of errors occurring with EP and to make recommendations to maximise benefits and minimise risks.

Methods We studied a large hospital using inpatient EP. From April to June 2016, semistructured interviews were conducted with purposively sampled prescribers involved with a prescribing error. Interviews explored prescribers’ perceived causes of the error and views about EP; they were audio-recorded and transcribed verbatim. Data were thematically analysed against a framework based on Reason’s accident causation model, with a focus on identifying latent conditions.

Results Twenty-five interviews explored causes of 32 errors. Slips and rule-based mistakes were the most common active failures. Error causation was multifactorial; environmental, individual, team, task and technology error-producing conditions were all influenced by EP. There were three broad groups of latent conditions: the EP system’s functionality and design; the organisation’s decisions around EP implementation and use; and prescribing behaviours in the context of EP.

Conclusions Errors were associated with the design of EP itself and its integration within the healthcare environment. Findings suggest that EP vendors should focus on revolutionising interface design and usability issues, bearing in mind the wider healthcare context in which such software is used. Healthcare organisations should draw upon human factors principles when implementing EP. Consideration of work environment, infrastructure, training, prescribing responsibilities and behaviours should be considered to address local issues identified.

  • medication safety
  • information technology
  • human error
  • root cause analysis

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  • Handling editor Mary Dixon-Woods

  • Contributors SJP and BDF designed the study. SJP conducted data collection. SJP and BDF analysed the data, wrote and edited the manuscript.

  • Funding This article represents independent research funded by the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre, and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, PHE or the Department of Health.

  • Competing interests BDF is supervising a PhD studentship funded by a commercial electronic prescribing company that is unrelated to this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.