J Am Med Inform Assoc - Ambulatory prescribing errors among community-based providers in two states.

Tópicos

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Resumo

JECTIVE: 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.MATERIAL AND METHODS: 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.RESULTS: 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.DISCUSSION: 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.CONCLUSIONS: Further characterizing prescribing errors of community-based providers may inform strategies to improve ambulatory medication safety, especially e-prescribing.TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov, NCT00225576.

Resumo Limpo

jectiv littl known frequenc type prescrib error ambulatori set among communitybas primari care provid therefor rate type prescrib error assess among communitybas primari care provid two statesmateri method nonrandom crosssect studi conduct provid new york provid massachusett use paper prescript septemb novemb use standard methodolog prescript medic record review identifi errorsresult prescript analyz patient overal prescrib error rate exclud illeg error per prescript ci vari signific provid state p one nonilleg error found prescript rate illeg error high per prescript ci inappropri abbrevi direct error also occur frequent error per prescript respect review determin vast major error elimin use eprescrib clinic decis supportdiscuss prescrib error appear occur high rate among communitybas primari care provid especi compar studi academicaffili provid found near threefold lower error rate illeg error particular problematicalconclus character prescrib error communitybas provid may inform strategi improv ambulatori medic safeti especi eprescribingtri registr number httpwwwclinicaltrialsgov nct

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