A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system

Abstract

Background Computerised Physician Order Entry (CPOE) is considered to enhance the safety of prescribing. However, it can have unintended consequences and new forms of prescribing error have been reported. Objective The aim of this study was to explore the causes and contributing factors associated with prescribing errors reported by multidisciplinary prescribers working within a CPOE system. Main Outcome Measure Multidisciplinary prescribers experience of prescribing errors in an CPOE system. Method This qualitative study was conducted in a hospital with a well-established CPOE system. Semi-structured qualitative interviews were conducted with prescribers from the professions of pharmacy, nursing, and medicine. Interviews analysed using a mixed inductive and deductive approach to develop a framework for the causes of error. Results Twenty-three prescribers were interviewed. Six main themes influencing prescribing were found: the system, the prescriber, the patient, the team, the task of prescribing and the work environment. Prominent issues related to CPOE included, incorrect drug name picking, default auto-population of dosages, alert fatigue and remote prescribing. These interacted within a complex prescribing environment. No substantial differences in the experience of CPOE were found between the professions. Conclusion Medical and non-medical prescribers have similar experiences of prescribing errors when using CPOE, aligned with existing published literature about medical prescribing. Causes of electronic prescribing errors are multifactorial in nature and prescribers describe how factors interact to create the conditions errors. While interventions should focus on direct CPOE issues, such as training and design, socio-technical, and environmental aspects of practice remain important.

Development, implementation and evaluation of the digital transformation of renal services in Wales: the journey from local to national

“…Critical success factors during development of EPMA were the co-creation with service-users patients and staff, and the development of an in-house product, tailored to suit the needs of the service. This is in line with literature, whereby a system-wide service redesign, taking into account prescriber attitudes, patients and the existing workflow is recommended [17] and where understanding of the service specific constraints is highlighted as essential [37]. A clear implementation strategy was pivotal to national scale-up, incorporating a project initiation period, with a dedicated team of clinical staff (Delivery Team), experienced in technology.…”

“…A clear implementation strategy was pivotal to national scale-up, incorporating a project initiation period, with a dedicated team of clinical staff (Delivery Team), experienced in technology. Engagement of key stakeholders at all time, with demonstrations, events, and creation of publicly available videos helped to maintain momentum and create enthusiasm about the transformation, and a suite of digitally accessible, lean and paper-light training materials supported flexible learning and multi-professional training, as suggested in literature [17]. In line with literature, staff concerns about IT skills or limitations of the system pre-implementation, including safety back-ups, were alleviated with this approach [30].…”

“…In some cases, no impact on medication errors has been found and even an increase in discrepancies has been reported [16]. Issues such as incorrect drug picking, population of dosages and remote prescribing have been identified as contributing to these errors [17].…”

Impact of automated drug dispensing system on patient safety

“…This may be because patient counseling is an integral part of the pharmacist role prior to medication dispensing regardless to the dispensing system. Patient education plays a major role in ensuring patient satisfaction with pharmacy care, 49,50 patient awareness and compliance with drugs and correct drug administration. 51 Although the reduction in patient waiting time improves patient satisfaction, the previous studies warranted the positive effect of pharmacist freed-up time in ADDs.…”

Issues with the Swedish e-prescribing system – An analysis of health information technology-related incident reports using an existing classification system

“…Medication errors or issues related to the e-prescribing system are common in countries such as the USA, 67 , 68 Australia, 69 , 70 the UK, 71 – 73 and European countries, such as Denmark, 26 Norway 25 and the Netherlands. 28 Like many other countries, Sweden is no exception to being prone to these challenges; however, limited attempts have been made to overcome these issues since most reported events are repetitive, causing reduced trust in the healthcare system.…”