Main Article Content
OBJECTIVES: To compare prescribing errors arising from prescribing drugs by computerized prescribing system and handwritten prescribing system and to explore the possible factors that cause prescribing errors between the two systems.
MATERIALS AND METHODS: : A retrospective study collected data from outpatient prescriptions at Bangkok Hospital Chiang Mai from January 1- December 31, 2019 by a simple random sampling method. A total of 18,211 drug prescriptions were included in this study which consisted of prescribing the drug with the computerized prescribing system and the handwritten prescribing system. The data obtained were analyzed by frequency distribution, percentage, mean and standard deviation. Factors that caused discrepancies in prescribing drugs during computerized prescribing and handwritten prescriptions were tested by means of Chi-square test. A value of 0.05 odds ratio and 95% Confident interval was considered statistically significant.
RESULTS: In this study, the discrepancy from the handwritten prescribing system was 2.6 % higher than that of the computerized prescribing system (0.24%). The study was also classified by the severity of the discrepancy which demonstrate both systems experienced the highest severity on a scale of 0 (Near miss event) by 2.6 % for the handwritten prescribing system and 0.2 % for the computerized prescribing system. In addition, the top three discrepancy errors from computerized prescribing were wrong time, wrong dose and wrong quantity at 0.07%, 0.06% and 0.05 %, respectively. As for the handwritten prescribing system, the discrepancy errors were wrong time, wrong quantity and wrong dose at 1.24%, 0.56% and 0.35%, respectively.
CONCLUSION: There were significant differences in the proportion of errors in the group of the handwritten prescribing system and the computerized prescribing systems (OR = 0.091, p < 0.05); namely, the risk of errors by the computerized prescribing systems was reduced by 91% compared with the handwritten prescribing system. However, there were no statistically significant differences in physician ‘s work experience, departments, and age groups.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Karunrat Tewthanom K, Tananonthiwadi S. Medication error and Prevention guide for patient’s safety. Veridian E-J, SU 2007; 2(1):195-217.
Fener RE, Aronson JK. Clarification of terminology in medication errors: definitions and classification. Drug Saf 2006; 29(11):1011- 12. doi: 10.2165/00002018-200629110-00001.
Fortescue EB, Kaushal R, Landrigan CP, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric in patients. Pediatrics 2003;111(4 Pt 1):722-9. doi: 10.1542/peds.111.4.722.
Kopp BJ, Erstad BL, Allen ME, et al. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Crit Care Med 2006; 32(2):415-25.doi:10.1097/01.ccm.0000198106.54306.d7.
Moyen E, Camiré E, Stelfox HT. Clinical review: medication errors in critical care. Crit Care 2008;12(2):208. doi: 10.1186/cc6813.
Van Doormaal JE, Van den Bemt PM, Zaal RJ, et al. The influ-ence that electronic prescribing has on medication errors and preventable adverse drug events; an interrupted time – series study. J Am Med Inform Assoc 2009;16(6):816-25. doi: 10.1197/jamia.M3099.
Songkramsri S, Laopaiboon M. Computerized prescribing system for reducing prescription errors in Nonghan Hospital, Udonthani Province: IJPS, 2017;13(2):53-66.
Thanathorn Tungkhasamit, Itsaraphong Bumrung. Computerized physician ordering entry system for chemotherapy at Udon Thani Cancer Hospital. J Thai Med Info Assoc 2017;2: 65-71.
Nualsri A. Medication errors and in- patient computerized prescribing system. Songkla Med J 2006;24(1):1-8.
Shulman R, Singer M, Goldston J, et al. Medication errors: a prospective cohort study of hand-written and computerized physician order entry in the intensive care unit. Crit Care 2005;9(5):R516-21. doi: 10.1186/cc3793.
Knudsen P, Herborg H, Mortensen AR, et al. Preventing medication errors in community pharmacy; frequency and seriousness of medication errors. Qual Sef Health Care 2007;16(4):291-6. doi: 10.1136/qshc.2006.018770.
Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998;280(15):1311-6. doi: 10.1001/jama.280.15.1311.
Thawithangkul S, Thawithangkul W, Wananukul W. Benefits and bostacles of computerized physician order entry (CPOE) system in Ramathibodi Hospital. J Thai Med Info Assoc 2016;2:128-33.
Longhurst CA, Parast L, Sandborg CI, et al. Decrease in hospital - wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics 2010;126(1):140-21. doi: 10.1542/peds.2009-3271.
Medical Affair Office Bangkok hospital Chiangmai. Annual performance report in 2017. Chiangmai: Bangkok Hospital Chiang Mai; 2020.
Pintakiew P. Head of Pharmacy department. Chiangmai: Bangkok Hospital Chiang Mai; [interviews], December 7, 2021.
Zakharov S, Tomas N, Pelcolva D. Medication errors: and enduring problem for children and elderly patient. Ups J med Sci 2012;117(3):309-17. doi: 10.3109/03009734.2012.659771.
Mary P Tully. Prescribing errors in hospital practice. Br J Clin Pharmacol 2012;74(4):668-75. doi: 10.1111/j.1365-2125.2012.04313. x.
Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric in patients. JAMA 2001; 285(16):2114-20. doi: 10.1001/jama.285.16.2114.