Electronic prescription as contributory factor for hospitalized patients' safety
The following study was performed to identify factors related to medication errors in the computerized physician order entry and their advantages and disadvantages according to doctors, nursing team and administrative officers. It is a survey descriptive study carried out at three units of a Brazilian academic hospital in the southeast area. The study was divided in two phases. In the first phase, we analyzed a total of 1,349 prescriptions from general medical unit, surgical and orthopaedic wards during 30 days consecutively. A semi-structured instrument, elaborated by a group of researchers for the study proposals, was used. In the second phase, a semi-structured questionnaire was applied to the health professionals containing closed and open items approaching their opinion about the composition of electronic prescription, the advantages and disadvantages of them, and their suggestions for its improvement. Out of 1,349 prescriptions observed, 17.5% presented deletions, 25.0% medicines written manually and 17.0% of them were incomplete. Some of the advantages pointed by health professionals were its legibility (37.5%), little time spent when elaborating and emitting them (20.5%) and the way they are a practical and organized (8%). The disadvantages pointed were repetition of previous prescriptions (34%), typing mistakes (17%), dependence on computers (11%) and alterations made manually (7%). We conclude, this way, that the computerized prescription order entry represents a great progress among the strategies used to minimize medication errors caused by prescriptions badly formulated. However, it doesn't eradicate the possibility of medication error occurrences, needing some system modifications.
2. Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: National Academy Press, 1999.
3. Timbs, O. Leading role for pharmacists to reduce drug errors and improve patient safety. Pharm J 2002, 268(7190): 392.
4. Ridley AS, Booth SA, Thompson CM. Prescription errors in UK critical care units. Anaesthesia 2004; 59: 1193-200.
5. Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med 2002; 162:1897-1903.
6. Berger RG, Kichak J, PCHAK, BA. Computerized physician order entry: helpful or harmful? J Am Med Inform Assoc 2004;11:100–3.
7. Allard J, Carthey J, Cope J, Pitt M, Woodward S. Medication errors: Causes, prevention and reduction. Br J Haematol 2002; 116(2): 255-65.
8. Winterstein AG, Thomas E, Rosenberg EI, Hatton RC, Gonzalez RR, Kanjanarat P. Nature and causes of clinically significant medication errors in a tertiary care hospital. Am J Health Syst Pharm 2004; 61(18): 1908-16.
9. Rosa MB, Perini E. Erros de medicação: quem foi? Rev Assoc Med Bras 2003; 49(3): 335-41.
10. Cassiani SHB, Freire CC, Gimenes FRE. Computerized physician order entry in a university hospital: writing failure and user´s opinios. Rev Esc Enferm USP 2003; 37(4): 51-60.
11. Bates DW. Improving medication safety across institutions. Journal on Quality Improvement 2000; 26(6):319-20.
12. Howell S. e-Rx systems seek to improve care. Quality Indicator, Pharmacy Resource 2000; 3(4), 3-7.
13. Cassiani SHB, Freire CC, Gimenes FRE. Computerized physician order entry in a university hospital: writing failureand user´s opinions. Rev Esc Enferm USP 2003; 37(4): 51-60.
14. Winslow EH, Nestor VA, Davidoff SK. Thompson PG, Borum JC. Legibility and completeness of physicians´ handwritten medication orders. Heart Lung 1997; 26:158-64.
15. Bates DW et al. The impact of computerized physician order entry on medication errors prevention. J Am Med Inform Assoc 1999; 6 (4): 313-21.
16. Vaida AJ, Peterson J. Incomplete directions can lead to dispensing errors. Pharmacy Times 2002; 5: 34-8.
17. Marques FB. Erros de medicação. Revista Informação Terapêutica 2000; 4: 3-5.
18. Cohen M. Letter and number characters that run together may lead to serious errors. Int Pharm J 1999; 13(3):108-9.
19. Lyra Junior DP, Prado MC, Abriata JP, Pelá IR. Recetas médicas como causantes de riesgo de problemas relacionados con medicamentos. Seguim Farmacoter 2004; 2 (2): 86-96.
20. Cohen MR, Senders J, Davis NM. Failure mode and effects analysis: a novel approach to avoiding dangerous medication errors and accidents. Hosp Pharm 1994; 29 (4): 319-30.
21. Lilley LL, Guanci R. Unfamiliar drug uses. Am J Nurs. 1995, 95(1):15.
22. Kalmeijer MD, Holtzer W, Dongen R, Guchelaar HJ. Implementation of a computerized physician medication order entry system at the Academic Medical Centre in Amsterdam. Pharm World Sci 2003; 25(3): 88–93.
23. Lesar TS, Briceland LL, Delcoure K, Parmalee JC, Masta-Gornic V, Pohl H. Medication prescribing errors in a teaching hospital. JAMA 1990; 263 (17): 2329-34.
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