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

Abstract

Background Health information technology (HIT) is known to reduce prescribing errors but may also cause new types of technology-generated errors (TGE) related to data entry, duplicate prescribing, and prescriber alert fatigue. It is unclear which component behaviour change techniques (BCTs) contribute to the effectiveness of prescribing HIT implementations and optimisation. This study aimed to (i) quantitatively assess the HIT that reduces prescribing errors in hospitals and (ii) identify the BCTs associated with effective interventions. Methods Articles were identified using CINAHL, EMBASE, MEDLINE, and Web of Science to May 2020. Eligible studies compared prescribing HIT with paper-order entry and examined prescribing error rates. Studies were excluded if prescribing error rates could not be extracted, if HIT use was non-compulsory or designed for one class of medication. The Newcastle-Ottawa scale was used to assess study quality. The review was reported in accordance with the PRISMA and SWiM guidelines. Odds ratios (OR) with 95% confidence intervals (CI) were calculated across the studies. Descriptive statistics were used to summarise effect estimates. Two researchers examined studies for BCTs using a validated taxonomy. Effectiveness ratios (ER) were used to determine the potential impact of individual BCTs. Results Thirty-five studies of variable risk of bias and limited intervention reporting were included. TGE were identified in 31 studies. Compared with paper-order entry, prescribing HIT of varying sophistication was associated with decreased rates of prescribing errors (median OR 0.24, IQR 0.03–0.57). Ten BCTs were present in at least two successful interventions and may be effective components of prescribing HIT implementation and optimisation including prescriber involvement in system design, clinical colleagues as trainers, modification of HIT in response to feedback, direct observation of prescriber workflow, monitoring of electronic orders to detect errors, and system alerts that prompt the prescriber. Conclusions Prescribing HIT is associated with a reduction in prescribing errors in a variety of hospital settings. Poor reporting of intervention delivery and content limited the BCT analysis. More detailed reporting may have identified additional effective intervention components. Effective BCTs may be considered in the design and development of prescribing HIT and in the reporting and evaluation of future studies in this area.

Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures

“…The involvement of the multidisciplinary team, as well as monitoring of electronic prescriptions to prevent or detect errors or suboptimal treatment, are behaviour change techniques that have been adopted in successful intervention studies relating to prescribing. 37 Additionally, the interaction with a specialist can provide education and an opportunity to respond to prescriber concerns and to share the responsibility of the decision-making, which have also been found to influence behaviour. 37 A higher rate of positive outcome measures was reported in studies where changes to prescribing or decision-making behaviour were not required (5/5 versus 39/124).…”

“… 37 Additionally, the interaction with a specialist can provide education and an opportunity to respond to prescriber concerns and to share the responsibility of the decision-making, which have also been found to influence behaviour. 37 A higher rate of positive outcome measures was reported in studies where changes to prescribing or decision-making behaviour were not required (5/5 versus 39/124). This may highlight the lack of published research focusing on integrating behaviour change techniques alongside other interventions when implementing health technologies.…”

“…This may highlight the lack of published research focusing on integrating behaviour change techniques alongside other interventions when implementing health technologies. 37 …”

Developments in healthcare information systems in Ireland and internationally

“…Healthmail enables GPs and those in charge of nursing homes to organise prescriptions for nursing home residents. In addition to reducing the burden placed on individuals, there is evidence that e-prescribing greatly reduces prescribing errors for patients (Devin et al, 2020).…”

Prescription of Aminoglycosides in 23 French Neonatal Intensive Care Units

“…This prescribing aid is all the more justified in the case of neonates, as they represent the most prescribing errors of all patients present in a hospital [ 4 ]. Computerization of medication order entry in NICU resulted in a significant decrease in the occurrence and severity of medication errors [ 1 , 4 , 5 , 6 ]. These errors are favored by the complexity of prescribing, which is linked to the need to adapt the dosage rapidly to their degree of metabolic immaturity (liver, kidney, distribution volumes).…”