Title:
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Investigating pharmacist-intercepted prescribing errors and healthcare professionals' satisfication in the context of hospital electronic prescribing system
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Pharmacists have an essential role in intervening upon hospital prescribing errors
(PEs). Electronic prescribing (e-prescribing) systems have been proposed to reduce PEs
in hospitals. Measuring satisfaction of technology users is important to enhance system
utilisation. This four-step programme of work aimed at: 1) developing and assessing
the feasibility of a computerised method to collect PEs from a hospital's e-prescribing
system, 2) validating the reasons recorded by doctors and pharmacists for
discontinuing medication orders at hospital discharge, 3) investigating, using the
developed computerised method, the number, types, severity, pharmacists' impact, and
predictors of PEs in the context of e-prescribing system at hospital discharge, and 4)
assessing the attitudes of pharmacists and doctors towards e-prescribing systems at
three teaching hospitals.
A pilot validation study was conducted initially that comprised two steps:
electronically extracting discontinued orders from the e-prescribing system followed
by structured interviews with doctors and pharmacists who made the discontinuation.
To characterise pharmacists' interventions upon PEs, a four-week study was
conducted; meetings were conducted within a week of data extraction with
pharmacists performing their routine clinical work, who categorised the occurrence,
type, and severity of their interventions using a scale. An independent senior
pharmacist retrospectively rated the severity and potential impact, and subjectively
judged whether any error was a computer-related error (CRE). The emerging results,
together with the literature findings, were used to adapt a previously published
questionnaire for a survey of pharmacists and doctors.
The methodological approach was deemed valid, efficient and feasible. The majority of
recorded discontinuation reasons were judged accurate (97,93.3%). The incidence of
PEs was 8.4% (n= 664/7920; 95% CI: 7.8%-9.0%). Omission (31.0%), drug selection
(29.4%) and dosage regimen (18.1%) error types were the most frequent. There were 18
(2.9%) serious, 481 (76.3%) significant and 131 (20.8%) minor erroneous orders. Most
erroneous orders (469,74.7%) were rated as being of significant severity and significant
impact of pharmacists. CREs (n=279) accounted for 44% of erroneous orders. Drugs
with multiple formulations (OR 2.1,95% CI: 1.25-3.37) and prescribing by junior
doctors (OR 2.54,95% CI: 1.08-5.90) were significant predictors of PEs. The majority
of pharmacists and doctors agreed that the e-prescribing system improved the
efficiency of prescribing and reduced dosage regimen errors. Pharmacists were more
satisfied with their e-prescribing systems than doctors. Satisfaction was predicted with
more efficiency-related attributes of the e-prescribing system, than those related to the
quality of patient care.
This work showed that PEs commonly occur even with the use of an e-prescribing
system. The high rate of CREs raised a substantial question as to the ability of the eprescribing
system to facilitate certain types of PEs, or alternatively, that the working
system in a hospital has to be changed and made safer. Pharmacists played an
important role in efficiently documenting and preventing PEs before they could reach
and possibly harm patients. CREs should be understood by pharmacists who need to
complement, rather than duplicate, the strengths of the e-prescribing system.
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