Aim To develop an electronic prescribing system (EPS), in a tertiary care paediatric hospital.
Method One of the many benefits of electronic prescribing (EP) in secondary care, is the reduction in prescribing error rates.1 However, implementing EP in paediatrics, presents many challenges such as the increased complexity of medication dosing2 and varying doses of drugs depending on indication.2 An EPS was acquired from a local adult secondary care hospital and developed to include a specialist paediatric drug library with clinical decision support. The pharmacy department used a dispensing patient medication record system that was incompatible with the EPS, so the latter had to work side-by- side with the former, as the drug chart. A smaller training team was deployed with external trainers, from the hospital where the system was acquired from and they were enlisted for the pilot.
Results The pilot was launched in April 2017, on the hepatology ward, consisting of 14 beds. All patients that were treated under the hepatology medical and surgical teams were placed on the e-prescribing system and this accounted for 95 patients, from the launch over a period of 3 months. Although the benefits of an EPS became a reality, which included a reduction in medication and administration errors, many drawbacks still existed that hindered a more complete EPS. Certain drugs were found to be missing from the drug library and drug monographs lacked the appropriate clinical decision support for prescribers and administrators alike. This was observed by the sharp rise in incident reporting from 20 reports, in the 3 months prior to the launch, to 55 reports, in the 3 months post-launch. Pharmacy processes, that proved effortless on drug charts and discharge prescriptions, became complex for pharmacists and technicians, as the EPS lacked the necessary features including insufficient message functionality to document patient’s own medicines and supply from pharmacy, discharge prescription alerting and modification of prescriptions once printed. The absence of sufficient and relevant clinical support staff became apparent soon after external trainers returned to their respective bases; with only one support member remaining that had held a clinical position previously. Difficulties quickly became apparent when attempting to explain specific clinical EP functions to non-clinical support staff.
Conclusion In preparation for rollout across the trust, many areas could be improved upon to ensure substantial progress could be made, from the pilot. Developing a more robust system to build and review drug monographs to include both medical and nursing input, from their respective clinical specialities and ensuring that all drugs whether supplied with or without pharmacy involvement are included in the paediatric drug library. Observing the work of pharmacists and other healthcare professionals, to ensure their day-today tasks, on drug charts or discharge prescriptions, are replicated successfully on the EPS. Increased pharmacy involvement in training and support, would benefit the EPS greatly, from a clinical perspective.
Franklin G, O’Grady K, Donyai P, Jacklin A, Barber N. The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: A before-and-after study. QualSaf Health Care2007;16:279–84.
Johnson KB, Lehmann CU. Council on clinical information technology. Technical report: Electronic prescribing in paediatrics: Toward safer and more effective medication management. Paediatrics2013;131(4):e1350–e1356.
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