Wednesday, June 8, 2011

Switching to eRX

A team of physician-scientists from Weill Cornell Medical College in a study funded by AHRQ tracked 19 physicians in an adult ambulatory clinic in the process of switching to a new eRX system to see if prescription errors were being made. They followed the physicians again after 12 weeks after the switch and once again a year later.

The study’s researchers analyzed nearly 4,000 prescriptions for more than 2,000 patients and noted mistakes in abbreviations, usage directions, dosage, quantity of medications to be dispensed, and several other factors. They conducted a survey to assess how the physicians viewed the switch with the results published in the “Journal of General Internal Medicine.”

The researchers found:

• The rate of prescription errors dropped by two-thirds, from about 36 percent to about 12 percent one year later
• The rate of improper abbreviations, such as the outmoded “QD” used once daily fell by three-quarters from about 24 percent to about 6 percent one year later
• The rate of non-abbreviation errors rose from about 9 percent to about 18 percent 12 weeks later but did not decline to the baseline level after one year

“Averting these types of errors will likely result in fewer callbacks from pharmacies”, said Senior author Dr. Rainu Kaushal, Chief of the Division of Quality and Medical Informatics in the Department of Pediatric and Public Health at the Medical College.

The physicians had their own thoughts on the implementation of the new system:

• Forty percent of the physicians weren’t satisfied with the implementation of the new system
• Only one-third thought it was safer than the old system
• Sixty percent reported that the alerts weren’t useful
• Two-thirds indicated that the new system slowed down drug orders and refills

To further the transition and reduce prescription errors, the researchers suggested that the systems should be designed to detect and fix the most typical mistakes as well as focus on the most clinically important mistakes so that providers don’t begin to ignore alerts wherever they appear. It was also thought that physicians should receive individualized instruction and close follow-up attention as they have substantial requirements for training and support.

For more information, contact Andrew Klein at