Deficiencies in GP prescribing systems
Computer systems used by three-quarters of GP practices have important deficiencies in their prescribing safety features, researchers report in an e-health themed issue of the BMJ.
Bernard Fernando, a GP in Kent, and colleagues evaluated the safety features,
such as alerts for contraindicated drugs and hazardous drug-drug combinations,
of the four main GP computing systems used in the UK.
They tested 18 prescribing scenarios to find out if the systems produce
appropriate safety alerts. Examples used included methotrexate being
prescribed in pregnancy, the combined contraceptive pill being prescribed
for a patient with a history of deep vein thrombosis, propranolol prescribed
in a patient with a history of asthma and a repeat prescription of salbutamol
being issued before it was scheduled.
None of the computer systems produced alerts for all of the 18 scenarios,
and the number produced ranged from three to seven.
The researchers comment that the computer systems “may fail to
warn in a situation when a warning is expected, thus potentially creating
a health hazard to patients” (BMJ 2004;328:1171).
In an accompanying editorial, Robin Ferner, director of the West Midlands
Centre for Adverse Drug Reaction Reporting, said that timely and relevant
warnings are needed.
“The systems could be improved. They might list every contraindication
to a drug whenever it was prescribed. That change would trap more errors
but risk overwhelming the user with alerts: primary care physicians ignore
alerts from nagging computers. Relevance is key,” he said (ibid,
p1172).
The study was funded by the National Patient Safety Agency, which is
now examining ways to resolve the problems identified. In a press statement,
Sue Osborn, joint chief
executive of the NPSA, said: “This study highlights the importance
of looking at the system rather than the individual.” |
The
Pharmaceutical Journal
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