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Study Finds Poorly Written e-Prescriptions Lead to Errors

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Paige Tears-Gladstone2 years ago

A newly published study shows the free-text Notes field in electronic prescriptions often contains information which should be submitted in other existing data fields or which contradicts other prescription data leading to confusion and prescription errors,

About the E-Prescription Study

According to Medscape, the free-text Notes field is intended for the inclusion of patient-specific information relevant to the prescription which does not have a dedicated field. A retrospective, qualitative study was published online Marth 7th in JAMA Internal Medicine to determine the usage of this field in e-prescriptions and the errors it can cause when misused.

Three certified pharmacy technicians completed the research as they independently analyzed more than 25,000 e-prescriptions which had been randomly drawn from 3,024,737 e-prescriptions with notes which were sent to U.S. pharmacies the week of November 10, 2013.This data came from 22,549 different prescribers and nearly 500 different e-prescribing software systems.

In this one-week interval, 15% of the new e-prescriptions filed contained information in the notes section. After they had obtained the base data, the researchers began the qualitative analysis in which they determined whether the text within the prescription’s note field was appropriate, inappropriate, or unnecessary.

This research revealed that more than 66% of the notes were inappropriate, and belonged in a different field on the e-prescription pertaining to categories like insurance benefits or diagnosis information. 5.3% were unnecessary and didn’t provide any information to pharmacists.

The remaining 28.6% of note were appropriate, but closer review showed that these notes often contained information which conflicted with that found elsewhere on the prescription. For instance, 19% of these notes contained patient directions different from those given in the designated directions field.

Misuse and Resolution

This inclusion of contradictory information on the e-prescription represents a potential safety concern for patients as they may be uncertain which directions to follow and can also result in dispensing errors by pharmacy staff.

Researchers speculate that restrictive or challenging electronic health record systems, inadequate user training, and character limits in other fields are at the root of the misuse. They also cite a failure to implement a set of approved standards.

However, the inappropriate usage can lead to medication errors, dispensing delays, and adverse patient outcomes due to miscommunication. In the study commentary Dr. Schnipper draws extrapolations from the research data to postulate that more than 34 million of these errors occur annually.

The study findings show a need for a change in pre and post-marketing testing and surveillance of e-prescription software applications as well as providing vital data to improve the current systems to reduce future confusion.  Review of the appropriate notes revealed that nearly half of them would be included in structured text fields currently planned for a future update.

These new structured fields range from notifying the pharmacy of a patient allergy to a need for the label to be printed in a foreign language. Dr. Schnipper recommends that resolution for these errors can be achieved by updating and consolidating prescription standards, implementing new structured fields, improved systems training for prescribers, and ongoing surveillance of this abused field to guide future updates.


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