Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error?

Abstract

In a recent article, published in the Journal of the Royal Society of Medicine, Jamie J Coleman and other authors aimed to identify the extent to which routine prescribing data might be useful in identifying individuals who are at higher risk of making a serious prescribing error. We read this article with interest and compare with other articles with the same issue and accept that Electronic prescribing (EP) reduces prescribing errors and also complete the article with under issues. Electronic prescribing systems could drastically cut previously intractable hospital medication errors, a study of two Sydney hospitals has found. Professor Westbrook, the director of the centre for health systems and safety research in the Australian Institute of Health Innovation at the University of NSW said: ‘We found a significant and very large reduction in overall prescribing error rates . . . and in serious errors.’ But the electronic systems were not a fix-all. They reduced ‘system-related’ errors such as unclear or incomplete orders by about 90% but introduced some new clinical errors, such as when doctors accidentally pressed the wrong button and ordered the wrong drug.1 Electronic prescribing systems without CDSS may not prove to be beneficial in reducing the number of errors; some such systems in fact have been reported to increase prescribing errors and even mortality.2,3 Electronic prescribing (EP) has been shown to reduce prescribing errors in US hospitals.4,5 Considerable investments are being made in commercial electronic prescribing systems (e-prescribing) in many countries. Few studies have measured or evaluated their effectiveness at reducing prescribing error rates, and interactions between system design and errors are not well understood, despite increasing concerns regarding new errors associated with system use. Implementation of these commercial e-prescribing systems resulted in statistically significant reductions in prescribing error rates.6