Notes from academic paper: E-prescribing: A focused review and new approach to addressing safety in pharmacies and primary care

Important paper

The effect of e-prescribing on patient safety and
quality of patient care in hospital settings:

Generally, the research findings on the effect of e-prescribing on medication errors were partially attributed to their settings, the system design features, or the nature of prescribers’ work. Studies conducted on homegrown systems (vs. commercial products/systems) or on systems with manual chart review show a higher ability to detect medication errors with e-prescribing. One study stated that design features of e-prescribing such as poor drop-down menu, poor screen design, or inaccurate or incomplete patient medication lists especially in certain diseases can pose a threat to patient safety. Another study that examined the relationship between prescribing errors, use of e- prescribing technology, complexity of tasks and interruptions in healthcare settings reported that common errors that occurred include: selection of incorrect medication, dose, route, and formulation. When prescribers were interrupted when performing tasks on e-prescribing systems, they required almost three times longer to complete complex tasks when compared to simple tasks. Interruptions when using e-prescribing systems were suggested to be a possible contributing factor to medications errors when using this technology possibly due to loss of concentration by the user.

On the receiving end: community pharmacies

Patient safety is commonly thought of in health-
care settings as the freedom from medication errors and patient harm.

Studies on safety of e-prescribing in community
pharmacies are particularly important as they are the recipients of the product (e-prescriptions) of e-prescribing systems. The literature on the safety issues related to e-prescribing use in community pharmacies is sparse when compared to studies that have been conducted in hospital settings. Unlike hospital settings, community pharmacies do not have access to real-time patient information that may help them detect when incorrect information is present on the e-prescription.

Pharmacists need to understand the new kinds of prescribing errors generated using new technologies used in healthcare delivery, especially related to e-prescribing technol- ogy use, for them to be better equipped to detect and prevent errors.

Issues associated with e-prescriptions in pharmacies have been reported to be caused by omission of vital information by prescribers, poor design in pharmacies and physician office and other inherent technology limitations. E- prescribing, like other types of HIT, has the potential to improve patient safety in pharmacies but if poorly designed or implemented can pose a risk to patient safety. Issues arising from using such HIT safely are increasingly being recognized as more healthcare organizations across the health system implement these technologies.

Using HFE to improve safety in technology use in pharmacy

Human Factors Engineering(HFE) is a science focused on studying the interactions between people, work systems, environment and how all these important elements might affect safety and human performance.

Pharmacies can also proactively reduce safety
risks related to using e-prescribing technology. This can be achieved by using HFE methods to identify underlying causes of e-prescribing errors and improve shared situational awareness about issues related to using e-prescribing technology.

HFE approaches are currently being applied to
evaluate the benefits and challenges with HIT in hospital settings but have not been widely used in pharmacies or ambulatory care. Patient safety experts are increasingly obtaining guidance from HFE on how to improve usability of e-prescribing design in hospital settings but no research has looked into community pharmacy. It is clear that usability testing of any HIT is a necessity. A fundamental design principle of technology usability is transparency and visibility. Qualitative studies of use of computerized provider order entry systems in hospital settings applying HFE approaches have uncovered challenges with usability involving physicians and nurses which lead to errors. Application of HFE concepts and techniques to improve e-prescribing safety will require collaborative effort from e-prescribing vendors, prescribers, and pharmacists.


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