The effects of electronic prescribing on the quality of prescribing.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Electronic prescribing has been shown to reduce prescribing errors in US hospitals. However we know little about its effect on prescribing quality, or its effectiveness in UK hospitals where systems for medication prescribing and supply are very different. Hospital pharmacists already review prescriptions to both detect errors and improve prescription quality.

WHAT THIS STUDY ADDS: Electronic prescribing significantly increased prescribing quality in a UK hospital, as shown by fewer pharmacists' interventions and fewer prescribing errors. However, some new types of error were introduced. There was relatively little overlap between prescribing errors and pharmacists' interventions, signifying their different contributions to prescribing quality. Electronic prescribing and pharmacists' interventions should be viewed as an integrated system.

AIMS: To investigate the effects of electronic prescribing (EP) on prescribing quality, as indicated by prescribing errors and pharmacists' clinical interventions, in a UK hospital.

METHODS: Prescribing errors and pharmacists' interventions were recorded by the ward pharmacist during a 4 week period both pre- and post-EP, with a second check by the principal investigator. The percentage of new medication orders with a prescribing error and/or pharmacist's intervention was calculated for each study period.

RESULTS: Following the introduction of EP, there was a significant reduction in both pharmacists' interventions and prescribing errors. Interventions reduced from 73 (3.0% of all medication orders) to 45 (1.9%) (95% confidence interval (CI) for the absolute reduction 0.2, 2.0%), and errors from 94 (3.8%) to 48 (2.0%) (95% CI 0.9, 2.7%). Ten EP-specific prescribing errors were identified. Only 52% of pharmacists' interventions related to a prescribing error pre-EP, and 60% post-EP; only 40% and 56% of prescribing errors resulted in an intervention pre- and post-EP, respectively.

CONCLUSIONS: EP improved the quality of prescribing by reducing both prescribing errors and pharmacists' clinical interventions. Prescribers and pharmacists need to be aware of new types of error with EP, so that they can best target their activities to reduce clinical risk. Pharmacists may need to change the way they work to complement, rather than duplicate, the benefits of EP.