The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals

Westbrook, Johanna I.; Baysari, Melissa T.; Li, Ling; Burke, Rosemary; Richardson, Katrina L; Day, Richard O.

doi:10.1136/amiajnl-2013-001745

Cited by 92 publications

(97 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The implementation of eMeds has been demonstrated to significantly improve the safety of prescribing and dispensing in the hospital setting. 2 Although the primacy of the consumer is embedded in Australia's National Medicines Policy, this consideration has often been lacking in many of the strategies related to safe prescribing and dispensing. I believe that more actively engaging consumers in the prescription of medicines will improve safety and is the critical next step.…”

Section: E D I T O R I a L S Safe Prescribing Rocket Science And Conmentioning

confidence: 99%

Safe prescribing, rocket science and consumers

McLachlan

2018

Pharmacy Practice and Res

View full text Add to dashboard Cite

pharmacy practice where the profession is potentially divorced from drug distribution is a rather bleak vision, raising a future where a strong, distinct and unique skillset and practice focus is compromised or absent.In this edition of the Journal we see further discussion of the progress of electronic medication management systems, adding more weight to claims that this approach is a justified strategy to reduce medicationrelated harm. One aspect of the efficacy of this type of approach is based upon removing human fallibility from the processes of prescribing and medication management, but can this type of approach accommodate consideration of both the science and art required for these tasks? This edition also addresses, on the other hand, an approach that advocates a role for pharmacists in teaching less experienced doctors how to prescribe. This observer suggests that the two types of strategy should not be mutually preclusive -in fact, they can and should exist side by side. This way, should the unthinkable unfold and a prescriber or dispenser find themselves in a situation without access to electronic support, it is conceivable that the necessary tasks could still be completed safely, if not perhaps quite as effectively. Many would think that this is sensible, and counsel caution to maintain access to both types of approach.In the final analysis, it is worth considering the origins of the most enduring symbol associated with a prescription, the eye of Horus (Rx). This routine feature of prescriptions past was in part a historical and traditional deference in the form of a prayer to gods of healing. The symbol denotes the eye of Horus, who was said to have had a damaged eye removed, then healed by another god, but he then ultimately gave his healed eye to his dead father to bring him back to life.3 Of course, Rx is also an abbreviation for the Latin word 'recipe'. We might well consider a prescription a simple recipe that should be written carefully and followed accurately -or, we might imbue the prescription with a certain mysticism that addresses such a complicated and challenging process that it requires assistance to acquit capably and reliably. A rationalist would favour the former view, a pragmatist (and perhaps a romantic) would adopt the latter.

show abstract

Section: E D I T O R I a L S Safe Prescribing Rocket Science And Conmentioning

confidence: 99%

Safe prescribing, rocket science and consumers

McLachlan

2018

Pharmacy Practice and Res

View full text Add to dashboard Cite

show abstract

“…An investigation of 1164 prescribing errors post-eMM in two adult Australian hospitals found 42.4% were facilitated by the system (78 per 100 admissions). 23 The most frequent mechanism was incorrect selection from a drop-down menu. Results from that study were used to instigate changes to eMM software and to inform changes to user training programmes.…”

Section: Can Information Technology Reduce Medication Errors?mentioning

confidence: 99%

“…The study was one of the first to quantify the rate of 'system-related' errors and produced an innovative dual classification for categorising both the manifestations and mechanisms of these system-related errors. 23 The nature and magnitude of such potential new risks have rarely been studied in paediatrics.…”

Section: Can Information Technology Reduce Medication Errors?mentioning

confidence: 99%

See 1 more Smart Citation

Stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce medication errors, adverse drug events and average length of stay at two paediatric hospitals: a study protocol

Westbrook

Raban

et al. 2016

BMJ Open

View full text Add to dashboard Cite

IntroductionMedication errors are the most frequent cause of preventable harm in hospitals. Medication management in paediatric patients is particularly complex and consequently potential for harms are greater than in adults. Electronic medication management (eMM) systems are heralded as a highly effective intervention to reduce adverse drug events (ADEs), yet internationally evidence of their effectiveness in paediatric populations is limited. This study will assess the effectiveness of an eMM system to reduce medication errors, ADEs and length of stay (LOS). The study will also investigate system impact on clinical work processes.Methods and analysisA stepped-wedge cluster randomised controlled trial (SWCRCT) will measure changes pre-eMM and post-eMM system implementation in prescribing and medication administration error (MAE) rates, potential and actual ADEs, and average LOS. In stage 1, 8 wards within the first paediatric hospital will be randomised to receive the eMM system 1 week apart. In stage 2, the second paediatric hospital will randomise implementation of a modified eMM and outcomes will be assessed. Prescribing errors will be identified through record reviews, and MAEs through direct observation of nurses and record reviews. Actual and potential severity will be assigned. Outcomes will be assessed at the patient-level using mixed models, taking into account correlation of admissions within wards and multiple admissions for the same patient, with adjustment for potential confounders. Interviews and direct observation of clinicians will investigate the effects of the system on workflow. Data from site 1 will be used to develop improvements in the eMM and implemented at site 2, where the SWCRCT design will be repeated (stage 2).Ethics and disseminationThe research has been approved by the Human Research Ethics Committee of the Sydney Children's Hospitals Network and Macquarie University. Results will be reported through academic journals and seminar and conference presentations.Trial registration numberAustralian New Zealand Clinical Trials Registry (ANZCTR) 370325.

show abstract

“…Implementer sites have also over time developed important insights surrounding the limitations of commercial systems and devised strategies to manage potential safety risks associated with altered user workflows and technological interface design 22 , 24 – 26…”

Section: Introductionmentioning

confidence: 99%

Five key recommendations for the implementation of Hospital Electronic Prescribing and Medicines Administration systems in Scotland

Cresswell

Slee

Sheikh

2017

jhi

View full text Add to dashboard Cite

National Health Service (NHS) Scotland is about to embark on the implementation of hospital electronic prescribing and medicines administration systems. There are a number of risks associated with such ventures, and thus drawing on existing experiences from other settings is crucial in informing deployment.Drawing on our previous and ongoing work in English hospitals as well as the international literature, we reflect on key lessons that NHS Scotland may wish to consider in going forward. These deliberations include recommendations surrounding the key aspects of deployment strategy: 1) the way central coordination should be conceptualised, 2) how flexibility in strategy can be ensured, 3) paying attention to optimising systems from the outset, 4) how expertise should be developed and centrally shared, and 5) ways in which learning from experience can be maximised.Our five recommendations will, we hope, provide a starting point for the strategic deliberations of policy makers. Throughout this journey, it is important to view the deployment of hospital electronic prescribing and medicines administration systems as part of a wider strategic goal of creating integrated digital infrastructures across Scotland.

show abstract

The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals

Cited by 92 publications

References 21 publications

Safe prescribing, rocket science and consumers

Safe prescribing, rocket science and consumers

Stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce medication errors, adverse drug events and average length of stay at two paediatric hospitals: a study protocol

Five key recommendations for the implementation of Hospital Electronic Prescribing and Medicines Administration systems in Scotland

Contact Info

Product

Resources

About