Abstract
Abstract Background Anticoagulant drugs are the leading cause of medication harm in hospitals and prescribing errors are common with traditional paper prescriptions. Electronic medicines management can reduce prescribing errors for many drugs; however, little is known about the impact of e-prescribing on anticoagulants. Our case study reports on the lessons learned during conversion from paper to e-prescribing and the ongoing optimization process. Methods The iterative implementation of an anticoagulant prescribing platform in an integrated electronic medical record (ieMR) and ongoing continuous enhancements was applied across five digital hospital sites utilizing a single domain. The collaborative management of each class of anticoagulant, optimization strategies, governance structures, and lessons learned is described. An analysis of the rate of errors and adverse events pre- and post-go live is presented. Results The transition to e-prescribing relied on a strong inter-disciplinary governance framework to promote the safe management of anticoagulants. There was no increase in overall prescribing errors, however unfamiliarity with the new system caused a transient increase in errors with unfractionated heparin (1.8/month pre-ieMR vs. 5.5/month post-ieMR). A dedicated real-time surveillance dashboard was introduced. The iterative nature of changes indicated the complexities involved with anticoagulants and the need for an interactive, optimization approach. This led to a significant decrease in anticoagulant related hospital acquired complications (12.1/month pre-ieMR vs. 7.8/month post-ieMR, p = 0.01). Conclusion Digitizing anticoagulant prescribing led to an overall reduction in errors, but a continuous iterative optimization approach was needed to achieve this outcome. The knowledge presented can help inform optimal therapeutic anticoagulation ieMR design strategies.
Highlights
The digital transformation of hospitals continues to evolve, most first world nations are still transitioning or maturing
There was no increase in overall prescribing errors, unfamiliarity with the new system caused a transient increase in errors with unfractionated heparin (1.8/month pre-integrated electronic medical record (ieMR) vs. 5.5/month post-ieMR)
The iterative nature of changes indicated the complexities involved with anticoagulants and the need for an interactive, optimization approach. This led to a significant decrease in anticoagulant related hospital acquired complications (12.1/ month pre-ieMR vs. 7.8/month post-ieMR, p 1⁄4 0.01)
Summary
The digital transformation of hospitals continues to evolve, most first world nations are still transitioning or maturing. In Australia there are currently only two advanced level 6/7 Healthcare Information and Management Systems Society (HIMSS) hospitals. There are six HIMSS level 6/7 sites in the United Kingdom, six in Italy, none in France, Japan or India and many other countries are only beginning the digitization of their health care systems.[1] A key component to harnessing the benefits of an electronic medical record (EMR) is the implementation of an electronic medication management system (eMMS) to reduce prescribing errors.[2] High-risk, complex medications are key candidates for EMR intervention strategies. Health care organisations with traditional paper-based systems use decision support tools to minimise medication risks, they are often inaccessible at the point of care. Anticoagulant drugs are the leading cause of medication harm in hospitals and prescribing errors are common with traditional paper prescriptions. Our case study reports on the lessons learned during conversion from paper to e-prescribing and the ongoing optimization process
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