Department of Pediatrics, Weill Medical College of Cornell University, New York, New York 10065, USA.
J Am Med Inform Assoc. 2012 Jul-Aug;19(4):644-8. doi: 10.1136/amiajnl-2011-000345. Epub 2011 Dec 1.
Little is known about the frequency and types of prescribing errors in the ambulatory setting among community-based, primary care providers. Therefore, the rates and types of prescribing errors were assessed among community-based, primary care providers in two states.
A non-randomized cross-sectional study was conducted of 48 providers in New York and 30 providers in Massachusetts, all of whom used paper prescriptions, from September 2005 to November 2006. Using standardized methodology, prescriptions and medical records were reviewed to identify errors.
9385 prescriptions were analyzed from 5955 patients. The overall prescribing error rate, excluding illegibility errors, was 36.7 per 100 prescriptions (95% CI 30.7 to 44.0) and did not vary significantly between providers from each state (p=0.39). One or more non-illegibility errors were found in 28% of prescriptions. Rates of illegibility errors were very high (175.0 per 100 prescriptions, 95% CI 169.1 to 181.3). Inappropriate abbreviation and direction errors also occurred frequently (13.4 and 4.2 errors per 100 prescriptions, respectively). Reviewers determined that the vast majority of errors could have been eliminated through the use of e-prescribing with clinical decision support.
Prescribing errors appear to occur at very high rates among community-based primary care providers, especially when compared with studies of academic-affiliated providers that have found nearly threefold lower error rates. Illegibility errors are particularly problematical.
Further characterizing prescribing errors of community-based providers may inform strategies to improve ambulatory medication safety, especially e-prescribing.
http://www.clinicaltrials.gov, NCT00225576.
社区基层医疗机构的初级保健提供者在门诊环境中开具处方时的错误频率和类型知之甚少。因此，评估了两个州的社区基层医疗机构初级保健提供者的处方错误发生率和类型。
2005 年 9 月至 2006 年 11 月，对来自纽约的 48 名提供者和马萨诸塞州的 30 名提供者进行了一项非随机的横断面研究，他们均使用纸质处方。使用标准化方法，审查处方和病历以识别错误。
对 5955 名患者的 9385 份处方进行了分析。排除字迹不清错误后，总的处方错误率为每 100 份处方 36.7 份（95%置信区间 30.7 至 44.0），来自每个州的提供者之间没有显著差异（p=0.39）。28%的处方存在一种或多种非字迹不清错误。字迹不清错误的发生率非常高（每 100 份处方 175.0 份，95%置信区间 169.1 至 181.3）。不适当的缩写和指示错误也经常发生（分别为每 100 份处方 13.4 和 4.2 份错误）。审查员确定，绝大多数错误都可以通过使用具有临床决策支持的电子处方来消除。
与发现错误率低三倍的学术附属医疗机构的研究相比，基层医疗机构的初级保健提供者开具处方的错误似乎发生率非常高。字迹不清错误尤其成问题。
进一步描述社区基层医疗机构提供者的处方错误可能有助于制定改善门诊药物安全的策略，尤其是电子处方。
