A comparison of handwritten and computer-assisted prescriptions in an intensive care unit

Abstract

BackgroundWe conducted a prospective comparative study to evaluate the potential benefit of computer-assisted prescribing (CAP). We compared the accuracy, completeness and time use of CAP with that of conventional handwritten prescribing at the intensive care unit (ICU) of the John Radcliffe Hospital, Oxford, UK.ResultsTwenty-five clinicians and 2409 drug entries were evaluated for accuracy, completeness, legibility and time spent prescribing. One hundred and twenty-eight handwritten and 110 CAP charts were monitored. One hundred percent of CAP charts were complete compared to 47% of handwritten charts.Drug prescriptions were divided into three categories: intravenous fluids, intravenous infusions and intermittent drugs. Percentage of correct entries in each category were 64%, 47.5% and 90% for handwritten, compared to 48%, 32% and 90% for CAP charts, respectively.The mean time taken to prescribe was 20 s for hand written prescribing and 55 s for CAP.ConclusionsComputer-assisted prescriptions were more complete, signed and dated than handwritten prescriptions. Errors in prescribing, including failure to discontinue a drug were not reduced by CAP. Handwritten prescribing was quicker than CAP. Simple enhancements of the computer software could be introduced which might overcome these deficiencies. CAP was successfully integrated into clinical practice in the ICU.

The Impact of an Electronic Prescribing Template with Decision Support upon the Prescribing of Subcutaneous Infusions at the End of Life in a Community Setting: A Future Vision for Community Palliative Care

“…This was because the electronic prescription could not be completed unless all the required fields were populated. Overall, the findings of this study are in line with the available evidence in that electronic prescription interventions are linked to a notable decline in omission errors [ 13 , 19 , 20 , 21 , 22 , 23 ].…”

An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit

“…Such errors of duplicated therapy orders were described in other studies on the impact of CPOE. [ 13 , 14 ] In our study, the use of a CPOE system was associated with an increase in duplicated therapy (7/1593 (0.4%) vs 25/1388 (1.8%)). Physicians should however be aware of duplicated therapies as our CPOE system alerts them about these duplicated orders.…”

“…[ 32 , 33 ] Similar to our study, Westbrook et al showed that CPOE was efficient in decreasing administration route errors or dosage errors and Evans et al showed elimination of prescriptions in which the route of administration or dosage were missing. [ 13 , 15 ] These types of errors do not seem to be related to substantial negative outcomes for patients, however, they are time-consuming for nurses and their correction by CPOE is therefore relevant. [ 34 ] When a physician prescribes a medication with CPOE, some items must indeed be specified so that the doctor can validate prescription.…”

“…CPOE mainly reduces errors associated with hand-written prescriptions by reducing the number of illegible orders, incomplete orders or incorrect dosages. [ 13 – 16 ] A systematic review [ 17 ] indicates that 23 of the 25 selected studies reported a 13–99% decrease in the relative risk of medication errors after the implementation of CPOE, while one study found no change [ 18 ] and one study resulted in a significant increase in the relative risk of medication errors. [ 19 ] Other studies have reported the introduction of new errors or an increase in mortality related to implementation.…”

Duplicate Medication Order Errors: Safety Gaps and Recommendations for Improvement

“…3,4 Duplicate medication orders are one prominent type of medication error that has increased after the implementation of CPOE and other health information technology (health IT) in some contexts. [4][5][6][7][8][9][10][11] For example, a study evaluating medication error and adverse event data found an increase in the frequency of duplicate medication orders after the implementation of CPOE even with duplicate medication alerts, most of which were for identical orders for the same medication. 11 Though there are some nuances, duplicate medication order errors are commonly defined as two or more unintentional active orders for the same medication or medications within the same therapeutic class.…”