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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR16

Evaluation of an electronic prescribing and administration system in a British hospital

By F. Fowlie*†, M. Bennie*, G. Jardine*†, S. Bicknell, D. Toner and M. Caldwell†

Introduction Medication errors remain an ongoing issue in British hospitals, and their global impact on National Health Service expenditure is still unknown.1,2 Electronic prescribing and administration (EPA) may offer advantages over current paper systems and is supported by the NHS information strategy,3 but evaluation within British hospitals is limited. This study sought to assess the safety of an EPA system through assessment of medication errors and the quality of prescription writing.

Method The study was conducted in a 36-bedded orthopaedic ward (350-bedded hospital) from February, 1998, to July, 1999. The established paper system involved prescribing drugs directly on to a drug kardex. The EPA system (Pharmakon UK), linked to the pharmacy stock control system and the hospital patient administration system, provided online prescribing support and generated electronic discharge prescriptions. Medication administration involved a computer attached to the drug trolley, displaying the required medication at each administration period.
A three-phase observational study was conducted: paper system (Group A); EPA system post introduction - 1 month (Group B) and 12 months (Group C). All prescriptions were assessed for: standard of writing, except Group C; and, prescribing errors (PE - a prescription not appropriate for the patient). Medication administration errors (MAE - a deviation from the prescriber's instructions) were identified using a disguised observation-based method.2 All errors were categorised and clinical significance assessed independently by six judges (scale 0 to 10, 0 - no harm, 10 - death).4

Focal point

  • EPA systems are being advocated through NHS information management and technology strategies
  • Minimal data are available on the impact these systems will have on staff and patient safety within British hospitals
  • This study demonstrates that an EPA system (Pharmakon UK) can improve the quality of prescription writing and reduce medication errors compared with a paper system
  • If further studies confirm these findings then EPA systems may be an effective strategy to reduce medication errors and support quality assurance of drug prescribing and administration in hospitals

Results For Group A, conformance to standards of prescription writing (12 criteria) ranged from 1.8 per cent to 99.0 per cent, 11 criteria reaching 100 per cent in Group B. The frequency of PE and MAE is detailed in Table 1. Comparison of PE for Group A with B and Group B with C demonstrated a difference (c2, P<0.001) for inpatient but not discharge prescriptions. The clinical significance, median (IQR), of inpatient PE was: Group A, 4(3,4); Group B, 3(2,4); Group C, 3(3,4). A similar distribution was observed for discharge prescriptions. Comparison of MAE for Group A with B and Group A with C demonstrated a difference (c2, P<0.001). The clinical significance of MAE was: Group A, 2(1,2); Group B, 2(1,2); Group C, 1(0,1).

Table 1

Discussion An EPA system can improve the quality of prescription writing and reduce medication errors in an orthopaedic ward. The MAE rate for Group A, 9.0 per cent, is higher than the median 5.8 per cent (range 3.0 to 8.0 per cent) reported by Barber et al.1 Detailed review identified variation in patient groups, type of drugs studied and definition of an MAE, which may explain the difference.
Study limitations include: lack of a control group to address change over time; exclusion of intravenous and controlled drugs from the MAE study, omitted due to non standard administration times; and restriction to a surgical unit.

* Department of pharmaceutical sciences, University of Strathclyde, Glasgow; department of pharmacy† and department of orthopaedics, Ayrshire and Arran Acute Hospitals NHS trust, Ayr

References

1. Barber N, Dean B. The incidence of medication errors and ways to reduce them. Clin Risk 1998; 4:103-6.
2. Taxis K, Dean B, Barber N. Hospital drug distribution systems in the UK and Germany: a study of medication errors. Pharm World Sci 1999; 21:25-31.
3. An information strategy for the modern NHS 1998-2005: a national strategy for local implementation. Birmingham: NHS Information Authority; 1999.
4. Dean BS, Barber ND. A validated, reliable method of scoring the severity of medication errors. Am J Health Syst Pharm 1999; 56:57-62.