06.01.11
Getting to grips with ePrescribing
With patient safety a top priority, the NHS is constantly exploring ways to eradicate mistakes from patient care. One of the most important areas to eliminate mistakes from is the provision of medication, reports Richard Mackillican
The last decade has seen the NHS focus on delivering both a wider variety of services for patients and better quality care. As the range of services has increased, so has demand, meaning that staff have had to work even harder to deliver high quality care.
This extra pressure has led to mistakes being made with many errors involving medication.
Some of these errors were highlighted in a report by The Guardian in September 2008 which, using data from the National Patient Safety Agency, found that medication errors in the NHS had doubled in two years from 36,335 reported errors in 2005 to a staggering 86,085 reported errors in 2007.
Many clinicians had complained that handwritten prescriptions were open to misinterpretation and that a clearer and more reliable way was needed. This is where ePrescribing technology comes in, allowing clinicians to make clearer, computerized entries, which could be used to provide a robust audit trail for the entire medication use process.
One trust which has recently begun to use this kind of technology is Birmingham’s Heart of England National Health Service Foundation Trust, implementing an ePrescribing and medicines administration system across three of its acute sites.
Niall Poole, deputy director of pharmacy and governance lead at the trust said: “Before the implementation of our ePrescribing and medicines administration system, we had a paper based system, much the same as the majority of trusts throughout Britain.
“Some of the typical problems which pharmacists were experiencing included things like incomplete or illegible prescriptions and allergies not being reported properly. Although these seem like simple administrative errors, they can have some very serious consequences if they go unchecked.”
The trust began looking into ePrescribing as far back as February 2003 as part of the National Programme for IT.
“At the time there were various government drivers saying that we should all be doing electronic prescribing, with one government white paper saying that all acute trusts should be using ePrescribing by 2005. Clearly this target was a little too ambitious.”
Although there was not the widespread take-up envisaged by the government, trusts did become very interested in seeing exactly what ePrescribing could do for their trusts and ultimately for their patients.
“Our interest led us to begin a pilot in 2003, where we used ePrescribing on a thoracic surgery ward. Luckily we had a very supportive consultant on that ward which helped us tremendously.”
Despite the promising results which this pilot yielded, there wasn’t the political pressure on trust management at the time to go ahead and procure a full system.
“Because of the changing political focus of the National Programme for IT, there simply wasn’t the political will to invest fully in a system. However, this situation changed about two years ago when both the political will and available funding came together to enable us to take this to the next level.”
Although staff had been using smaller scale ePrescribing systems on a number of wards, the trust now had the green light to implement a full scale roll out.
“We had managed to creep our usage up from the initial pilot on one ward to seven by the time the management decided to implement the system fully across the trust in early 2009.”
With only a few very minor exceptions the trust now had ePrescribing technology in use across between 50 and 60 ward areas and the exercise is now beginning to yield some impressive results.
“The primary benefit is one that many staff take for granted, which is basic completeness and legibility of prescriptions. This may seem simply enough but there are in fact a lot of papers, mainly American ones, which state that just by ensuring basic legibility and completeness of prescriptions, a trust can look to more than halve its medication errors.”
Given that the NHS spends many millions of pounds ever year in compensation claims to patients who have been given the wrong medication, millions of pounds could potentially be saved by halving the amount of incidents which occur.
“This was an argument which we used when we were putting together our case for procuring an ePrescribing system. However, we found it difficult to find quantitative evidence to back this, simply because no one seems to have investigated fully the link between prescription legibility and the financial and legal implications of patient outcomes.
“So in the end we put forward a case around care quality. We didn’t actually promise to save the trust any money. Procuring the system would actually cost the trust extra. However, our case showed that this extra investment would ensure a significant rise in the quality of patient care at the trust because we were enabling a more efficient way for staff to work.”
Niall admits that whilst this increase is hard to measure, it is certainly enabling the trust to operate more smoothly.
“The kind of feedback which we receive is more qualitative. For example, we hear that nursing staff no longer have to waste time clarifying illegible prescriptions, but then it would be hard to calculate exactly how many minutes have been saved.”
As with many exercises in NHS efficiency, there is always a danger that the process which staff would have to go through to quantify the benefits of implementation could actually counteract the original efficiency savings being made.
When staff have to work in a high pressure environment where the stakes are very high it always pays to be well organized and an ePrescribing system offers clinicians a way to take some of that pressure away from them by making certain transactions far more easy to complete correctly.
The trust is also gaining extra benefits from a sideline facility which comes with the ePrescribing system.
“We have experienced some benefits from using the electronic ordering system which came with the package, such as not having to move paperwork down to pharmacy because it can be scanned remotely.
“This results in a three fold benefit. One is that the risk of a chart being lost is lessened considerably. Then there is the fact that nurses can always administer treatment because the patient charts are always where they need to be, rather than down in the pharmacy. Overall the system makes our job easier to carry out properly and we are currently working to streamline that system to deliver more benefits to us.”
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