scholarly journals A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system

2020 ◽  
Author(s):  
Fahad Alshahrani ◽  
John F. Marriott ◽  
Anthony R. Cox
Keyword(s):  
Qualitative Study ◽  
Qualitative Interviews ◽  
Unintended Consequences ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Environmental Aspects ◽  
Order Entry ◽  
Contributing Factors ◽  
Prescribing Error ◽  
Physician Order Entry

Abstract Background Computerised Physician Order Entry (CPOE) is considered to enhance the safety of prescribing. However, it can have unintended consequences and new forms of prescribing error have been reported. Objective The aim of this study was to explore the causes and contributing factors associated with prescribing errors reported by multidisciplinary prescribers working within a CPOE system. Main Outcome Measure Multidisciplinary prescribers experience of prescribing errors in an CPOE system. Method This qualitative study was conducted in a hospital with a well-established CPOE system. Semi-structured qualitative interviews were conducted with prescribers from the professions of pharmacy, nursing, and medicine. Interviews analysed using a mixed inductive and deductive approach to develop a framework for the causes of error. Results Twenty-three prescribers were interviewed. Six main themes influencing prescribing were found: the system, the prescriber, the patient, the team, the task of prescribing and the work environment. Prominent issues related to CPOE included, incorrect drug name picking, default auto-population of dosages, alert fatigue and remote prescribing. These interacted within a complex prescribing environment. No substantial differences in the experience of CPOE were found between the professions. Conclusion Medical and non-medical prescribers have similar experiences of prescribing errors when using CPOE, aligned with existing published literature about medical prescribing. Causes of electronic prescribing errors are multifactorial in nature and prescribers describe how factors interact to create the conditions errors. While interventions should focus on direct CPOE issues, such as training and design, socio-technical, and environmental aspects of practice remain important.

scholarly journals Role of Computerized Physician Order Entry Usability in the Reduction of Prescribing Errors

2013 ◽  
Vol 19 (2) ◽  
pp. 93 ◽  
Author(s):  
Hamid Reza Peikari ◽  
Mohamad Shanudin Zakaria ◽  
Norjaya M. Yasin ◽  
Mahmood Hussain Shah ◽  
Abdelbary Elhissi
Keyword(s):  
Computerized Physician Order Entry ◽  
Prescribing Errors ◽  
Order Entry ◽  
Physician Order Entry

Perceptions of Physician Order Entry: Results of a Cross-Site Qualitative Study

2003 ◽  
Vol 42 (04) ◽  
pp. 313-323 ◽  
Author(s):  
P. N. Gorman ◽  
M. Lavelle ◽  
P. Z. Stavri ◽  
J. Lyman ◽  
L. Fournier ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Success Factors ◽  
Inpatient Setting ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Field Notes ◽  
Using Data ◽  
High Level ◽  
Physician Order Entry ◽  
Cross Site

Summary Objective: To identify perspectives of success factors for implementing computerized physician order entry (POE) in the inpatient setting. Design: Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes. Results: A taxonomy of ten high level themes was developed, including 1) separating POE from other processes, 2) terms, concepts, and connotations, 3) context, 4) tradeoffs, 5) conflicts and contradictions, 6) collaboration and trust, 7) leaders and bridgers, 8) the organization of information, 9) the ongoing nature of implementation, and 10) temporal concerns. Conclusion: The identified success factors indicate that POE implementation is an iterative and difficult process, but informants perceive it is worth the effort.

Effect of computerized physician order entry in the prescribing errors in inpatient care in a pulmonology unit

2015 ◽  
Author(s):  
Elena Villamañán ◽  
Aldara García-Sánchez ◽  
Ester Zamarron ◽  
Eduardo Armada ◽  
Yolanda Larrubia ◽  
...  
Keyword(s):  
Inpatient Care ◽  
Computerized Physician Order Entry ◽  
Prescribing Errors ◽  
Order Entry ◽  
Physician Order Entry

Medication prescribing errors: a pre- and post-computerized physician order entry retrospective study

2018 ◽  
Vol 41 (1) ◽  
pp. 228-236 ◽  
Author(s):  
Naïs Rouayroux ◽  
Violaine Calmels ◽  
Bérengére Bachelet ◽  
Brigitte Sallerin ◽  
Elodie Divol
Keyword(s):  
Retrospective Study ◽  
Computerized Physician Order Entry ◽  
Prescribing Errors ◽  
Order Entry ◽  
Medication Prescribing ◽  
Physician Order Entry

scholarly journals The impact of health information technology on prescribing errors in hospitals: a systematic review and behaviour change technique analysis

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Joan Devin ◽  
Brian J. Cleary ◽  
Shane Cullinan
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Behaviour Change ◽  
Error Rates ◽  
Behaviour Change Techniques ◽  
Prescribing Errors ◽  
Order Entry ◽  
Prescribing Error ◽  
The Impact

Abstract Background Health information technology (HIT) is known to reduce prescribing errors but may also cause new types of technology-generated errors (TGE) related to data entry, duplicate prescribing, and prescriber alert fatigue. It is unclear which component behaviour change techniques (BCTs) contribute to the effectiveness of prescribing HIT implementations and optimisation. This study aimed to (i) quantitatively assess the HIT that reduces prescribing errors in hospitals and (ii) identify the BCTs associated with effective interventions. Methods Articles were identified using CINAHL, EMBASE, MEDLINE, and Web of Science to May 2020. Eligible studies compared prescribing HIT with paper-order entry and examined prescribing error rates. Studies were excluded if prescribing error rates could not be extracted, if HIT use was non-compulsory or designed for one class of medication. The Newcastle-Ottawa scale was used to assess study quality. The review was reported in accordance with the PRISMA and SWiM guidelines. Odds ratios (OR) with 95% confidence intervals (CI) were calculated across the studies. Descriptive statistics were used to summarise effect estimates. Two researchers examined studies for BCTs using a validated taxonomy. Effectiveness ratios (ER) were used to determine the potential impact of individual BCTs. Results Thirty-five studies of variable risk of bias and limited intervention reporting were included. TGE were identified in 31 studies. Compared with paper-order entry, prescribing HIT of varying sophistication was associated with decreased rates of prescribing errors (median OR 0.24, IQR 0.03–0.57). Ten BCTs were present in at least two successful interventions and may be effective components of prescribing HIT implementation and optimisation including prescriber involvement in system design, clinical colleagues as trainers, modification of HIT in response to feedback, direct observation of prescriber workflow, monitoring of electronic orders to detect errors, and system alerts that prompt the prescriber. Conclusions Prescribing HIT is associated with a reduction in prescribing errors in a variety of hospital settings. Poor reporting of intervention delivery and content limited the BCT analysis. More detailed reporting may have identified additional effective intervention components. Effective BCTs may be considered in the design and development of prescribing HIT and in the reporting and evaluation of future studies in this area.

P30 The effects of introducing electronic prescribing for paediatric chemotherapy using aria on prescribing error rates at a primary treatment centre

2018 ◽  
Vol 103 (2) ◽  
pp. e2.33-e2
Author(s):  
Peter Cook ◽  
Andy Fox
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Error Rate ◽  
Lymphoblastic Leukaemia ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Patient Specific ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Error Type ◽  
Before And After

IntroductionPrescribing of medication in children is a very complex process that involves an understanding of paediatric physiology, disease states, medication used and pharmacokinetics as well as patient specific details, their co-morbidities and their clinical condition. The most common medication errors have been identified as dosing, route of administration, and frequency of administration. Computerised provider order entry has been shown to reduce the number of prescribing errors related to chemotherapy as well as the likelihood of dose and calculation errors in paediatric chemotherapy prescribing. Locally, paediatric chemotherapy is prescribed on pre-printed paper prescriptions. Adaptation and implementation of ARIA electronic prescribing (EP) system for use in paediatric chemotherapy was undertaken by a Specialist Paediatric Oncology Pharmacist and was rolled out for use in January 2016 for patients with acute lymphoblastic leukaemia.MethodThe United Kingdom National Randomised Trial for Children and Young Adults with Acute Lymphoblastic Leukaemia and Lymphoma 2011 (UKALL, 2011) was developed for use on EP, with prescribing of all other chemotherapy remaining on paper. The number and type of prescribing errors were collected during a pre-implementation phase from January 2015 to June 2015. After the introduction of EP and following a 2 month acclimatisation period, a second period of data collection took place between March 2016 and July 2016. Overall prescribing error rates and the frequency of each error type were calculated both before and after implementation.ResultsBefore the introduction of EP for paediatric chemotherapy, the overall error rate was 18.4% with a total of 16 different errors seen. Post implementation, overall error rate increased to 25.7% (p<0.001) with a total of 10 different errors seen. After introduction of EP, prescribing error rates on paper were 30.6% and on EP were 7.0% (p<0.001). Only 5 different error types were seen with electronic prescribing. The most commonly seen errors in prescribing with paper, both before and after were almost eliminated with the introduction of EP.ConclusionThe introduction of EP has resulted in a significant reduction in prescribing error rates compared to paper based prescribing for paediatric chemotherapy. Overall the prescribing error rate increased after the introduction of EP but this was related to an increased rate on the paper prescriptions. One possible reason for this was the use of dual systems for prescribing. In addition there was unforeseen relocation and building work within the paediatric cancer unit, which affected prescribing time allocation. There were also several staff shortages within the prescribing team after implementation and this resulted in an increased workload on the remaining chemotherapy prescribers. All these issues could have attributed to the increase in error rates. The most common errors seen with chemotherapy prescribing have been reduced with EP as protocols have been developed with a focus on prescribing safety. Further work is needed as more prescribing takes place on EP to assess the full impact it has on paediatric chemotherapy error rates.

scholarly journals Characteristics of pharmacist’s interventions triggered by prescribing errors related to computerised physician order entry in French hospitals: a cross-sectional observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e045778
Author(s):  
Manon Videau ◽  
Bruno Charpiat ◽  
Céline Vermorel ◽  
Jean-Luc Bosson ◽  
Ornella Conort ◽  
...  
Keyword(s):  
Observational Study ◽  
Acceptance Rate ◽  
Drug Related Problems ◽  
Prescribing Errors ◽  
Order Entry ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Clinical Consequences ◽  
Physician Order Entry ◽  
Certified Software

ObjectivesComputerised physician order entry (CPOE) systems facilitate the review of medication orders by pharmacists. Reports have emerged that show conception flaws or the misuse of CPOE systems generate prescribing errors. We aimed to characterise pharmacist interventions (PIs) triggered by prescribing errors identified as system-related errors (PISREs) in French hospitals.DesignThis was a cross-sectional observational study based on PIs prospectively documented in the Act-IP observatory database from January 2014 to December 2018.SettingPISREs from 319 French computerised healthcare facilities were analysed.ParticipantsAmong the 319 French hospitals, 232 (72.7%) performed SRE interventions, involving 652 (51%) pharmacists.ResultsAmong the 331 678 PIs recorded, 27 058 were qualified as due to SREs (8.2%). The main drug-related problems associated with PISREs were supratherapeutic (27.5%) and subtherapeutic dosage (17.2%), non-conformity with guidelines/contraindications (22.4%) and improper administration (17.9%). The PI prescriber acceptation rate was 78.9% for SREs vs 67.6% for other types of errors. The PISRE ratio was estimated relative to the total number of PIs. Concerning the certification status of CPOE systems, the PISRE ratio was 9.4% for non-certified systems vs 5.5% for certified systems (p<0.001). The PISRE ratio for senior pharmacists was 9.2% and that for pharmacy residents 5.4% (p<0.001). Concerning prescriptions made by graduate prescribers and those made by residents, the PISRE ratio was 8.4% and 7.8%, respectively (p<0.001).ConclusionComputer-related prescribing errors are common. The PI acceptance rate by prescribers was higher than that observed for PIs that were not CPOE related. This suggests that physicians consider the potential clinical consequences of SREs for patients to be more frequently serious than interventions unrelated to CPOE. CPOE medication review requires continual pharmacist diligence to catch these errors. The significantly lower PISRE ratio for certified software should prompt patient safety agencies to undertake studies to identify the safest software and discard software that is potentially dangerous.

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