News and updates from today's Optimising Hospital Electronic Prescribing to Reduce Medication Errors
This National Summit will focus on optimising Hospital Electronic Prescribing and Medicines Administration (HePMA) to ensure a reduction in Medication Errors . The summit will examine the development of electronic prescribing systems towards advanced eprescribing and ensuring the full clinical benefits are achieved.
The conference is chaired by Sean Brennan - Independent Consultant in Healthcare Informatics, Clinical Matrix.
Ann Slee - ePrescribing Lead, NHS England will deliver a National Update: Accelerating and optimising HePMA. Ann is a pharmacist, an expert in electronic prescribing and a former clinical lead for ePrescribing for England. She has extensive experience in both the development and deployment of ePrescribing systems. She has also worked at Director of Pharmacy level in the NHS leading the development of clinical pharmacy and the modernization of the service using robotics and health-IT. She holds a number of honorary clinical academic appointments, has held a Health Foundation Leadership Fellowship and been a member of the NHS Evidence and NCAS Advisory Boards. She is currently part of the steering group for the NIHR research grant evaluating the introduction of ePrescribing into secondary care and is leading the ePrescribing work underway as part of the Integrated Digital Care Record initiative with NHS England
Dr Elizabeth Camacho - Senior Research Fellow (Health Economics), University of Manchester will also deliver a national update on Medication Errors & Medication Related Harm.
In 2017, the World Health Organisation (WHO) launched its third Global Patient Safety Challenge: Medication Without Harm. Through this Challenge WHO aims to reduce severe avoidable medication-related harm globally by 50% over 5 years. In response to this Challenge the Department of Health and Social Care commissioned a review of the evidence base on medication errors in England to assess the extent and scale of medication error. The Department also established a Short Life Working Group (SLWG) to advise on improving medication safety.
Prevalence and economic burden of medication errors
To assess the prevalence and burden of medication errors in England, data from existing observational studies were used. The error rate observed in a particular region or hospital were scaled up to estimate the number and severity of errors across the whole of England. An estimated 237 million medication errors occur at some point in the medication process in England per year. This is a large number, but 72% have little/no potential for harm. It is likely that many errors are picked up before they reach the patient, but we do not know how many. We estimated that 66 million potentially clinically significant errors occur per year.
Fortunately only a small proportion of errors are associated with serious adverse events, however observational data from English hospitals suggest that 3-4% of admissions are due to definitely avoidable medication errors. When applying this rate to the whole of England, this equates to a large number of patients being admitted to hospital each year (136,811 bed days/year), costing the NHS around £84m. When medication errors that occur in secondary care are added to this, the estimated NHS cost of avoidable errors increases to between £98m per year, consuming 181,626 bed days, and contributing to 1,708 deaths.
A key conclusion of the report was that there was a need to develop strategies to reduce medication errors and improve safety. This is where the Short Life Working Group comes in, summarising key evidence and making recommendations about how best to do this.
Shahzan Zafar - Senior Medicines Information Pharmacist, Burton Hospitals NHS Foundation Trusts session on Optimising Electronic Prescribing to reduce Medication Errors will focus on advancing eprescribing and embedding an electronic prescribing system to drive changes in clinical practice.
This presentation is designed to cover what an advanced ePrescribing is from a trust that has had electronic prescribing in some form since 1992. The focus then shifts to how we at Burton Hospitals NHS Foundation Trust have adapted to the changes in technology in order to improve our clinical practice and the treatment our patients receive. This involves demonstrating what our EPR, Meditech, looks like for our staff when using it on a day to day basis.
Hetal Halai - Senior Pharmacist Electronic Prescribing and Tisha Causing-Cruzzi - Senior Clinical Systems Analyst, EPMA at Kings College Hospital NHS Foundation Trust will present a case study on Electronic prescribing and medication errors.
Kings College Hospital - Denmark Hill first launched EPMA (iSoft) in 2008. In August 2016 the trust switched to Allscript’s Sunrise EPMA solution. Earlier this year in January 2018, we began EPMA implementation for inpatient locations at our Princess Royal University Hospital (PRUH) site. We have completed roll out to all inpatient locations except adult ITUs and we are now preparing for roll out to the PRUH Emergency Department. Configuration of our EPMA system has been carefully designed to mitigate medication safety risks especially with regards to high risk drugs and also to align prescribing with the appropriate guidelines. This presentation will explore some of the different methods we have used to minimise medication related errors.
Helen McHale - Lead Pharmacist & Electronic Prescribing, Portsmouth Hospital NHS Trust will present a case study on Electronic Prescribing in Intensive Care.
Pre conference abstract:
Studies investigating electronic prescribing in critical care have shown benefits such as reductions in some types of medication errors1,2,3,4, adverse drug events2 and the ability to improve guideline compliance5,6. However some studies have also shown increased rates of medication errors3,4, for example, dosing errors due to miss-selection and free- typing, duplication of drugs and required drugs not being prescribed.
In 2010 the Critical Care Unit at Queen Alexandra Hospital in Portsmouth investigated a new replacement electronic medical record system. An electronic prescribing module was desired to minimise medication errors.
The senior critical care staff visited several critical care units to view their systems and a demonstration day was arranged for manufacturers to demonstrate their products. A single solution that incorporated medical notes, patient physiology, biochemistry monitoring and electronic prescribing, GE centricity xxx was chosen.
The systems drug library was completely reconfigured by the Critical Care Electronic Prescribing Consultant and checked by the critical care pharmacist to ensure it met the unit’s needs. The library was then tested extensively to identify any issues, configuration modified, and then retested to ensure it was user friendly and safe to use. Protocols were developed to provide a plan of action in the event of any scheduled or unforeseen down time. Then training was provided for all medical and nursing staff on the unit and “How-to” guidelines were created and placed on each bed space to aid prescribing and administration.
The system was launched in a structured fashion with no major problems which ensured all patients drugs were prescribed on the system before the system went live. During the first week the electronic prescribing team were present to help with any support.
On going maintenance is required on an ad hoc basis with new drugs being added and drug configurations updated in response to local adverse drug incidents or national prescribing alerts.
Implementation was a major success as the system was customised to meet our specific needs and due to the extensive training carried out for all staff no issues arose.
Configuration of the drug library to minimise the risk of ambiguous or unsafe prescriptions was the most challenging and time consuming process of implementing the prescribing system. However, as a result, we now have prescriptions and records of administration which are much clearer and legible and traceable prescribers.
Being able to guide the choices of drugs prescribed and also carry out audits are also very useful features of the system.
In the future we will continue to add more drugs to the library, configure a paediatric drug library and explore more features of the system to improve the quality of patient care the unit provides.
Events which may also be of interest:
Demonstrating & Improving Prescribing Competence & Practice: Implementing the National competency framework for all prescribers
Reducing Medication Errors in Hospitals National Summit 2018
Controlled Drugs Summit: Ensuring the Safer Management of Controlled Drugs: Diversion & Abuse, Prescribing & Use
A Practical Guide to Effective Non Medical Prescribing In Cardiology
9 July 2018