The Effect of Computer-assisted Prescription Writing on Emergency Department Prescription Errors

Authors

  • Kenneth E. Bizovi MD,

    Corresponding author
    1. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
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  • Brandon E. Beckley BS,

    1. School of Medicine, Oregon Health & Science University, Portland, OR
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  • Michelle C. McDade BS,

    1. School of Medicine, Oregon Health & Science University, Portland, OR
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  • Annette L. Adams MA, MPH,

    1. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
    2. Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, OR
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  • Robert A. Lowe MD, MPH,

    1. Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, OR
    2. Division of Medical Informatics & Outcomes Research, Oregon Health & Science University, Portland, OR
    3. Leonard Davis Institute for Medical Economics, University of Pennsylvania, Philadelphia, PA
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  • Andrew D. Zechnich MD, MPH,

    1. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
    2. Department of Emergency Medicine, Providence St. Vincent's Medical Center, Portland, OR.
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  • Jerris R. Hedges MD, MS

    1. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
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ast;**Oregon Health & Science University, CSB 550, Department of Emergency Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97201. Fax: 503-494-0615; e-mail: bizovik@ohsu.edu.

Abstract

Objective: To determine whether computer-assisted prescription writing reduces the frequency of prescription errors in the emergency department (ED). Methods: A pre—post retrospective analysis was used to compare errors between handwritten (HW) and computer-assisted (CA) ED prescriptions. Prescriptions were reviewed for pharmacist clarifications. A clarification was defined as an error if missing information, incorrect information, incorrect dose, non-formulary medication, or illegibility was the reason for clarification. The HW and CA error rates were compared using odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: During the pre-intervention period, there were 7,036 patient visits with 2,326 HW ED prescriptions filled for 1,459 patients. There were 91 clarifications, with a rate of 3.9%. There were 54 HW errors, for an error rate of 2.3%. During the post-intervention period, there were 7,845 patient visits with 1,594 CA prescriptions filled for 1,056 patients. There were 13 clarifications, with a clarification rate of 0.8%, and 11 errors, for a CA error rate of 0.7%. The CA prescriptions were substantially less likely to contain an error [OR 0.31 (95% CI = 0.10 to 0.36)] or to require pharmacist clarification [OR 0.19 (95% CI = 0.10 to 0.36)] than were the HW prescriptions. Conclusions: Computer-assisted prescriptions were more than three times less likely to contain errors and five times less likely to require pharmacist clarification than handwritten prescriptions.

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