Applying the National Inpatient Medication Chart audit to electronic medication management systems: what does it tell us?

Background: Medication errors in hospitals are common. Although electronic medication management systems (eMMS) have the potential to reduce errors during inpatient care, little is known about their effect in emergency departments (ED). Aim: The aims of this study were to report on the types of prescribing errors in an ED prior to implementation of an eMMS, to assess the risk the errors pose to patient safety and to evaluate whether safety-critical errors were potentially preventable with a newly implemented eMMS. Methods: Medication orders on paper charts were assessed for prescribing errors by a clinical hospital pharmacist. Error severity was rated using a five-point scale. Errors of moderate or higher severity, and all errors involving defined high-risk medicines were considered safety-critical errors. The potential for safety-critical errors to be prevented by the eMMS was rated (likely, possibly or unlikely). Results: Across 239 medication orders, 208 errors (27 clinical, 181 legal or procedural) were identified. The overall prescribing error rate was 0.87 errors/order. There were 67 safety-critical errors (53 legal or procedural, 14 clinical). Overall, 82.1% of errors were likely preventable by eMMS. However, of the clinical safety-critical errors, only 2 (14.3%) were considered likely preventable. Conclusion: Although eMMS has the capacity to prevent a high proportion of safety-critical legal or procedural errors in the ED, clinical prescribing errors in this category were unlikely to be prevented by using eMMS. Further investigation of these more severe error types could guide the design of eMMS decision support to improve system effectiveness.

Section: Methodsmentioning

confidence: 99%

The potential impact of an electronic medication management system on safety‐critical prescribing errors in an emergency department

Raban

Walter

Pont

et al. 2019

“…5,6 Literature suggests that even though documentation type errors are reduced through use of EMM, there is little change to clinical errors such as wrong strength, wrong drug and inadequate monitoring. [7][8][9] This lack of vast improvement has been attributed to the lack of clinical decision support toolssuch as policies, guidelines and protocolsworking within EMM systems. 7,8 The availability of clinical decision support tools and prompt admission medication reconciliation are key components required to reduce prescribing errors.…”

Section: Introductionmentioning

confidence: 99%

Safe prescribing in the digital age – evaluation of a pharmacist‐led prescribing program for intern medical officers

McCleery

Forman

Edmunds

et al. 2021

Improving intern medical officers' (IMOs') prescribing skills and self-confidence, in the age of digital prescribing, presents a modern healthcare challenge. This study evaluated the effectiveness of a pharmacist-led prescribing program to IMOs during orientation. The interactive program aimed to identify useful clinical prescribing support tools through case-based learning using the hospitals' digital prescribing program. The program was delivered to 90 IMOs with 56 matched pre-and post-program questionnaires completed. There was an increase in IMOs' self-confidence and ability to apply prescribing knowledge to clinical cases post-program, and 100% of IMOs agreed that the program should be included in future medical intern orientation programs. Five post-program interviews highlighted that key learnings were used in clinical practice and knowledge was sustained post-program. This pharmacist-led prescribing program for IMOs that introduced clinical decision tools to support safe prescribing using a digital system, resulted in overall improved self-confidence and prescribing skills.

“…11 The NIMC audit tool, developed by the Australian Commission on Safety and Quality in Health Care, 12 is used in Australian hospitals at regular intervals to evaluate the safety and quality of prescribing and medication chart documentation, and has recently been applied to e-prescribing. 13 The presence of baseline NIMC audit data and methodology provided an opportunity to objectively evaluate the safety of paper-based prescribing versus e-prescribing using EPAS. The hypothesis of the present study using the NIMC audit methodology was that e-prescribing would decrease prescribing errors in SA public hospitals compared with the NIMC.…”

Section: Introductionmentioning

confidence: 99%

Prescribing errors and adverse drug reaction documentation before and after implementation of e‐prescribing using the Enterprise Patient Administration System

Al-Sarawi

Polasek

Caughey

et al. 2019

Background Medication errors are a leading cause of harm to patients in hospital that can be decreased by electronic medication management systems. Aims This study determined the effects of electronic prescribing using the Enterprise Patient Administration System (EPAS) on prescribing errors and adverse drug reaction (ADR) documentation in South Australian public hospitals. Methods A prospective structured medication chart audit was conducted before (in 2012) and after the implementation (in Dec 2014) of EPAS, comparing the paper‐based National Inpatient Medication Chart (NIMC) with prescribing. All inpatients were eligible for inclusion in the study. Prescribing order errors were determined by the percentage of medication orders that had unclear, illegal or unsafe prescriptions. The quality of ADR documentation was assessed by the percentage of patients with correct documentation. Results The total number of prescribing errors before and after the implementation of EPAS was 67.7 and 2.8 per 100 orders, respectively. The frequency of prescribing order errors due to unclear, illegal and unsafe prescriptions decreased to almost zero with EPAS. Prescriptions classified as unsafe due to incorrect dose, route of administration or dosing frequency decreased from 5.8% to 0.03% of medication orders before versus after EPAS implementation (p < 0.0001). Completed ADR documentation was similar between the paper‐based NIMC and EPAS, but the percentage of patients with ADR alerts who required them was 100% in EPAS compared with 27% on the NIMC (p < 0.0001). Conclusions E‐prescribing using EPAS significantly decreased prescribing errors and increased ADR alerts. Continued implementation of electronic medication management systems is an important approach to improve medication safety.