A Clinical Quality Improvement Project to Reduce the Rate of Electronic Prescription Errors in Primary Care Practice

Prescription errors are not uncommon in clinical practice. At the Bukit Merah Polyclinic, the rates of prescription errors for the month of May and June 2009 were 0.40% to 0.45% respectively. The error rates for other clinics at Singhealth Polyclinics ranged from 0.35% to 0.97% over the same period of time. The objective of the project was to reduce electronic prescription error rates at the Bukit Merah Polyclinic. Initial data showed that most of the errors occurred because of wrong patient identification, as well as errors in dosing and frequency which were perpetuated by repeating mistakes made previously when all the medications were repeated en-bloc in our Electronic Prescription Manager (Rx Manager). Using Quality Improvement tools, the team identified possible causes, and implemented interventions. Our interventions, abbreviated “IR” as an easy-to-remember mnemonic, were targeted at the main sources of errors. This involved “I”dentifying the patient correctly and “R”e-typing and amending the erroneous prescriptions on our Rx Manager, “R”e-printing and “R”e-sending them to the pharmacy, before dispensing could occur. Post-intervention results were analysed to evaluate the effectiveness of the measures taken. The results showed a significant and sustainable drop in our prescription error rates (0.45% in June 2009 before the commencement of the interventions, compared to 0.15% in December 2009, upon completion of the project). By targeting patient identification and correcting mistakes made in the Rx Manager, we managed to reduce electronic prescription error rates.