Electronic prescriptions cut errors, studies show

Two new reports suggest that hospitals can help prevent medical mistakes by using electronic prescriptions and implementing a streamlined system for reviewing X-rays.

Peter Nightingale, MD, and colleagues at the University of Birmingham, England, report that a kidney unit in one hospital reduced the number of prescription errors using a computerized system. Prescription pads were abandoned in the unit in 1998 in favor of wireless computers used to prescribe and record drugs given to all patients.1

Nightingale says the system does more than eliminate the need for deciphering doctors’ handwriting. Some prescription errors occur because doctors and nurses lack information about a patient’s allergies or other medications taken, so those details and other information, like the results of lab tests, are included in the system. When a physician prescribes a new drug, the system sets off a warning signal when it detects a potential problem. While some of those messages can be overridden, the most serious ones — such as warnings about drug allergies — cannot.

During an 11-month period when nearly 88,000 prescriptions were written for more than 1,600 patients, the system detected 58 unsafe prescriptions, according to the report. In addition, the system issued more than 700 serious warnings about medications.

While some physicians and nurses have been reluctant to sign on to computerized prescription systems due to the perception that it would take too much time, the researchers report that more than 80% of the doctors and nurses at the hospital said the new system was an improvement over conventional prescribing.

Streamlining the system

In a second study, James Espinosa, MD, of Overlook Hospital in Summit, NJ, reports that streamlining the way X-rays are interpreted in a hospital emergency room can prevent mistakes.2 Before the new system was put into place at the hospital, an X-ray may have been read by an emergency room physician or a radiologist, depending on what time and what day of the week a patient showed up at the emergency room. Under this system, about 3% of the time the doctors missed something on the X-ray that was important for patient care, according to the report.

The hospital streamlined the system and required that all X-rays in the emergency room be interpreted first by an emergency room physician and then reviewed by a radiologist within 12 hours. After the system was put into place, only 1.2% of the time did doctors miss something important. A further redesign decreased that number to 0.3%. In addition, the average time each patient spent at the hospital was cut in half, and the rate of patient satisfaction improved substantially.

References

1. Nightingale PG, Adu D, Richards NT, et al. Implementation of rules based computerised bedside prescribing and administration: Intervention study. BMJ 2000; 320:737-740.

2. Espinosa JA, Nolan TW. Reducing errors made by emergency physicians in interpreting radiographs: Longitudinal study. BMJ 2000; 320:750-753.