scholarly journals Electronic Prescribing and Robotic Dispensing: The Impact of Integrating Together on Practice and Professionalism

2017 ◽  
Author(s):  
Roderick J. Beard
Keyword(s):  
Electronic Prescribing ◽  
The Impact

scholarly journals A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 53
Author(s):  
Amandeep Setra ◽  
Yogini Jani
Keyword(s):  
Care Setting ◽  
Electronic Prescribing ◽  
Longitudinal Assessment ◽  
Prescribing Practices ◽  
Record System ◽  
Audit Data ◽  
Core Components ◽  
Secondary Care Setting ◽  
The Impact

Accurate and complete prescriptions of insulin are crucial to prevent medication errors from occurring. Two core components for safe insulin prescriptions are the word ‘units’ being written in full for the dose, and clear documentation of the insulin device alongside the name. A retrospective review of annual audit data was conducted for insulin prescriptions to assess the impact of changes to the prescribing system within a secondary care setting, at five time points over a period of 7 years (2014 to 2020). The review points were based on when changes were made, from standardized paper charts with a dedicated section for insulin prescribing, to a standalone hospital wide electronic prescribing and medicines administration (ePMA) system, and finally an integrated electronic health record system (EHRS). The measured outcomes were compliance with recommended standards for documentation of ‘units’ in full, and inclusion of the insulin device as part of the prescription. Overall, an improvement was seen in both outcomes of interest. Device documentation improved incrementally with each system change—34% for paper charts, 23%–56% for standalone ePMA, and 100% for ePMA integrated within EHRS. Findings highlight that differences in ePMA systems may have varying impact on safe prescribing practices.

2 The impact of health information technology on medication errors in a paediatric intensive care unit

2018 ◽  
Vol 103 (2) ◽  
pp. e2.12-e2
Author(s):  
Moninne Howlett
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Medication Error ◽  
Medication Errors ◽  
Error Rate ◽  
Paediatric Intensive Care Unit ◽  
Electronic Prescribing ◽  
Novel Technology ◽  
The Impact ◽  
Smart Pump

AimsHealth information technology (HIT) is increasingly being promoted as a medication error reduction strategy. Electronic prescribing and smart-pump technology are examples of HIT widely advocated in the hospital setting. In critical care, the risks associated with paediatric infusions have been specifically addressed with calls for the use of standard concentration infusions (SCIs) in conjunction with smart-pump technology. Evidence on the benefits of HIT in the paediatric setting remains limited. This study aims to assess the impact of both electronic prescribing and a smart-pump drug library of SCIs on medication errors in paediatric critical care.MethodsA retrospective, observational study based on an interrupted time series design was conducted in the 23-bed paediatric intensive care unit (PICU) of a tertiary children’s hospital. 3400 randomly selected medication orders were reviewed over 4 epochs: pre-implementation of either technology (Epoch 1); post-implementation of SCIs (Epoch 2); immediate post-implementation of electronic prescribing (Epoch 3); and 1 year post-implementation of both (Epoch 4). Orders prescribed during the study period were included provided they had undergone clinical pharmacy review. Intravenous fluids, epidural/regional blocks, total parental nutrition, chemotherapy and patient/nurse controlled analgesia were excluded. Medication error rates were calculated applying pre-specified definitions and inclusion criteria.1 Novel technology-generated errors were identified and defined using a modified Delphi process. Errors were graded for severity using a combination of two validated grading tools.2,3ResultsOverall medication error rate based on all orders were similar in Epoch 1 and 4 (10.2% vs 9.7%; p=0.66). Altered error distribution was however evident. Incomplete and wrong unit errors were eradicated, but duplicate orders increased. Dosing errors remained the most common. 77% of pre-implementation errors were considered likely to be removed by the new technology. 24% of post-implementation errors were considered to be novel technology-generated errors. Examples included incorrect formulation selection and errors on altered electronic orders. In Epoch 2, the implementation of SCIs prior to electronic prescribing significantly reduced infusion-related prescribing errors (31.4% to 12.6%; p<0.01). An infusion error rate of 7.9% was reported post-implementation of electronically-generated standard infusion orders in Epoch 4.ConclusionThe overall medication error rate in PICU was largely unchanged by the introduction of electronic prescribing. Some errors disappeared but new errors directly attributable to the implemented technologies emerged. In the complex PICU environment, dosing errors remain common. A significant reduction in infusion-related errors was found as a consequence of the introduction of SCIs and smart-pump technology. The introduction of electronically-generated standard infusion orders brought further benefits. The results of this study show that the benefits of HIT in the paediatric setting cannot be assumed and highlight the need for further studies with increasing use of HIT in paediatric settings.ReferencesGhaleb MA, Barber N, Dean Franklin B, et al. What constitutes a prescribing error in paediatrics?BMJ Qual Saf2005;14(5):352–7.Dean BS, Barber ND. A validated, reliable method of scoring the severity of medication errors. Am J Health Syst Pharm1999;56(1):57–62.National Coordinating Council for Medication Error Reporting and Prevention. Taxonomy of medication errors1998. http://www.nccmerp.org/about-medication-errors

scholarly journals Repeat prescribing – reducing errors

2011 ◽  
Vol 3 (2) ◽  
pp. 153 ◽  
Author(s):  
Steven Lillis ◽  
Hayley Lord
Keyword(s):  
Error Detection ◽  
Significant Proportion ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Contributing Factors ◽  
Repeat Prescribing ◽  
Cause Of Error ◽  
General Practices ◽  
Practice Assessment ◽  
The Impact

BACKGROUND AND CONTEXT: Prescribing errors account for a significant proportion of overall error in general practice. Repeat prescribing occurs commonly in New Zealand and is a likely cause of error in practice. ASSESSMENT OF PROBLEM: This paper reports on two related aspects of repeat prescribing; an audit of adherence to a repeat prescribing protocol and self-reported repeat prescribing incidents in a network of 97 general practices. RESULTS: The audit of adherence to the repeat prescribing protocol revealed that some issues persist. In particular, prescribing medication outside an approved list and exceeding specified time limits or maximal scripts before clinical review were problematic. Repeat prescribing encompassed a range of departures of process from minor (such as prescription not available on time) to major (wrong medication). Corrective measures highlighted the importance of both the pharmacist and the patient in error detection. STRATEGIES FOR IMPROVEMENT: Repeat prescribing needs to be recognised as a process potentially fraught with error. Effective practice systems, patient involvement and enhanced pharmacy communication are important contributing factors in reducing error. LESSONS: There is need for robust data regarding error rates in prescribing and the impact of changing prescribing protocols on error rates. KEYWORDS: Medication errors; electronic prescribing

scholarly journals Impact of Electronic Prescription on Prescribing Errors

2021 ◽  
pp. 212-220
Author(s):  
Ameen M. Almohammadi ◽  
Huda M. Al-Dhahri ◽  
Shroug H. Al-Harbi
Keyword(s):  
Study Design ◽  
Intervention Study ◽  
Dosage Forms ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Post Intervention ◽  
Electronic Prescription ◽  
Prescription Errors ◽  
Trade Names ◽  
The Impact

Aims: There are series of medical errors that can be prevented by taking precautions.             Therefore, the study evaluates the impact of the electronic prescribing system on prescription errors. Study Design:  A pre-post study design was conducted. Place and Duration of Study: The study was conducted at outpatient pharmacy services of a teaching hospital in Jeddah city. Methodology: Prescriptions were evaluated for the presence of the essential prescription elements such as patient information, drug name, dose, frequency, strength, and other prescription completeness parameters. Results: In the pre-intervention study, 1182 handwritten prescriptions were evaluated, and 6627 errors were detected from these prescriptions. The length of the pre-and post-intervention period was two weeks each. The most prevalent prescribing errors were that of medications written without defined dosage forms were recorded 1653 (55.90%) time followed by prescriptions written by trade names 1493 (22.5%), without route of administration 1266 (19.1%), and without specified duration 1009 (15.2%). However, 1512 prescriptions were evaluated in the post-intervention study, among which 339 errors were detected. The errors included prescriptions written without diagnosis (5.09%), or without doctor’s name or stamp (1.52%), written by trade names (4.49%), without defined dosage forms (4.29%), and without specified duration (2.84%). Conclusion: The study concluded that E-prescribing eliminated prescription errors that resulted from handwritten prescriptions.

scholarly journals P047 Evaluating the impact of pre-prepared neonatal intubation premedication kits on a level 3 neonatal unit (Project NIK)

2019 ◽  
Vol 104 (7) ◽  
pp. e2.52-e2
Author(s):  
Suzannah Hibberd ◽  
Alok Sharma ◽  
Marhamat Chavoshzadeh
Keyword(s):  
Nursing Staff ◽  
Response Rate ◽  
Electronic Prescribing ◽  
Drug Preparation ◽  
Prescribing Errors ◽  
Before And After ◽  
Level 3 ◽  
Perceived Impact ◽  
Set Up ◽  
The Impact

BackgroundIn January 2018, neonatal intubation premedication kits containing atropine, suxamethonium and fentanyl were introduced alongside the implementation of dose- banding for these medicines according to patient’s weight and regardless of the patient’s gestation. A prescribing bundle on the electronic prescribing system was also created to automatically populate the doses based on the patient’s weight. Seven kits are produced each week by the Pharmacy Technical Services Unit.AimTo assess the staff perceived impact of pre-prepared intubation drug kits with associated dose-banding of the medication.MethodsThree months after the kits were implemented, a survey was sent to all nursing and medical staff to establish their thoughts on the intubation process before and after the introduction of pre-made intubation drug kits.Results78 staff responded, 45.5% were doctors and 54.5% were nursing staff. The response rate was 53.8%. 78% of respondents reported being part of a difficult intubation over the last 5 years. The main problems identified, prior to the implementation of the neonatal intubation drug kits, included the intubation process (51.5%), preparation and communication prior to intubation, (13.6%), time drawing up intubation drugs (10.6%) and the patient having a difficult airway (9%). 87.2% found the premade intubation kits very useful, none of the respondents thought the kits were not useful. Four themes were found irrespective of whether the respondent was a doctor or member of nursing staff. The themes were: they made the process easier; quicker; reduced risk of error and helped provide better patient care. When asked if any complications had arisen, 4% reported that they had run out of kits and 2.7% said there was confusion when signing the kits out of the controlled drug (CD) register.Three weeks out of 25 saw all the kits being used, average usage is 4 intubation kits per week. 97.4% reported the doses used were effective in sedating and paralysing the baby prior to intubation, 2.6% commented that they were somewhat effective but that in one occasion the paralysis had not been optimal, however they questioned whether the cannula had been functioning properly.ConclusionThe implementation of ready to use intubation drug kits has made the process of preparing for an intubation easier and quicker for all involved in the process. Having the dose banding set up on the electronic prescribing system has reduced the chance of prescribing errors and the pre- filled kits have reduced the chances of calculation errors during drug preparation. When the kits run out there are instructions in the guideline detailing how to make the required concentrations. As a result of this study standardised teaching videos were introduced from the beginning of July 18. Further simulations have been completed to ensure that all staff follow a standardised process. Next steps are to ensure that the documentation in the CD register includes all necessary information without any need for amendments. To overcome this, a stamp is being designed to use in the book each time a patient requires a kit, thereby providing a prompt for the nurses.

scholarly journals The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

2020 ◽  
Vol 11 (02) ◽  
pp. 323-335 ◽  
Author(s):  
Moninne M. Howlett ◽  
Eileen Butler ◽  
Karen M. Lavelle ◽  
Brian J. Cleary ◽  
Cormac V. Breatnach
Keyword(s):  
Intensive Care ◽  
New Technology ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Before And After ◽  
The Impact ◽  
Before And After Study

Abstract Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)—facilitated by smart-pump technology—were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Objective The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. Methods A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. Results A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. Conclusion The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.

Effect of Electronic Prescribing Compared to Paper-Based (Handwritten) Prescribing on Primary Medication Adherence in an Outpatient Setting: A Systematic Review

2021 ◽  
Vol 12 (04) ◽  
pp. 845-855
Author(s):  
David Aluga ◽  
Lawrence A. Nnyanzi ◽  
Nicola King ◽  
Elvis A. Okolie ◽  
Peter Raby
Keyword(s):  
Medication Adherence ◽  
Randomized Study ◽  
The United States ◽  
Outpatient Setting ◽  
Electronic Prescribing ◽  
Future Research ◽  
Medical Subject Headings ◽  
Keywords And Phrases ◽  
Significant Difference ◽  
The Impact

Abstract Background Electronic prescriptions are often created and delivered electronically to the pharmacy while paper-based/handwritten prescriptions may be delivered to the pharmacy by the patients. These differences in the mode of creation and transmission of the two types of prescription could influence the rate at which outpatients fill new prescriptions of previously untried medications. Objectives This study aimed to evaluate literatures to determine the impact of electronic prescribing compared with paper-based/handwritten prescribing on primary medication adherence in an outpatient setting. Methods The keywords and phrases “outpatients,” “e-prescriptions,” “paper-based prescriptions,” and “primary medication adherence” were combined with their relevant synonyms and medical subject headings. A comprehensive literature search was conducted on EMBASE, CINAHL, and MEDLINE databases, and Google Scholar. The results of the search were screened and selected using predefined inclusion and exclusion criteria. The Critical Appraisal Skills Program (CASP) was used for quality appraisal of included studies. Data relevant to the objective of the review were extracted and analyzed through narrative synthesis. Results A total of 10 original studies were included in the final review, including 1 prospective randomized study and 9 observational studies. Nine of the 10 studies were performed in the United States. Four of the studies indicated that electronic prescribing significantly increases initial medication adherence, while four of the studies suggested the opposite. The remaining two studies found no significant difference in primary medication adherence between the two methods of prescribing. The variations in the studies did not allow the homogeneity required for meta-analysis to be achieved. Conclusion The conflicting findings relating to the efficacy of primary medication adherence across both systems demonstrate the need for a standardized measure of medication adherence. This would help further determine the respective benefits of both approaches. Future research should also be conducted in different countries to give a more accurate representation of adherence.

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