A Quantitative and Qualitative Analysis of Electronic Prescribing Incidents Reported by Community PharmacistsFunding This project was funded by a grant from the Community Pharmacy Foundation.
18. November 2018
23. April 2019
05. Juni 2019 (online)
Background Electronic prescribing (e-prescribing) technology was introduced as an alternative to handwritten prescriptions allowing health care professionals to send prescriptions directly to pharmacies. While the technology has many advantages, such as improving pharmacy workflow and reducing medication errors, some limitations have been realized.
Objective The objective of this study was to examine the frequency, type, and contributing factors of e-prescribing quality-related incidents reported to two national error-reporting databases in the United States.
Methods This was a retrospective analysis of voluntarily reports of e-prescribing quality-related incidents. A quantitative and qualitative analysis was conducted of incidents reported between 2011 and 2015 to the Pharmacy Quality Commitment (PQC) and the Pharmacy Provider e-prescribing Experience Reporting Portal (PEER) databases. For the qualitative analysis, events were combined from the PQC and PEER portal and a 10% random sample of events were analyzed.
Results A total of 589 events were reported to the PEER Portal. Of these, problems with patient directions were the most frequent incident type (n = 210) of which 10% (n = 21) reached the patient. Quantity selection (n = 158) and drug selection (n = 96) were the next most frequently reported events, 20% of which reached the patient. The PQC system received 550 reports. The most frequent event type reported to this system was incorrect directions (23.3%, n = 128) followed by incorrect prescriber (17%), incorrect drug (15%), and incorrect strength (12%). The most common theme in the qualitative analysis was a perceived increased likelihood of patient receiving incorrect drug therapy due to e-prescribing. Another theme identified included confusion and frustration of pharmacy personnel as result of e-prescription quality-related events.
Conclusion The use of qualitative and quantitative incident data revealed that patient directions and quantity selection were the most common quality issues with e-prescribing. In turn, this may increase the likelihood of patients receiving incorrect drug therapy.
Protection of Human and Animal Subjects
This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. This study was considered nonhuman research by the Institutional Review Board at the University of Cincinnati, 20155596.
- 1 Odukoya OK, Chui MA. E-prescribing: a focused review and new approach to addressing safety in pharmacies and primary care. Res Social Adm Pharm 2013; 9 (06) 996-1003
- 2 Odukoya O, Chui MA. Retail pharmacy staff perceptions of design strengths and weaknesses of electronic prescribing. J Am Med Inform Assoc 2012; 19 (06) 1059-1065
- 3 Hincapie AL, Warholak T, Altyar A, Snead R, Modisett T. Electronic prescribing problems reported to the Pharmacy and Provider ePrescribing Experience Reporting (PEER) portal. Res Social Adm Pharm 2014; 10 (04) 647-655
- 4 Reed-Kane D, Kittell K, Adkins J, Flocks S, Nguyen T. E-prescribing errors identified in a compounding pharmacy: a quality-improvement project. Int J Pharm Compd 2014; 18 (01) 83-86
- 5 Esmaeil Zadeh P, Tremblay MC. A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks. Res Social Adm Pharm 2016; 12 (01) 1-19
- 6 Warholak TL, Rupp MT. Analysis of community chain pharmacists' interventions on electronic prescriptions. J Am Pharm Assoc (2003) 2009; 49 (01) 59-64
- 7 Rupp MT, Warholak TL. Evaluation of e-prescribing in chain community pharmacy: best-practice recommendations. J Am Pharm Assoc (2003) 2008; 48 (03) 364-370
- 8 Odukoya OK, Stone JA, Chui MA. E-prescribing errors in community pharmacies: exploring consequences and contributing factors. Int J Med Inform 2014; 83 (06) 427-437
- 9 Redwood S, Rajakumar A, Hodson J, Coleman JJ. Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents. BMC Med Inform Decis Mak 2011; 11 (01) 29
- 10 Odukoya OK, Stone JA, Chui MA. Barriers and facilitators to recovering from e-prescribing errors in community pharmacies. J Am Pharm Assoc (2003) 2015; 55 (01) 52-58
- 11 Gagnon M-P, Nsangou É-R, Payne-Gagnon J, Grenier S, Sicotte C. Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions. J Am Med Inform Assoc 2014; 21 (03) 535-541
- 12 Surescripts. National Progress Report on E-prescribing; 2017 . Available at: https://surescripts.com/docs/default-source/national-progress-reports/2151_npr_2017_finalB.pdf . Accessed May 10, 2019
- 13 Scott DM, Friesner DL, Rathke AM, Peterson CD, Anderson HC. Differences in medication errors between central and remote site telepharmacies. J Am Pharm Assoc (2003) 2012; 52 (05) e97-e104
- 14 Chinthammit C, Rupp MT, Armstrong EP, Modisett T, Snead RP, Warholak TL. Evaluation of a guided continuous quality improvement program in community pharmacies. J Pharm Policy Pract 2017; 10 (01) 26
- 15 Fassett WE. Patient safety and quality improvement act of 2005. Ann Pharmacother 2006; 40 (05) 917-924
- 16 Zhao Z, Cox J, Albright R, Jin N. , eds. Using Boolean Rule Extraction for Taxonomic Text Categorization for Big Data. SAS Conference; 2015
- 17 Porterfield A, Engelbert K, Coustasse A. Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting. Perspect Health Inf Manag 2014; 11 (Spring): 1g
- 18 Dhavle AA, Ward-Charlerie S, Rupp MT, Kilbourne J, Amin VP, Ruiz J. Evaluating the implementation of RxNorm in ambulatory electronic prescriptions. J Am Med Inform Assoc 2016; 23 (Suppl. 01) e99-e107
- 19 Surescripts. E-Prescribing Quality Guidelines; 2016 . Available at: https://surescripts.com/company-initiatives/quality-program/quality-resources/ . Accessed May 10, 2019
- 20 ISMP. Guidelines for the Safe Electronic Communication of Medication Information Safe Presentation. Horsham, PA: Institute for Safe Medication Practices; 2015
- 21 Liu H, Burkhart Q, Bell DS. Evaluation of the NCPDP structured and codified Sig format for e-prescriptions. J Am Med Inform Assoc 2011; 18 (05) 645-651
- 22 Wormser GP, Erb M, Horowitz HW. Are mandatory electronic prescriptions in the best interest of patients?. Am J Med 2016; 129 (03) 233-234
- 23 Brown CL, Reygate K, Slee A. , et al. A literature review of the training offered to qualified prescribers to use electronic prescribing systems: why is it so important?. Int J Pharm Pract 2017; 25 (03) 195-202