You have full text access to this OnlineOpen article

Outpatient Prescribing Errors and the Impact of Computerized Prescribing

  1. Tejal K. Gandhi MD, MPH1,
  2. Saul N. Weingart MD, PhD2,
  3. Andrew C. Seger Pharm D1,
  4. Joshua Borus BA1,
  5. Elisabeth Burdick MS1,
  6. Eric G. Poon MD, MPH1,
  7. Lucian L. Leape MD3,
  8. David W. Bates MD, MSc1

Article first published online: 5 AUG 2005

DOI: 10.1111/j.1525-1497.2005.0194.x

Issue

Journal of General Internal Medicine

Journal of General Internal Medicine

Volume 20, Issue 9, pages 837–841, September 2005

Additional Information

How to Cite

Gandhi, T. K., Weingart, S. N., Seger, A. C., Borus, J., Burdick, E., Poon, E. G., Leape, L. L. and Bates, D. W. (2005), Outpatient Prescribing Errors and the Impact of Computerized Prescribing. Journal of General Internal Medicine, 20: 837–841. doi: 10.1111/j.1525-1497.2005.0194.x

Author Information

  1. 1

    Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA

  2. 2

    Center for Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA

  3. 3

    Harvard School of Public Health, Boston, MA, USA.

*Address correspondence and requests for reprints to Dr. Gandhi: Division of General Medicine, Brigham and Women's Hospital, 1620 Tremont Street, 3rd floor, Boston, MA 02120 (e-mail: tgandhi@partners.org).

  1. The authors have no conflicts of interest to report.

  2. Preliminary results of this study were presented at the First National Ambulatory Primary Care Research and Education Conference on Patient Safety. Chicago, IL 2003, Society of General Internal Medicine Annual Meeting 2001, and the American Medical Informatics Association Annual Meeting 2001.

Publication History

  1. Issue published online: 19 AUG 2005
  2. Article first published online: 5 AUG 2005
  3. Received for publication December 23, 2004 and in revised form March 28, 2005 Accepted for publication April 26, 2005

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (94K)

Keywords:

  • medication error;
  • electronic prescribing;
  • ambulatory care

Background: Medication errors are common among inpatients and many are preventable with computerized prescribing. Relatively little is known about outpatient prescribing errors or the impact of computerized prescribing in this setting.

Objective: To assess the rates, types, and severity of outpatient prescribing errors and understand the potential impact of computerized prescribing.

Design: Prospective cohort study in 4 adult primary care practices in Boston using prescription review, patient survey, and chart review to identify medication errors, potential adverse drug events (ADEs) and preventable ADEs.

Participants: Outpatients over age 18 who received a prescription from 24 participating physicians.

Results: We screened 1879 prescriptions from 1202 patients, and completed 661 surveys (response rate 55%). Of the prescriptions, 143 (7.6%; 95% confidence interval (CI) 6.4% to 8.8%) contained a prescribing error. Three errors led to preventable ADEs and 62 (43%; 3% of all prescriptions) had potential for patient injury (potential ADEs); 1 was potentially life-threatening (2%) and 15 were serious (24%). Errors in frequency (n=77, 54%) and dose (n=26, 18%) were common. The rates of medication errors and potential ADEs were not significantly different at basic computerized prescribing sites (4.3% vs 11.0%, P=.31; 2.6% vs 4.0%, P=.16) compared to handwritten sites. Advanced checks (including dose and frequency checking) could have prevented 95% of potential ADEs.

Conclusions: Prescribing errors occurred in 7.6% of outpatient prescriptions and many could have harmed patients. Basic computerized prescribing systems may not be adequate to reduce errors. More advanced systems with dose and frequency checking are likely needed to prevent potentially harmful errors.

View Full Article (HTML) Get PDF (94K)