What Are The Types and Causes of Prescribing Errors Generated from Using Electronic Prescribing Systems? A Systematic Review
Electronic prescribing (ePrescribing) is the process of ordering medicines electronically for a patient. A range of potential benefits support the use of ePrescribing systems such as improved patient safety and potential cost savings. However, there have also been reports that ePrescribing has contributed to some new types of medication errors. This review aims to identify the types and causes of prescribing errors associated with the use of ePrescribing systems.
We performed a systematic review of the literature. Eligibility criteria included studies that discussed the occurrence of prescribing errors that were generated from using an ePrescribing system and their underlying causes. The search included English language articles that were published since 2004. All clinical settings and types of ePrescribing system were included. Articles from non-peer-reviewed publications, editorials and commentaries were excluded. Three large databases, the Cumulative Index Nursing and Allied Health Literature (CINAHL), Embase and Medline were searched. Broad search terms related to ‘Electronic Prescribing’ and ‘Errors’ were used. Three authors independently reviewed the titles; abstracts and full texts were then reviewed independently by two authors, with one acting as a constant across all publications. Data was extracted and a narrative synthesis of all eligible studies was undertaken.
The search returned 1,185 publications; after reviewing titles, abstracts and full texts, a total of 34 publications were included comprising of 31 full texts and 3 abstracts. The results of this review have identified eight key areas, which have been associated with ePrescribing errors: (1) Computer screen display, for example an incomplete display of a patient’s medication may result in duplicate doses; (2) Drop-down menus and autopopulation, can result in look-alike-sound-alike drugs being selected from a list in error; (3) Confusing Wording, can cause prescribers to misinterpret information; (4) Default settings, can be overly restrictive and make it difficult to prescribe medicines according to the patient’s usual regime;(5) Non-intuitive or inflexible ordering, may promote the use of workarounds, e.g. when prescribing a tapering course of steroids;(6) Repeat prescriptions and automated processes, can propagate erroneous prescriptions; (7) Users work processes, studies reported instances of prescribers working on another individual’s account, and (8) Alerting, clinical decision support may fail to warn prescribers about potential errors.
Due to the relative newness of ePrescribing systems in many health care organisations, users may be unaware of these ‘new’ errors and lack the necessary experience to resolve them. Furthermore, a lack of knowledge about the types and causes of such errors could prevent developers, healthcare organisations and end-users from implementing prevention strategies. Therefore, this review outlines the types and causes of prescribing errors that occur from using electronic prescribing systems and summarises the salient points in relation to how these systems can be improved.