Does an Electronic Discharge Referral System Improve the Quality of Medication Prescribing?

Abstract

ABSTRACTBackgroundUnintentional discrepancies in medication lists at the time of discharge are common and a significant cause of avoidable harm. Electronic discharge referral (eDR) systems represent an opportunity to reduce the risk of harm. However, there are few Australian studies describing this approach.AimTo investigate the impact of an eDR system on the quality of medication prescribing.MethodA prospective, observational study of discharge medication orders was undertaken in a 520‐bed principal referral hospital. A structured audit tool was used to assess the quality (volume, type and severity) of prescribing errors on patients' discharge summaries for 2 weeks immediately before the implementation of the eDR system (pre‐eDR) and re‐audited 6 weeks after implementation (post‐eDR).ResultsDischarge summaries from 776 patients were evaluated (n = 377 pre‐eDR (handwritten process); n = 399 post‐eDR (electronic process)). The number of discharges with one or more prescribing errors decreased significantly after implementation of the eDR system (relative difference −39.6%; P < 0.001), including errors relating to: supply quantities (P < 0.001), legibility (P < 0.0001), drug selection (P = 0.009), prescription format selection (P = 0.026), patient details (P = 0.039) and signing of orders (P = 0.007). However, no significant difference was observed in the overall mean severity score for errors between the electronic and handwritten discharge processes (3.5 vs 3.4; P = 0.28).ConclusionImplementation of an eDR system resulted in an improved quality and potential safety of patients' discharge medication orders. However, despite a reduced frequency of errors, the emergence of new error types was observed, and the profile and overall severity of prescribing errors remained unchanged.