The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.
OBJECTIVE
To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time.


METHODS
Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward.


METHODS
Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system.


METHODS
Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks.


RESULTS
Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; chi(2) test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; chi(2) test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; chi(2) test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; chi(2) test).


CONCLUSIONS
A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.
Franklin
Bryony Dean
BD
Hammersmith Hospital, London, UK. bdean@hhnt.nhs.uk
O'Grady
Kara
K
Donyai
Parastou
P
Jacklin
Ann
A
Barber
Nick
N
D016303:Clinical Pharmacy Information Systems; D011307:Drug Prescriptions; D006757:Hospital Units / Q000458:organization & administration*; D006784:Hospitals, Teaching; D006801:Humans; D008131:London; D050316:Medical Order Entry Systems; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D009738:Nursing Service, Hospital; D010355:Patient Identification Systems; D010607:Pharmacy Service, Hospital
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