Application of Failure Mode and Effects Analysis (FMEA) to identify failure modes in e-prescribing at “X” Regional Hospital, Surakarta

Medication errors at the prescribing stage remain a persistent threat to patient safety despite the growing adoption of electronic prescribing (e-prescribing). RSUD “X” in Surakarta, which processes approximately 12,600 prescriptions per month, has implemented e-prescribing within its Hospital Management Information System (SIMRS), yet failure modes in this process had never been systematically identified. This study aimed to identify failure modes in the outpatient and inpatient e-prescribing process at RSUD “X” Surakarta and to determine the Risk Priority Number (RPN) of each failure mode using Failure Mode and Effects Analysis (FMEA). A descriptive mixed-methods design was applied from November 2025 to January 2026. Semi-structured interviews and direct observation involving 2 specialist physicians and 8 pharmacists/pharmacy technicians were conducted to identify potential failure modes, followed by a risk-assessment questionnaire in which 36 respondents rated severity, occurrence, and detection on a 1–10 scale. Eleven failure modes are identified, with RPN values ranging from 36 to 200. The three highest priorities are medication-picking errors during dispensing and labeling (RPN = 200), omission of dose rechecking for compounded prescriptions during screening (RPN = 192.97), and patient misidentification during medication handover (RPN = 190.45). This study concludes that most failure modes stem from limitations SIMRS features that do not yet fully support safe prescribing, making the development of such features a priority, including integrated LASA/HAM markers, weight-based dose validation supported by a Clinical Decision Support System, patient photo display for identity verification, and integration with insurance formulary information, should be prioritized to strengthen patient safety in e-prescribing.