High rates of paper-based prescribing errors found among community-based primary care providers

Patient Safety and Quality

A great deal is known about the rates and types of prescribing errors in hospitals, but not in the outpatient setting. Now a new study reveals high rates of prescribing errors among community-based providers in two States. Errors resulting from illegible prescriptions were the biggest problem.

The study looked at 48 ambulatory care providers in New York and 30 providers in Massachusetts who used paper prescriptions for a period of 15 months. A total of 9,385 prescriptions were reviewed for 5,955 patients to identify any prescribing errors. Provider groups in both States experienced high error rates. Overall, the rate of prescribing errors was 36.7 per 100 prescriptions, not including illegibility errors. There was no difference in rates between the groups. This amounted to 27.8 percent of prescriptions having at least 1 prescribing error. Although these errors have low potential for patient harm, they do result in significant rework for physicians, nurses, and pharmacists and delays in receiving medications for patients. The near-miss rate was 1.1 per 100 prescriptions, again with no difference between groups, and with illegibility errors excluded. Prescribing errors that were most common were illegibility errors, the use of inappropriate abbreviations, direction errors, and strength errors. Illegibility errors and dose errors were most responsible for near misses.

Among drug categories, antibiotics had the most prescribing errors, followed by cholesterol medications, narcotic analgesics, and blood pressure drugs. According to the researchers, use of electronic prescribing with a basic clinical decision support (CDS) system in place could have prevented 32 percent of prescribing errors; an advanced CDS system would have pushed this rate to 57 percent. A CDS system would also have prevented all of the illegibility errors and 42 percent of the near misses. The study was supported in part by the Agency for Healthcare Research and Quality (HS15397).

See "Ambulatory prescribing errors among community-based providers in two states," by Erika L. Abramson, MD, David W. Bates, MD, M.Sc., Chelsea Jenter, and others in the Journal of the American Medical Informatics Association 19, pp. 644-648, 2012.

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Page last reviewed January 2013
Internet Citation: High rates of paper-based prescribing errors found among community-based primary care providers: Patient Safety and Quality. January 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/research-activities/13jan/0113RA3.html