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Improving IV Insulin Administration in a Community Hospital

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Published on: June 11, 2012

Electronic prescribing improves medication safety in community-based office practices.

Rainu Kaushal¹, Lisa M Kern, Yolanda Barrón

¹Department of Pediatrics, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY 10065, USA. rak2007@med.cornell.edu

Journal of General Internal Medicine

|February 27, 2010

Summary

Electronic prescribing (e-prescribing) significantly reduced ambulatory prescribing errors by nearly sevenfold. This technology, with clinical decision support, greatly improved medication safety in community practices.

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Area of Science:

Health Informatics
Medication Safety
Ambulatory Care

Background:

Electronic prescribing (e-prescribing) shows potential for preventing prescription errors in ambulatory settings.
Existing research on the effectiveness of e-prescribing in reducing errors remains inconclusive.
Prescribing errors may be more prevalent in community-based practices than previously understood.

Purpose of the Study:

To evaluate the impact of a stand-alone e-prescribing system on the frequency and types of prescribing errors.
To assess the effectiveness of clinical decision support features within an e-prescribing system.

Main Methods:

A prospective, non-randomized study with a pre-post design was conducted.
Fifteen providers adopted an e-prescribing system, with fifteen paper-based providers serving as concurrent controls.
Prescribing errors were identified through standardized prescription and chart reviews over a one-year follow-up period.

Main Results:

E-prescribing adopters experienced a nearly sevenfold decrease in error rates, from 42.5 to 6.6 per 100 prescriptions (p < 0.001).
Non-adopters showed no significant change in error rates (37.3 to 38.4 per 100 prescriptions, p = 0.54).
Illegibility errors, initially high (87.6 per 100 prescriptions), were completely eliminated by e-prescribing.

Conclusions:

Stand-alone e-prescribing systems with clinical decision support significantly enhance medication safety in ambulatory care.
The implementation of e-prescribing led to a substantial reduction in prescribing errors, particularly illegibility.
Findings suggest e-prescribing is a valuable tool for improving the quality of care in community-based practices.