An electric solution to shocking errors

Supporters of EMM systems promise safer, more efficient handling of medications. 

It won’t surprise anyone who has had to take regular prescribed medication that errors in this task are the second most common type of medical incident reported in hospitals.

Omission and overdose are most frequently occurring medication errors. A recent report identifies the need to rectify these alarming mistakes, which have an immediate impact upon patient safety and welfare. The report’s proposed solution is electronic medication management (EMM) systems.

An EMM enables the prescribing, supplying and administration of medication to be completed electronically. The Australian Government’s Electronic Medication Management Systems – Implementation Plan states that “EMM covers the entire hospital medication cycle including prescribing by doctors, review and dispensing of medication orders by pharmacists, and administration of medicines by nurses. EMM reduces medication errors through improved prescription legibility, dose calculation and clinical decision support.

The report suggests that EMM will enable best practice information to be more readily available to prescribers and improve linkages between clinical information systems. “It can also improve efficiency in the medication management process, such as reducing the time required to locate paper medication charts or to supply non-imprest medicines,” it states.

Lea Dias, clinical lead pharmacist, electronic medication management systems Perth Children’s Hospital, stresses that it’s imperative an EMM system is introduced throughout Australia.

“There are operational efficiencies in implementing electronic systems,” Dias says. “Clinicians will no longer have to rely on manual systems of ordering, dispensing and administering medications from paper charts. The flow of information is captured throughout the transitions of care.

“[Without EMM systems] medication errors such as omissions and overdoses may occur from illegible prescriptions, limitations in drug knowledge and difficulty accessing relevant patient information necessary for clinical decision-making.

“Clinical decision support with electronic prescribing allows dose range checking and several other parameters to be set, [in order to] guide the safe prescribing of medications, including high-risk medications.”

Of course an inefficient EMM system can cause more problems than it fixes and seriously put people’s health in danger. The government report mentioned earlier states that poorly implemented electronic systems have increased errors. It stresses that “with many Australian hospitals planning to implement EMM systems, it is essential that this risk is minimised by considering the international literature and learning from the experiences of early Australian EMM system implementations”.

Dias agrees.

“Evidence has shown that a poorly implemented system or a system based on best-of-breed approach without integration may potentially reduce patient safety as errors can occur if information does not flow smoothly across the transitions of care,” she says.

Dias has seen the best and worst of EMM locally and internationally, having received Churchill Foundation fellowship to travel overseas and investigate EMM systems around the world.

After visiting US hospitals in Wisconsin, San Francisco and Phoenix, Arizona, she also went to UK facilities in London and Cambridge.

She had worked of late in Princes Margaret Hospital in WA but was recently seconded to the new children’s hospital project, which is a $1.2 billion facility set to replace Princess Margaret in 2015.

Her various experiences have led her to believe EMM systems offer many benefits.

“The area of EMM systems is still developing throughout Australia, with Western Australia being late adopters of the system and technology,” she says.

“The imbedded safety alerts in the technology systems for allergies, adverse drug reactions, drug interactions and clinical decision support, will benefit elderly patients taking multiple medications with multiple co-morbidities ensuring the safe prescribing, dispensing and administration of medications.

“In addition, scanning the patient’s identification wrist band against the physician’s drug order ensures the correct patient is administered the correct medication.

“The system also has the ability to collect data around falls and medication-related sedation. This is particularly useful for patients who may take medications that cause drowsiness, thereby increasing the risk of falls. Safe dosage parameters or alerts can be put in place for this more ‘vulnerable’ group of patients.”

The government report also highlights the need for a safe and thorough system. In addition, it gives an example of a clearly defined implementation plan, which can then be used as an electronic template. The template has been designed to allow each hospital to modify it according to its own needs and data.

It sets out a detailed checklist for the implementation plan along with strict governance guidelines and risk and issue management.

Implementing an EMM system within a hospital is a major transformational project that affects clinical service delivery, hospital departments and the work of clinicians. It requires the full support of the hospital executive and senior clinical staff.

Dias says Australia is a long way behind other advanced hospital systems, particularly in the US.

“There are vendors throughout the United States that offer a whole-of-hospital integrated health system and many more vendors that offer best-of-breed systems to specialised areas, including oncology, intensive care units, anaesthesia and neo-natal intensive care units,” she says.

“In addition, growing evidence suggests integration into automation, including pharmacy robotics, intravenous robotics, smart pumps, automated medication units and bar code scanning technologies provides an electronic ‘closed loop’ medication management system with improved patient safety outcomes.”

She says most Australian hospitals have at least some manual input for medications, that some centres are primarily paper-based, and that about 10 per cent of hospital prescriptions are illegible, whilst the same proportion has omissions or errors.

In a closed-loop electronic system, these errors may be eliminated. Dias is on a mission to bring Australian hospitals an EMM system that will be the equal of anywhere else in the world.

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