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Computerized prescribing could reduce errors.(Practice Trends)
WASHINGTON -- Computerized prescribing could greatly reduce the number of medical errors, especially when it comes to adverse drug events, David Bates, M.D., said at a consensus conference sponsored by the American Association of Clinical Endocrinologists.
In his own health care research at Brigham and Women's Hospital in Boston, where he is chief of general medicine, Dr. Bates and colleagues looked at more than 10,000 medication orders and found 530 errors, an average of 1.4 per hospital admission. Included among those were 35 potential adverse drug events and five preventable adverse drug events.
These data suggest that "about 1 in 100 medication errors results in an [adverse drug event], and 7 in 100 have the potential to do so," said Dr. Bates, who also serves as medical director of clinical and quality analysis at Partners HealthCare, in Boston.
When do the errors occur? In another study, Dr. Bates and colleagues found that about half of prescribing errors (49%) occur at the ordering stage, followed by 26% at the administration stage, 14% at the dispensing stage, and 11% at the transcribing stage.
Although transcribing accounted for the smallest percentage of errors, it can still be a big problem. Dr. Bates showed a sample of a handwritten prescription for Avandia (rosiglitazone) that was mistakenly dispensed as Coumadin (warfarin). Such problems could be reduced or eliminated by the use of prescribing software, Dr. Bates said.
Ambulatory care settings are particularly ripe for prescribing errors, for several reasons, he said. "There is a long feedback loop, because often you don't hear from patients for a long time, and there are limited resources and redundancy," he said. In addition, "the average primary care encounter is 12 minutes, and the average time to the first interruption is 18 seconds. And 75% of patients leave with unanswered questions."
He cited a study by Tejal K. Gandhi, M.D., and colleagues showing that of 661 outpatients, 162 (25%) had adverse drug events, for a total of 181 events. Of those, 13% were serious and 11% were preventable (N. Engl. J. Med. 2003;348:1556-64).
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Source: HighBeam Research, Computerized prescribing could reduce errors.(Practice Trends)