The effect of the controlled entry of electronic prescribing and medicines administration on the quality or prescribing, safety and success of administration on an acute medical ward

Abstract

There is a need to reduce the frequency of adverse drug events arising from prescribing and drug-administration errors. It is perceived that this can be achieved by the implementation of electronic prescribing and medicines administration with clinical decision support. We investigated the effect of the implementation of a commercial, integrated, prescribing, administration and stock control system with clinical decision support in a controlled, prospective manner on a general medical ward. Its impact on the quality of medicine administration was evaluated over three months. We were also interested in the effect on the clinical efficiency of the ward and the need for education and training in the use of an electronic integrated prescribing and medicines-administration system. The results demonstrated that the proportion of medicines administered successfully rose from 90% on the existing paper-based system to 95% on the electronic system (p<0.001). The clinical pharmacist identified errors in 12% of paper prescriptions with 1% of administrations being deferred as a consequence of unclear prescribing or lack of administration details. All electronic prescribing ultimately passed clinical checks (94% after one or fewer modifications) and was always clear at the point of administration. The time taken for prescribing and medicines administration increased significantly, administration time doubling. A marginal improvement in wasted or returned medicines occurred. Implementation of a commercial, electronic, prescribing and medicines-administration system therefore improved the quality of prescribing and safety of medicines administration. The system was introduced into an acute setting with naïve electronic prescribers and those responsible for administration in a safe manner over a relatively short time scale. The cost in staff time to achieve this improvement in clinical safety was significant, however