Closing the Gap: Dramatic Improvement in Emergency Department Liquid Prescription Accuracy With Electronic Health Record Intervention

Prescribing the correct volume of liquid medication is critical for patient safety and operational efficiency. Shortage prescriptions—where the dispensed volume is less than required to complete a medication course—can lead to treatment delays and adverse outcomes. Similarly, excess prescriptions – where too much volume is provided – can lead to waste. We evaluated the impact of an intervention in the electronic health record that automatically calculated necessary liquid prescription volume based on dose volume, frequency, and total number of doses.

The EHR-based prescription automatic volume calculation was implemented on September 15, 2025 in two very-high volume urban academic EDs within our health system. We retrospectively analyzed prescriptions for liquid medications for 2.5 months post-intervention in 2025, versus the same time period in 2024. For each prescription, we compared the calculated volume (mL) needed to fulfill the medication course versus the volume actually prescribed. We compared exact, shortage, and excess prescriptions pre- and post-intervention. We used odds ratios, Chi-square, and Fisher’s exact tests to compute statistical significance, with a focus on shortage prescriptions as these are of greatest clinical concern.

We analyzed 467 prescriptions (2024: n=270; 2025: n=197). Exact prescriptions increased from 27.8% (75) pre-intervention to 75.6% (149) post-intervention. Shortage prescriptions dropped from 27.0% (73) to 2.0% (4). Excess prescriptions decreased from 45.2% (122) to 22.3% (44). Pearson’s chi-square statistic for shortage vs. non-shortage prescriptions was X²(1)=51.7, p<0.0001. Odds ratio for shortage prescriptions pre- versus post-intervention was 17.9 (95% CI: 6.4-49.9). Fisher’s exact test confirmed p<0.0001.

Prescription accuracy improved dramatically following implementation of this intervention. The categorical shift away from shortage prescriptions represents a clinically meaningful gain. Shortage prescriptions result either in incomplete treatment for the patient or the need for additional communications with the outpatient pharmacy, which are both undesirable outcomes. The reduction in excess prescriptions also minimizes waste and limits potential harms. Automatic prescription calculation is a promising intervention for improving both operational outcomes and medication safety.