RESUMEN
This review explores the impact of electronic prescribing (e-prescribing) systems on clinical pharmacy practice, highlighting the potential benefits and challenges associated with their use. Medication errors, a significant concern within healthcare settings, have been shown to decrease with the adoption of e-prescribing, offering a promising tool to enhance patient safety and reduce adverse drug events. However, the transition from traditional handwritten prescriptions to electronic methods introduces new challenges, including the emergence of new types of errors, such as incorrect drug selection, and potential increases in mortality rates, as observed in pediatric patient. Furthermore, it discusses the limited exploration of e-prescribing in primary care and community pharmacy settings, areas that require further investigation to fully understand the benefits and burdens of e-prescribing use. By examining barriers related to person, tasks, environment, tools and technologies, and organizational factors, this review emphasizes the importance of considering various aspects that influence the efficacy and safety of e-prescribing systems. The findings suggest a critical need for incorporating human factors principles in the design and evaluation of these systems to ensure they effectively support clinical pharmacy practice and enhance patient care.
RESUMEN
Background: The electronic prescribing system, either standalone or embedded in the electronic health record, is a powerful tool in the hands of healthcare providers, as it reduces half of medication errors caused by handwritten prescribing. Objective: This article synthesizes the international literature on electronic health records (EHRs), e-prescribing (EP) and medication errors (MEs) and provides a platform to World Health Organization Eastern Mediterranean Region (WHO-EMR) countries for implementing EHRs and EP in healthcare system. Methods: Computer searches of PubMed, MEDLINE, Quertle®, Google Scholar, Web Knowledge and International Pharmacy Abstract databases were conducted for the years 2000–2014 using several single- and combined-keyword strategies, with 184 articles retained for evaluation. Results: Although e-prescribing integrated with EHR reduces medication errors at all healthcare levels, decreases morbidity and mortality, enhances patient and healthcare provider satisfaction by reducing costs and improving quality of life, it produces different types of medication errors at various stages of the prescription process. An EHR with EP that has a clinical decision support system (CDSS), dose-limit range, drug–drug interaction alert protocols, and formulary decision support helps to improve EP and ensures greater patient safety and other multiple applications. Conclusion: EHRs with EP systems should be implemented in healthcare systems for the sake of better quality healthcare and patient safety throughout the WHO-EMR countries especially in the Kingdom of Saudi Arabia. Evidently there is limited data in these countries and hence further studies are needed to assess impact of EHRs and EP system (EPSs) on medication errors, quality of healthcare, patient safety and outcome, morbidity and mortality rates, patients’ and healthcare providers’ acceptance, and especially its cost-effectiveness.
RESUMEN
Background: A “near miss” or close call is a medication error that happened but did not result in injury or damage to the patient. These medication errors (MEs) are captured and corrected before affecting the patient either fortuitously or purposefully by designed system controls imbedded in electronic health record (EHR) as well as electronic prescribing systems (EPS). Objective: This study analyzed the reported electronic prescribing near misses (NMs) in King Saud Medical City (KSMC) in Riyadh city. Methods: The ME report forms were consecutively collected over a period of one year, from 1 January to 31 December, 2012. These forms were evaluated for data abstraction and a comparative analysis of NMs/NM report forms of first 6-month (n=1025, timeline 1) versus second 6-month (n=2398, timeline 2) was carried out. No systematic intervention prior to timeline 2 was used in this study. Results: The total number of MEs/NMs report forms was 3423 and total number of reported NMs was 7415, as each form could contain more than one NM. Drug prescription items, medication dispensing stages, NM makers and identifiers, underlying causes, sites of errors, prescribed drugs and suggested actions to avoid NM errors all differed significantly between the two timelines, which could be attributed to natural, real world practices in KSMC. Conclusion: This prospective study found significant differences in factors related to NMs between two six month periods in a single year. Reasons for these differences between two timeframes remain poorly understood. NMs comparative studies using systematic interventions are warranted in the Kingdom of Saudi Arabia.