Research digest: Effective use of EPMA could reduce medication-related errors

28th August 2024

Electronic prescribing and medicines administration (EPMA) could reduce the likelihood of a small number of low-harm and moderate-harm medication-related incidents, according to a team from the University of Nottingham and Nottingham University Hospital NHS Trust, UK.

By analysing the frequency of the different types of medication-related incidents that caused patient harm, the researchers found that more than half of the incidents (n=243, 62.8%) could not be mitigated by any use of EPMA, even with further development, but EPMA could reduce the likelihood of a small number of the least harmful incidents.

The research team, which included hospital pharmacy and medical staff, conducted a retrospective review of harmful incidents (n=387) for medication-related reports at a major UK teaching hospital between September 2020 and August 2021 and the frequency of different types of incidents were collated. DATIX reports and investigation results were reviewed to determine whether EPMA could have prevented the harmful incidents.

Administration errors were found to cause the largest proportion of harmful medication incidents (n=215, 55.6%), followed by incidents classified as ‘other’ (n=102, 26.4%) and ‘prescribing’ (n=46, 11.9%). The majority of incidents were classified as ‘low harm’ (n=321, 83.0%).

Reducing errors with EPMA

EPMA would not have been able to reduce the likelihood of the incident in 62.8% of all incidents where harm was identified due to issues where the software has no impact such as lack of communication, distractions or staff shortages.

However, the researchers found that implementation of EPMA could potentially reduce the likelihood of all incidents which caused harm by 18.6% (n=72) without any software configuration, and by an additional 7.5% (n=29) if configurations were made.

For the low harm incidents (n=59) and moderate harm incidents (n=13), EPMA could reduce the incident likelihood by 18.4% and 20.3% respectively without configuration. 

EPMA also has the potential to reduce medication errors caused by illegibility, multiple drug charts or missing drug charts, the researchers said.

The study shows that EPMA can lead to a reduction of harmful incidents in hospitals, particularly with targeted configuration and development of software and the researchers suggest the findings can be used by hospitals to optimise their EPMA systems.

Reference
Cattell M et al. Retrospective review of medication-related incidents at a major teaching hospital and the potential mitigation of these incidents with electronic prescribing and medicines administration. European Journal of Hospital Pharmacy 2024; Jun 21: doi.org/10.1136/ejhpharm-2022-003515.

Electronic prescribing system in ICU requires less pharmacist input to maintain patient safety

22nd June 2023

An electronic prescribing (EP) system within an intensive care unit (ICU) requires a lower level of clinical pharmacist input compared to a paper-based system, according to a recent prospective, longitudinal UK study.

Although EP systems are designed to reduce medication errors, the quality of evidence on their effectiveness is variable. Nevertheless, within an ICU setting, the use of commercial computerised provider order entry systems led to an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. However, few studies have focused on whether EP systems optimise medication therapy, reduce costs, improve the quality of prescribing and patient outcomes.

In the current study, published in the International Journal of Medical Informatics, researchers compared the clinical significance of pharmacist contributions in two ICU departments to understand the impact of an EP system on the quality of patient care.

The team chose one department that used an EP system and compared the extent of pharmacist input with a second department using a paper-based prescribing (PBP) system. The primary outcome was the distribution of clinical significance levels of pharmacist contributions. This was assessed using a tool that assigned a clinical significance rating to pharmacists’ contributions based on the mitigation of risk or negative outcome for the patient and ranged from I (low level) to V (high level).

Impact of electronic prescribing on pharmacist input

A total of 303 patients were included, with EP used in 171 patients. Overall, 1,658 contributions were analysed.

The median number of patient reviews in both groups was similar, as was the proportion of reviews with no change (49.3% vs 48.5%, PBP vs EP). In addition, there were 14.9% highly clinically significant pharmacist contributions (levels III and above) with EP compared to 44.6% with PBP.

The EP group had a lower odds for a higher clinical significance contribution compared to the PBP group (Odds ratio, OR = 0.05, 95% CI 0.02-0.12). However, over time, there was a lower odds of a higher level contribution from the PBP group (OR = 0.57, 95% CI 0.42 – 0.78, p < 0.001).

Based on these findings, the researchers concluded that the clinical significance of pharmacist contributions remained both low and stable in over time in the EP group. Moreover, while initially higher, pharmacists in an ICU using a PBP system actually reduced over time.

Taken together, the study suggests that the use of an EP system required significantly less pharmacist input to maintain patient safety, possibly because the EP system enables access to data to improve decision-making at the point of prescribing.