Factors contributing to electronic prescribing errors in healthcare settings: a qualitative study

Medication errors from illegible or incomplete handwritten prescriptions can compromise patient safety and increase costs. While E-prescribing aims to reduce errors through improved prescription quality and legibility, these systems can potentially introduce different types of medication errors due to various technical, environmental, and human factors. This qualitative study analyzed the factors contributing to E-prescribing errors at Iranian Social Security Organization outpatient centers.

Qualitative content analysis was performed on data from interviews with 10 physicians, pharmacists and pharmacy technicians. The participants had at least 6 months of experience using the E-prescribing. The interview data were coded until saturation and analyzed via the methods of Graneheim and Lundman.

This qualitative study identified four main categories of error sources: system, human, organizational, and medication-related factors. In the system domain, technical challenges such as problematic autocomplete features for drug names emerged as significant contributors to selection errors. Human factors, particularly prescriber fatigue and reduced physician-patient interaction time, were found to compromise prescribing accuracy. At the organizational level, insufficient training programs and inadequate staffing levels hindered effective system utilization. Medication factors, including look-alike drug names and complex dosing regimens, further increased error risks.

The findings revealed that E-prescribing errors stem from multiple interacting factors, affecting both clinician and non-clinician prescribers similarly. While system design improvements and enhanced user training are crucial, addressing the broader sociotechnical context is essential for error reduction. A balanced approach incorporating standardized protocols, integrated decision support systems, and continuous professional development is recommended to enhance system usability and patient safety.