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Electronic prescribing & administration (ePA)

Electronic prescribing & administration (ePA)

This is an update on a story about ePrescribing that we featured in our Quality Account 2012/2013 [view more about ePrescribing at Waitemata DHB].

Why is electronic prescribing & administration important?

Medicines are one of the highest causes of preventable harm to patients. International research suggests that approximately 50% of medication harm occurs during prescribing, 40% during administration, and 10% during dispensing and distribution. The Institute of Healthcare Improvement [1] recommends automation and computerisation as one of the most effective tools for preventing medication errors.

Electronic prescribing and administration (ePA) offers significant benefits over paper-based prescribing and administration, for example:

  • prescriptions are easier to read (legible)
  • errors made when prescribers chart medications are reduced
  • time spent finding medication charts is eliminated
  • much easier access to important safety information such as allergies, warnings when dose ranges are exceeded, and warnings about drug interactions

Did we make a difference?

The ePrescribing implementation was an outstanding success in a field where previous attempts both in New Zealand and overseas have been fraught with difficulty. Following the successful pilot we have now rolled out ePrescribing to approximately 400 beds across acute and older adult wards (including 95 medical and Acute Diagnostic and Cardiology Unit beds at Waitakere Hospital), and our forensic mental health unit (Mason Clinic).

Nursing using our ePA systemThe system has substantially improved medication safety and increased efficiency, for example:

  • 100% of prescriptions are legible and the individual prescribers can always be identified
  • transcribing errors have reduced due to paper medication charts no longer needing re-charting when they are full
  • nursing staff no longer have to fax medication charts to pharmacy for manual review
  • the percentage of medicines being removed from our electronic medication dispensing machines without a pharmacist review has reduced from an average of 25% to less than 10%
  • all medicines, blood products, intravenous fluids, oxygen, and special foods are prescribed on the electronic chart, ensuring there is an efficient single system in which clinicians prescribe and administer medicines
  • all clinical systems can now be viewed at the patient’s bedside so that staff no longer have to return to the nursing station or doctors’ office to retrieve information
  • nursing staff have unrestricted access to computers particularly at the patient’s bedside with immediate access to reference material for information such as administering infusions
  • an improved allergy alert system with allergies having to be entered only once against a substance. If a user attempts to prescribe a medicine that a patient has a documented allergy to, the system automatically warns and requires the user to enter in a reason if they attempt to override the warning

Where to from here?

Funding has been approved to roll-out ePrescribing in:

  • Emergency Departments at North Shore and Waitakere hospitals
  • Assessment and Diagnostic Unit at North Shore Hospital
  • General medical wards at North Shore Hospital
  • Cardiology and Coronary Care Unit at North Shore Hospital
  • Short stay and Gynaecology wards at North Shore Hospital
  • Surgery and Orthopaedic wards at North Shore Hospital
  • Intensive Care / High Dependency Unit at North Shore Hospital

This will take our coverage to approximately 700 beds (out of 1,100 beds), putting us well on the way towards our long-term vision of having ePA available right across the organisation.

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