A Prescription For Enhancing Electronic Prescribing Safety

Abstract

While electronic prescribing has been shown to reduce medication errors and improve prescribing safety, it is vulnerable to error-prone processes. We review six intersecting areas in which changes to electronic prescribing systems, particularly in the outpatient setting, could transform medication ordering quality and safety. We recommend incorporating medication indications into electronic prescribing, establishing a single shared online medication list, implementing the transmission of electronic cancellation orders to pharmacies (CancelRx) to ensure that drugs are safely and reliably discontinued, implementing standardized structured and codified prescription instructions, reengineering clinical decision support, and redesigning electronic prescribing to facilitate the ordering of nondrug alternatives.

Low‐Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System

“…Second, the lack of a documented indication does not exclude the possibility that there was an undocumented evidenced‐based indication. Prompting clinicians to document an indication for long‐term prescriptions can mitigate this clinical uncertainty while simultaneously improving documentation and the quality of care …”

“…Prompting clinicians to document an indication for long-term prescriptions can mitigate this clinical uncertainty while simultaneously improving documentation and the quality of care. 12,24 CONCLUSIONS Older adults are receiving PPI prescriptions at an alarmingly high rate, often against guidelines. This study suggests that potentially minor changes in EHR-based stopping rules and/or targeted physician profiling could have a substantial impact on reducing low-value prescribing.…”

Administration of gamma‐hydroxybutyrate instead of beta‐hydroxybutyrate to a liver transplant recipient suffering from propionic acidemia and cardiomyopathy: A case report on a medication prescribing error

“…Although the recent medical literature emphasizes the fact that the use of computerized prescription systems can decrease the frequency of prescription errors and iatrogenic adverse events and increase the safety of drug prescriptions, we consider that the system correction algorithm can sometimes generate errors ‐ especially in the setting of rare diseases. Indeed, recent literature on medication errors linked to a computerized physician order entry system emphasized the need to understand and then present the causes of these errors . Since PA is a rare inborn error of metabolism with a small number of patients, some treatments are not referenced and not well known—resulting in medication errors.…”

“…Indeed, recent literature on medication errors linked to a computerized physician order entry system emphasized the need to understand and then present the causes of these errors. [16][17][18][19][20][21][22] Since PA is a rare inborn error of metabolism with a small number of patients, some treatments are not referenced and not well known-resulting in medication errors. In the present case, the similarity between the two drugs' names ("BHB" vs "GHB," or "3-hydroxybutyrate" vs "4-hydroxybutyrate") increases the risk of confusion and the likelihood of automatically approving a computerized prescription of GHB rather than nonreferenced BHB.…”

Understanding CancelRx: Results of End-to-End Functional Testing, Proactive Risk Assessment, and Pilot Implementation

“…The importance of CancelRx for safe e-prescribing has been recognized by multiple stakeholders. 20,21 Despite the availability of CancelRx in the SCRIPT standard since 2010, adoption has been limited. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required EHRs to include electronic cancellation messaging to pharmacies, but prescribers and pharmacies must also certify their capacity to handle Can-celRx messages.…”