Implementation Of Electronic Prescribing Research Articles

A comprehensive study of prescribing, administering and drug handling medication errors in ten wards of a university hospital after implementation of electronic prescribing, clinical pharmacists or medication reconciliation.

Background and aim: Medication errors lead to preventable risks. Preventing strategies such as e-prescribing, clinical pharmacists and medication reconciliation have been implemented in recent years. However, information on long-term medication error rates in routine procedures is missing. Investigations: We aimed to identify predefined medication errors in ten wards of a university hospital where e-prescribing, clinical pharmacists and medication reconciliation have been partially implemented. Patient files were reviewed and routine processes were monitored for drug prescription errors (missing, unclear, outdated information), administration errors (wrong dispensed drugs) and drug handling errors (no light-, moisture-protection, wrong splitting, no separation of drugs, which ought to be taken by an empty stomach). Results: We analyzed 959 prescriptions with 933 solid peroral drugs for 182 patients (98 female, median age 66.5 years [Q25-Q75: 56-78 years]; the median number of drugs was 5 [Q25-Q75: 3-7]). The most frequent prescription error was a not specified drug form (91.1%). The most common administration error was a not adequately provided release dose formulation (72.7%). The lack of light protection for observed photosensitive drugs was the most frequent drug handling error (100%). We found a significantly higher amount of complete drug prescriptions with one of the implemented measurements e-prescribing, medication reconciliation and clinical pharmacists (Fisher's exact test two tailed, each p<0.001; CI 95%). Drug administration errors and drug handling errors were not significantly improved. Among the most frequently involved drug were drugs for acid-related disorders, immunosuppressant, and antineoplastic drugs. Conclusions: In the nearly 1,000 prescriptions and drugs analyzed, medication errors were still common. Various preventive strategies had been implemented in recent years, positively influencing the predefined errors rates.

Outpatient Service Business Development in an Effort to Reduce Service Time

Hospital service quality should be developed based on customer needs and satisfaction. Long service time at Bhayangkara Kediri Hospital Outpatient Unit (267,62 ± 136,41 min) becomes a problem for management. The process is an asset for an organization, especially the core process should be well managed. Business process management has been viewed as an effective concept to improve processes continuously. It is an operational research combining document review, stakeholder interview, focused group discussion, quantitative and qualitative process analyze, prioritization, and root cause analysis to give process redesign recommendations. There are five core processes in the outpatient unit, and we focus our research on the dispensing process in pharmacy. Then we made a process model based on evidence and interview-based discovery. The cycle time efficiency of the prescription analysis process was the worst with a value of 0.31. With non-value activities reach to 40% of all activities with the waste are over processing, waiting, and transportation. The selected problem was the disposition of prescriptions to the dispensing unit as waste. Based on the root cause analysis, we suggest two recommendations. For the short-term redesign, we support the use of a basket to transport the prescription embedded in the operational procedures. And for the long-term redesign, we suggest the implementation of electronic prescribing. These redesigns are assumed to reduce waiting time by 2.5 – 16.2 % of service time.

Users’ Views Regarding Electronic Prescribing Implementation: A Qualitative Case Study in A Private Hospital of Magelang City, Indonesia

The use of the Internet and digital system in a hospital named the Hospital Information System (HIS) has grown rapidly and remarkably, including in Indonesia. One of the HIS components is electronic prescribing (e-prescribing). Although the Indonesian government has mandated HIS in hospitals since 2011, successful implementation is not without challenges. Therefore, this study aimed to explore users' views regarding e-prescribing implementation through a case study in a private hospital in Magelang City, Indonesia. This study applied a qualitative approach. Participants were e-prescribing users who were selected purposively. Data were gathered using interviews. The Capability, Opportunity, Motivation, and Behavior (COM-B) model was used to structure the interview guideline. Data were transcribed verbatim and analyzed using a thematic approach. Twenty participants were interviewed. Five themes emerged through the interviews: selfreflection, perceived advantages, policy, capacity building, and quality assurance. The themes express optimism in implementing eprescribing. Users are central to e-prescribing system acceptance, as is explained in the self-reflection and perceived advantages themes. Furthermore, top management plays a pivotal role in improving the capacity and ensuring system implementation quality. This study’s findings imply that the user, system, and organization play crucial roles in enhancing health care service quality through e-prescribing.

EVALUASI PERESEPAN ELEKTRONIK DI DEPARTEMEN ILMU KESEHATAN ANAK

Background: &#x0D; Hospitals can prevent errors in medical actions or pharmaceutical services to patients called medication errors. One of the incidences of medication errors that are still high in Indonesia is the prescribing phase. So, currently, many hospitals have replaced manual prescription writing with electronic prescribing systems, including at Dr. Hospital. Cipto Mangunkusumo (RSCM).&#x0D; However, prescribing errors are still often found, especially in pediatric patients’ prescriptions.&#x0D; Objective: To evaluate the implementation of electronic prescribing and measure the results of personnel interventions on electronic prescribing in pediatric patients.&#x0D; Methods: Experimental with a quasi-experimental design, the one&#x0D; group pretest-posttest design. The research was conducted from&#x0D; December 2019 to January 2020 in pediatrics. The research subjects were 100 doctors participating in the Specialist Medical Education Program (PPDS). Training subjects carried out the intervention to write electronic prescriptions and provide feedback in the form of personal letters. Reassessment of the incidence of prescribing errors was carried out after four weeks.&#x0D; Results: The incidence of prescribing errors decreased after the intervention. (p = 0.05). The most types of prescription errors are&#x0D; the wrong dosage, strength, frequency. Prescribing errors in perinatology ward, pediatric inpatient ward and polyclinics decreased after&#x0D; intervention, while prescribing errors in the emergency room remained. There is a significant relationship between the provision of intervention with the level of education (p = 0.001). PPDS mid-level doctors make more prescribing errors in almost all types of errors&#x0D; and workplaces than junior and senior PPDS doctors. The results of the calculation of prescribing error pre and post intervention shows that giving an intervention can reduce the risk of prescription errors by up to 37%.&#x0D; Conclusion: Personnel intervention in education and providing&#x0D; feedback plays a role in reducing the incidence of prescribing errors. Education and providing feedback should be done regularly. In addition, it is necessary to add an electronic prescription support system to support the reduction of prescribing errors.&#x0D; &#x0D;

Strategies to promote access to medications during the COVID-19 pandemic.

During the COVID-19 pandemic, vulnerable and older people with chronic and complex conditions have self-isolated in their homes, potentially limiting opportunities for consultations to have medications prescribed and dispensed. The aim of this article is to describe initiatives to ensure ongoing access tomedications during the COVID-19 pandemic. Cooperation between wholesalers and purchase limits in pharmacies have helped to ensure supply of essential medications. Therapeutic substitution by pharmacists is permitted for specific products authorised by the Therapeutic Goods Administration. Prescribers are permitted to issue digital image prescriptions, and implementation of electronic prescribing has been fast-tracked. Expanded continued dispensing arrangements introduced during the bushfire crises have been temporarily extended. Pharmacists are permitted to provide medication management reviews via telehealth. A Home Medicines Service has been introduced to facilitate delivery of medications to people who are vulnerable or elderly. Anticipatory prescribing and medication imprest systems are valuable for access to end-of-life medications within residential aged care.

Healthcare professionals' attitudes of implementing a chemotherapy electronic prescribing system: A mixed methods study.

Recent research has investigated the attitudes of healthcare professionals when implementing electronic healthcare systems such as electronic medical records or electronic prescribing in primary care. There is limited research on implementation of electronic prescribing in secondary care and no published research exploring implementation of systemic-anticancer therapy (includes chemotherapy, TKIs, monoclonal antibodies, etc) electronic prescribing. By considering what attitudes healthcare professionals had towards the implementation of systemic-anticancer therapy (SACT) electronic prescribing systems, recommendations could be developed and used to aid successful future implementations. This mixed methods study was in three phases. The first phase was a qualitative exploration of attitudes of healthcare professionals towards the implementation of a systemic-anticancer therapy electronic prescribing system, with the development of a questionnaire based on these findings. This was followed by a quantitative second phase where the results from the questionnaire were used to assess if the qualitative results could be generalised to a larger population. Further progression in phase three looked at developing recommendations based on the factors found in order to aid future implementations for hospitals. Thirteen factors were found relating to attitudes of healthcare staff when implementing systemic-anticancer therapy electronic prescribing. Nine of these factors were cited by other researchers when implementing other electronic healthcare systems. Four factors appeared to be specific to systemic-anticancer therapy electronic prescribing implementations. Nineteen recommendations were proposed when implementing a systemic-anticancer therapy electronic prescribing system. This is the first study, to our knowledge, to examine the attitudes of healthcare professionals when implementing a systemic-anticancer therapy electronic prescribing system and the first to define important factors and list recommendations to manage these.

338 Evaluation of a new clinical pharmacy service model in a University Teaching hospital in Dublin, Ireland

Abstract Background Advances in medicines reconciliation, drug monitoring and patient counselling requirements as well as added non-clinical responsibilities at ward level have led to an increased workload on a ward-based pharmacist. There is a need to optimise the service to meet these demands. The aim of this study was to audit the current clinical pharmacy services and to implement a New Model of Clinical Pharmacy on four wards to aid in the optimisation and prioritisation of patients during the clinical ward service. Methods The study was undertaken in Dublin based, University Teaching Hospital between March and June 2018. The study included the following: (1) a comprehensive literature review, (2) focus groups with key decision makers, (3) the collection and analysis of quantitative data on patients screening and interventions performed pre- and post- model implementation, (4) the final stage involved a satisfaction surveys from pharmacists involved in the study. Local ethical approval was obtained for this study. Results The new clinical pharmacy model increased the amount of medicines reconciliation completed (pre-model implementation 77.7% (n=192) versus post-model implementation 81.6% (n=236)), decreased time to medication reconciliation completion on Mondays and Fridays, increased discharge information cards completed and did not show statistical inferiority in the amount of interventions picked up by pharmacists (p value= 0.86; two tailed t-test). Pharmacists in the study felt the model impacted their clinical ward visit positively and aided prioritisation but did not improve on their overall job satisfaction level. Conclusion The study shows that a new model of clinical pharmacy can impact positively on a pharmacist’s working day by formalising the prioritisation of high-risk patients, setting clear expectations and structure without impacting negatively on other clinical duties. It is believed that the model developed will continue to support the pharmacists’ decision making and workload prioritisation post implementation of electronic prescribing.

National Diabetes Audits inform best practice for diabetes foot care and hospital inpatients

National Diabetes Audits inform best practice for diabetes foot care and hospital inpatients

First insight to the Finnish nationwide electronic prescription database as a data source for pharmacoepidemiology research

Since 1994, the Finnish Prescription Register (FPR) has been the main data source for pharmacoepidemiology research in Finland. However, the FPR data are limited to reimbursed dispensations only. Implementation of electronic prescribing started in 2010 and after a stepwise extension, electronic prescribing became mandatory in all healthcare settings in 2017. Prescriptions issued and dispensed electronically are stored in the Prescription Centre of the nationwide Kanta database. To describe the contents of the Kanta database and to compare the coverage of Kanta with the FPR, using prescriptions and dispensations of oral anticoagulants (OACs) as an example. All prescriptions, dispensations, and their cancellations and corrections for OACs recorded in Kanta were retrieved for the period 2012-2016. In 2016, the total number of valid electronic prescriptions for OACs was 249 139 and the number of valid electronic OAC dispensations was 765 745. The number of identified direct oral anticoagulant (DOAC) users was higher in Kanta compared to the FPR since 2014, although more users of all OACs were identified from the FPR during 2012-2015. In 2016, an indication was identified in 44.7% of OAC prescriptions and dosing instructions in 99.5% of DOAC prescriptions. The Kanta database is a promising source of data on medication exposure. Because of reimbursement restrictions, use of DOACs was under-ascertained through the FPR.

What is the impact of introducing inpatient electronic prescribing on prescribing errors? A naturalistic stepped wedge study in an English teaching hospital.

Most studies evaluating the impact of electronic prescribing on prescribing safety have used comparatively weak study designs such as uncontrolled before-and-after studies. This study aimed to apply a more robust naturalistic stepped wedge study design to compare the prevalence and types of prescribing errors for electronic prescribing and paper prescribing. Data were collected weekly during a phased electronic prescribing implementation across 20 wards in a large English hospital. We identified 511 (7.8%) erroneous orders in 6523 paper medication orders, and 312 (6.0%) in 5237 electronic prescribing orders. Logistic regression suggested no statistically significant effect of electronic prescribing use or of study week; patient and ward had significant effects. Errors involving incorrect doses and illegible or incomplete orders were less common with electronic prescribing; those involving duplication, omission, incorrect drug and incorrect formulation were more common. Actions are needed to mitigate these error types; future studies should give more consideration to the effects of patient and ward.

Trends and variations in outpatient coprescribing of simvastatin or atorvastatin with potentially interacting drugs in Thailand.

Background:The aim of this study was to assess trends and variations in coprescribing of simvastatin or atorvastatin with interacting drugs in Thailand.Methods:Outpatient prescriptions between 2013 and 2015 in 26 tertiary care hospitals were analyzed for statin coprescribing. The proportion of patients exposed to coprescribing was estimated for semi-annual changes, using a time-series analysis and for hospital variations, using an interquartile range (IQR).Results:The coprescribing of simvastatin with all contraindicated drugs in 10 university and 16 general hospitals, respectively, was 3.6 and 3.1% in 2013, then decreased to 3.2 and 2.6% in 2014 and to 2.6 and 2.0% in 2015. The drug most frequently coprescribed with simvastatin, on a decreasing trend (by 0.19 percentage points) was gemfibrozil (in 2013, 2014 and 2015, respectively; 2.9, 2.3 and 2.0% in university hospitals, and 2.5, 2.0 and 1.6% in general hospitals). A similar trend was found in atorvastatin-gemfibrozil coprescribing. Patients coprescribed simvastatin with the rest of the contraindicated drugs were relatively stable at 0.6–0.8%. No protease inhibitors were coprescribed with simvastatin and atorvastatin. The IQR of simvastatin coprescribing in the university hospitals was smaller than that in the general hospitals and decreased over time.Conclusions:Coprescriptions potentially leading to drug interactions with simvastatin in Thailand were observed although the contraindicated drugs were acknowledged. Mutual awareness among health professionals and the implementation of electronic prescribing should be strengthened as zero drug interaction was possible as in the case of protease inhibitors in the present study.

The Barriers in Implementing Electronic Prescribing in The Health Care: a Systematic Review

Medication error remain extremely common, and the health care system can do much more to prevent it. Electronic prescribing is increasingly being viewed by health care stakeholders as an important step toward improved medication safety, better management of medication costs, increased practice efficiency, and improved health care quality. However, the adoption of e-prescribing has been difficult to attain owing to numerous barriers throughout the industry. Even with all the benefits of e-prescribing, many providers and pharmacists remained hesitant about completely adopting an e-prescribing system. The main purpose of this study was to explore and to assess the barriers of electronic prescribing implementation. The methodology for this study followed the basic principles of a systematic review with PRISMA methode retrieved from online database PubMed using a keyword “barriers” OR “obstacles” AND “electronic prescribing” OR “electronic prescription” AND “implementation”. Finally 6 documents were selected by full text inclucion and assessed for eligibility. The result of the study are inefficiency, the low uptake of the physicians, the cost of implementing the electronic prescription, system errors and the privacy and legacy. The conclusion from the studies should that electronic prescribing implementation barriers those we divided into 2 groups : the user factors and the system factors of the electronic prescription. Vendors or the consultants to facilitate more adequately the adoption of e-prescribing by giving the physicians the free trial and provide evaluation and improvement according to the physicians' needs for the features in the e-prescription.

Electronic prescribing reduces prescription errors in Sanglah General Hospital Denpasar

Background and purpose: Medication error is any preventable event that may lead to inappropriate medication use or patient harm. Prescription error, one component of medication error, at Sanglah General Hospital Denpasar is high. An electronic prescribing has been piloted at Angsoka Ward, Sanglah General Hospital Denpasar to reduce prescription errors. However, the evaluation of such implementation is never been conducted. This study aims to evaluate the effect of electronic prescribing on prescription errors at Sanglah General Hospital Denpasar.Methods: An evaluation study was conducted by adopting pre and post control design at Sanglah General Hospital Denpasar. Prescription errors at Angsoka Ward where the electronic prescribing is implemented, were compared to Kamboja Ward that uses manual prescribing. Heterogeneity of patients in these two wards was comparable. Prescription samples were selected using a simple random sampling. Prescription samples prior to implementation of electronic prescribing were taken from June and July 2016, while samples after implementation were taken from March and April 2017. Prescription samples from the control group were also taken from the same periods. A total of 96 prescriptions were taken from each arm – leading to 384 prescription samples in total. Prescription error was evaluated using three requirements namely: administrative (9 components), pharmacy (5 components) and clinical (3 components).Results: Our study found that there was a significant difference of prescription errors between pre and post implementation of electronic prescribing at Angsoka Ward (p&lt;0.05). The median values [IQR] for prescription error based on administrative requirements between pre and post intervention were 2 [3] vs. 0 [0] (p&lt;0.001); based on pharmacy requirements were 1 [2] vs. 0 [0] (p&lt;0.001); based on clinical requirements were 1 [2] vs 0 [0] (p&lt;0,001). In contrast, prescription error based on administrative and pharmacy requirements in Kamboja Ward was insignificantly reduced. The median values [IQR] for prescription error based on administrative requirements between pre and post intervention were 2 [2] vs. 2 [2] (p=0.505) and based on pharmacy requirements were 1 [2] vs. 1 [1] (p=0.295). There was a significant difference of prescription errors (p&lt;0.05) based on clinical requirements with median values [IQR] of 1 [1] vs. 1 [1]. Implementation of electronic prescribing reduced the proportion of prescription errors by 67.8%. After implementation of electronic prescribing, some errors were still apparent related to drug administration and order duplication.Conclusions: Implementation of electronic prescribing reduces prescription errors. Scaling-up of electronic prescribing followed by training on standardised prescribing practices are warranted.

The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study.

Objectives To explore paediatric nurses' experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice. Methods A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis. Results Two overarching analytical themes were identified: the centrality of risk management in nurses' role in the medication process and the distributed nature of nurses' medication risk management practices. Nurses' contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety. Conclusions Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

The implementation of electronic prescribing and medication administration (EPMA) systems is a priority for hospitals and a potential component of antimicrobial stewardship (AMS). To identify software features within EPMA systems that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features. A questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann-Whitney U -test. Responses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). Of the pharmacists, 59% had experience of EPMA in their hospitals compared with 35% of microbiologists. Pharmacists assigned higher priority to indication prompt ( P < 0.001), allergy checker ( P = 0.003), treatment protocols ( P = 0.003), drug-indication mismatch alerts ( P = 0.031) and prolonged course alerts ( P = 0.041) and lower priority to a dose checker for adults ( P = 0.02) and an interaction checker ( P < 0.05) than microbiologists. A 'soft stop' functionality was rated essential or high priority by 89% of respondents. Potential EPMA software features were expected to have the greatest impact on stewardship, treatment efficacy and patient safety outcomes with lowest impact on Clostridium difficile infection, antimicrobial resistance and drug expenditure. The survey demonstrates key differences in health professionals' opinions of potential healthcare benefits of EPMA, but a consensus of anticipated positive impact on patient safety and AMS.

Allergy transcription before and after the implementation of an inpatient electronic prescribing system in a tertiary referral hospital: a case study in two oncology wards

Patients with allergies can be protected from potentially life threatening harm by recording their allergen and reaction correctly. Electronic prescribing is being widely implemented with a view to improving patient safety; decision support functions can alert prescribers to the risk of prescribing an allergen. However the allergen must be correctly recorded to utilize this functionality. This study aimed to explore whether the introduction of an inpatient electronic prescribing system, in place of paper-based prescribing, has affected the accuracy of transfer of allergen data between hospital documentation systems. Retrospective case note review of a random sample of 100 patients admitted to two oncology wards in a UK hospital before implementation of electronic prescribing, and 100 admitted afterwards. We compared accuracy of allergy information transcribed from admission documentation to the inpatient prescribing system and then to the separate electronic discharge summary for paper-based versus electronic inpatient prescribing. We analyzed data separately for patients with no known drug allergy and those with a recorded allergen. There was no difference between prescribing systems in the transfer of ‘no known drug allergy’ status from the admission documentation to the inpatient prescribing record. However transfer of ‘no known drug allergy’ status was better on electronic discharge summaries prepared from the separate electronic inpatient system (transferred correctly for 58 of 72 discharges, 81 %) when compared with paper inpatient prescriptions (26 of 68 patient discharges, 38 %) p < 0.001. For patients with an allergy the correct transfer of allergens from admission documentation to the inpatient prescribing record was lower for the electronic prescribing system (10 of 28 patient admissions, 36 %) when compared with paper prescribing (21 of 32 patient admissions, 66 %) p = 0.02. However correct transfer of allergen information from the inpatient prescription to electronic discharge summary was better with electronic prescribing, being transferred correctly in 68 % (19 of 28) patients compared to 38 % (12of 32) with paper prescriptions p = 0.02. Implementing inpatient electronic prescribing does not guarantee a safer system for patients with allergies. The usability of the user interface for allergen recording may be an important selection criterion when purchasing an inpatient electronic prescribing system.

IMPROVING THE PRACTICE OF PRESCRIBING FOLINIC ACID RESCUE POST HIGH DOSE METHOTREXATE CHEMOTHERAPY

Aim To reduce the incidence of omitted or delayed doses of IV folinic acid rescue following the implementation of electronic prescribing. High dose methotrexate (MTX) is a component of some paediatric chemotherapy regimens. IV folinic acid rescue started 24–42 hours after MTX (dependent on protocol) is essential to avoid toxicity. Since the introduction of electronic prescribing (EP) there has been an increase in the number of delayed doses of folinic acid. Prior to the introduction of EP, this rescue was prescribed alongside the chemotherapy on the paper chart, allowing nurses to enter the folinic acid start time at the same time as starting the MTX. It is not possible to do this with the EP system. Method A list of all patients who have received high dose methotrexate since December 2012 was compiled and drugs charts reviewed to check the folinic acid prescription and administration. An audit tool was created to collect the data. Any new patients prescribed high dose methotrexate were audited prospectively. In addition the Trust incident database was interrogated for all previous reports of omitted/delayed doses of folinic acid to ensure all cases were captured. Several changes including checklists, paper and electronic based prompts have been implemented in an effort to resolve the problem. A retrospective audit and ongoing review of new prescriptions is being completed, identifying the compliance with the new measures and percentage of prescriptions where folinic acid has been prescribed and given at the correct time. Results In the ten month period prior to EP, 100% of prescriptions for folinic acid were complete and administered correctly. This reduced to 83% immediately following the introduction of EP. After the introduction of the first set of measures this increased to 94%. Conclusion Since the implementation of EP ongoing changes to the prescribing of folinic acid are helping to reduce the incidents of delayed and omitted doses. Continuous monitoring will enable deficiencies in our systems to be highlighted and resolved in a timely fashion in order to avoid a potentially serious adverse event. Further changes to our procedures are currently being evaluated, with an expectation that 100% compliance will be achieved.

Evaluation of electronic prescription implementation in polymedicated users of Catalonia, Spain: a population-based longitudinal study

ObjectivesTo assess whether electronic prescribing is a comprehensive health management tool that may contribute to rational drug use, particularly in polymedicated patients receiving 16 or more medications in the public...

PO-0976 Prescribing In The Electronic Age: Faster, Safer, Better?

Background and aims In December 2012 electronic prescribing (EP) and administration of medicines was introduced to the Trust (800 beds, 40 paediatric beds, 3 Paediatric HDU beds, 20 admissions/day) as a pilot – specifically to the Child Health Department – before general adoption across the Trust. Methods Pre-implementation, training was thoroughly and carefully organised for 40 paediatricians, 60 nurses and 5 pharmacists. Training was face to face and then on-line with face to face support. Mobile computing devices were distributed to the ward areas. All in-patient paper prescriptions were transcribed to electronic systems and paper prescriptions were removed. Ward based 24 h pharmacist/nurse support was available for the first week. Results All prescriptions were legible. Antibiotic stewardship easily audited – prescriptions with stop/review date 50%/indication 33% vs. 86%/80% respectively after an educational programme in child health. No paediatric patients have been given a medication to which they were known to be allergic after implementation of EP. Dispensary error rates from electronic prescription orders reduced from 5.38/month to 1.5/month post-implementation. Only 25% of paediatric staff would go back to paper prescriptions. The system is now adopted across most of the Trust. Conclusions Departmental involvement in planning was most important as was “buy-in” from the junior doctors and nursing staff. Well organised training for all staff, intensive and face-to-face, is felt to be essential. EP has been accepted and is a safer system which enables audit of practice down to individual levels. Outpatient use is planned in the future.

Drug Dosing in Patients with Renal Insufficiency in a Hospital Setting using Electronic Prescribing and Automated Reporting of Estimated Glomerular Filtration Rate

In patients with impaired renal function, drug dose adjustment is often required. Non-adherence to clinical prescribing recommendations may result in severe adverse events. In previous studies, the prevalence rate of non-adherence to recommended dosing has been reported to be 19-67%. Using the clinical support system Renbase(®) as reference, we investigated the use and dosing of drugs in patients with impaired renal function in a university hospital setting using electronic prescription and automatic reporting of estimated glomerular filtration rate (eGFR). In all, 232 patients with an eGFR in the range of 10-49ml/min./1.73m(2) were included. We identified 436 episodes with administration of renal risk drugs (prescribed to 183 patients): 410 drugs required dose adjustment according to the eGFR and 26 should be avoided. In total, the use or dosing of 66 (15%) of the 436 renal risk drugs was not in agreement with recommendations in Renbase(®) . This reflects less disagreement with expert guidelines than reported previously, indicating a possible beneficial effect of electronic prescribing and reporting of eGFR. However, we also found that disagreement to some extent reflected inappropriate drug use. We conclude that despite implementation of electronic prescribing and automated reporting of eGFR, patients with renal insufficiency may still be exposed to inappropriate drug use, with potential increased risk of adverse effects. Initiatives to reduce medication errors such as the use of electronic decision support systems should be explored.