The potential impact of an electronic medication management system on safety‐critical prescribing errors in an emergency department

Abstract

Background: Medication errors in hospitals are common. Although electronic medication management systems (eMMS) have the potential to reduce errors during inpatient care, little is known about their effect in emergency departments (ED). Aim: The aims of this study were to report on the types of prescribing errors in an ED prior to implementation of an eMMS, to assess the risk the errors pose to patient safety and to evaluate whether safety-critical errors were potentially preventable with a newly implemented eMMS. Methods: Medication orders on paper charts were assessed for prescribing errors by a clinical hospital pharmacist. Error severity was rated using a five-point scale. Errors of moderate or higher severity, and all errors involving defined high-risk medicines were considered safety-critical errors. The potential for safety-critical errors to be prevented by the eMMS was rated (likely, possibly or unlikely). Results: Across 239 medication orders, 208 errors (27 clinical, 181 legal or procedural) were identified. The overall prescribing error rate was 0.87 errors/order. There were 67 safety-critical errors (53 legal or procedural, 14 clinical). Overall, 82.1% of errors were likely preventable by eMMS. However, of the clinical safety-critical errors, only 2 (14.3%) were considered likely preventable. Conclusion: Although eMMS has the capacity to prevent a high proportion of safety-critical legal or procedural errors in the ED, clinical prescribing errors in this category were unlikely to be prevented by using eMMS. Further investigation of these more severe error types could guide the design of eMMS decision support to improve system effectiveness.

Implementing an emergency department pharmacy service and its effect on medication safety

“…Medication errors frequently occur in ED, due to its unique operating characteristics 1,2 A variety of methods have been suggested for the identification and reduction of medication errors in ED, but pharmacy has infrequently been highlighted as a solution. [3][4] However, there is emerging international evidence highlighting a growing presence of ED pharmacists where medicine-related activities have shown improved patient outcomes and decreased medication errors. [5][6][7] The Lancashire Teaching Hospitals (North West of England), comprising approximately 1000 beds over 2 sites and with over 100, 000 yearly ED attendances identified increasing pressure on the ED service especially in the early evenings (10% of all attendances occurred between 5 and 7.30pm).…”

Prescribing errors in emergency department medication history taking: will electronic medication management systems help?

“…Dear Editor, Raban et al 1 recently described prescribing errors made in the emergency department (ED), and showed that electronic medication management systems (eMMS) will not necessarily prevent safety-critical errors, with only two (14.3%) being considered preventable. One area contributing to prescribing errors not mentioned in that study is the issue of medication history (MH) taking.…”