Hospital electronic prescribing system implementation impact on discharge information communication and prescribing errors: a before and after study

Abstract

PurposeThe study aimed to test the hypothesis that hospital electronic prescribing and medicine administration system (HEPMA) implementation impacted patient discharge letter quality, nature and frequency of prescribing errors.MethodA quasi experimental before and after retrospective case note review was conducted in one United Kingdom district general hospital. The total sample size was 318 (random samples of 159 before and after implementation), calculated to achieve a 10% error reduction with a power of 80% and p < 0.05. Adult patients discharged after ≥24-h inpatient stay were assessed for discharge information documentation quality using a modified validated discharge document template. Prescribing errors were classified as medicine omissions, commissions, incorrect dose/frequency/duration, drug interactions, therapeutic duplications or missing/inaccurate allergy information. Post-implementation assessments were undertaken 4 months following HEPMA implementation. Error severity was determined by a multidisciplinary panel consensus using the Medications at Transitions and Clinical Handoffs (MATCH) study validated scoring system.ResultsThere were no statistically significant differences in patient demographics between the pre- and post-implementation groups. Discharge information documentation quality improved; allergy documentation increased from 11 to 159/159 (p < 0.0001). The number of patients with prescribing errors reduced significantly from 158 to 37/159 (p < 0.001). Prescribing error category incidence identified in pre-implementation patients was reduced (e.g. omission incidence from 66 to 18/159 (p < 0.001)), although a new error type (sociotechnical [errors caused by the system]) was identified post-implementation (n = 8 patients). Post-implementation prescribing errors severity rating identified 8/37 as likely to cause potential patient harm.ConclusionHEPMA implementation was associated with improved discharge documentation quality, statistically significant prescribing error reduction and prescribing error type alteration. There remains a need to be alert for potential prescribing errors.

Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review

“…We have identified that medication poses a frequent and enduring risk to patient safety following discharge from hospital, which reinforces care transfer being a WHO Global Patient Safety Challenge priority for action. We found across included studies that a median of one in two adult and elderly patients are affected by at least one ME post-hospital discharge, one in two affected by one or more UMD, and one in five affected by one or more ADEs (the median rate of MEs, UMDs and ADEs post-hospital discharge was 53% [IQR 33-60.5] (n = 5), 50% [IQR (n = 11) and 19% [IQR [16][17][18][19][20][21][22][23][24] (n = 7), respectively). We also reported emerging evidence of the nature of these risks, with a median of nearly one third of adult and elderly patients affected by clinically serious ADEs post-hospital discharge and medication classes most commonly reported with ADEs as antibiotics, antidiabetics, analgesics and cardiovascular drugs.…”

“…There is an emerging body of literature that reports on the prevalence and nature of MEs and ADEs [16] as well as medication discrepancies [17][18][19] at the point of hospital discharge (i.e. before patients return home).…”

How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis

“…Ten studies assessed the impact of EMS on PE rates, with a range of denominators reported across studies. 41–43 , 45 , 51 , 53–55 , 57 , 58 Heterogeneity in error rate reporting and study settings prevented meta-analysis of the association between EMS and rates of PE. EMS, with or without CDS, was associated with a significant reduction in PE rate in all but 1 study.…”

The impact of health information technology on prescribing errors in hospitals: a systematic review and behaviour change technique analysis

“…Twenty studies focused on adults [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56], ten on a paediatric or neonatal population [57][58][59][60][61][62][63][64][65][66], and five included a mixed population [67][68][69][70][71] (see Table 1). Ten studies were based in the US [37,41,42,48,54,57,58,64,67,70], eight in the UK [39,45,49,50,53,…”

“…Selection errors [45,49,60,68] and duplicate errors [38,47,60] were the TGE most frequently identified. Due to the simpler nature of some ePrescribing systems, free-text errors were possible [67].…”