Intended for healthcare professionals

Rapid response to:

Practice Safety Alerts

Safer administration of insulin: summary of a safety report from the National Patient Safety Agency

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5269 (Published 13 October 2010) Cite this as: BMJ 2010;341:c5269

Rapid Response:

Implement electronic prescribing to improve patient safety

Sir,

Lamont et al (1) have not alluded to an intervention which might have
avoided the tragic death and incident of severe harm reported by the NPSA
involving incorrect insulin doses. Experience in the United States has
shown that electronic (e-) prescribing has the potential to reduce the
rate of serious medication errors by up to 86% (2).

E-prescribing systems prevent many errors by eliminating handwriting
blunders and ensuring the completeness of prescriptions, but more
sophisticated systems linked to an electronic patient record have the
potential to reduce errors further and improve practice. E-prescribing
systems with clinical decision support (CDS) can check automatically for
dose errors, allergies, drug-drug and drug-disease interactions, and
provide immediate warning and guidance to the prescriber (3). There is
evidence that using CDS reduces medication errors and improves
practitioner performance. A Cochrane review of the evidence for
computerized advice on drug dosage to improve practice found significant
benefits including reduced risk of toxic dose (rate ratio 0.45) and
reduced length of hospital stay (standardised mean difference -0.35 days)
(4).

The introduction of an automated system which not only guarantees
complete, legible prescriptions and warns prescribers of incorrect doses,
but which may forbid prescribing of dangerous doses, may do more to
eliminate serious patient harm than any programme of education. It is
disappointing that e-prescribing in United Kingdom hospitals is limited to
so few sites.

Dr Gregory Scott, Academic Clinical Fellow, Imperial College
Healthcare NHS Trust
Mr Frank Cross, Consultant Surgeon and Clinical Safety Officer, Barts and
The London NHS Trust

1. Lamont T, Cousins D, Hillson R et al. Safer administration of
insulin: summary of a safety report from the National Patient Safety
Agency. BMJ 2010 341:c5269; doi:10.1136/bmj.c5269

2. Bates DW, Teich J, Lee J, Seger D, Kuperman GJ, Ma'Luf M, et al.
The impact of computerized physician order entry on medication error
prevention. J Am Med Inform Assoc. 1999; 6: 313-21

3. Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The effect
of electronic prescribing on medication errors and adverse drug events: a
systematic review.. J Am Med Inform Assoc. 2008;15(5):585-600

4. Durieux P, Trinquart L, Colombet I, Ni?s J, Walton R, Rajeswaran
A, R?ge-Walther M, Harvey E, Burnand B. Computerized advice on drug dosage
to improve prescribing practice. Cochrane Database of Systematic Reviews
2008, Issue 3. Art. No.: CD002894. DOI: 10.1002/14651858.CD002894.pub2

Competing interests: No competing interests

25 November 2010
Gregory P T Scott
Academic Clinical Fellow (Neurosciences)
Mr Frank Cross (Consultant Surgeon and Clinical Safety Officer, Barts and The London NHS Trust)
Imperial College Healthcare NHS Trust