+ Electronic Medication Management in EDs Richard Paoloni Emergency Physician Concord Hospital
+ Does EMM improve patient safety? Westbrook et al study Two different EMM systems in two different Sydney hospitals Non-EMM wards used as controls Prospective before and after study on prescribing error rates Overall prescribing error rates in intervention wards fell by 66%, compared with no change in control wards The major reduction in errors was in terms of “unclear, illegible, and incomplete orders” Limited change in overall clinical error rates (eg. wrong dose, wrong drug) BUT serious clinical errors decreased by 44% Minimal decision support in either system Both hospitals experienced a small number of system-related errors, which differed between the sites Subsequent study by same research group in these same wards: No change in overall time spent on direct patient care or on medication related tasks by either doctors or nurses in an inpatient setting.
+ How does EMM improve patient safety? Five ‘R’s of medication safety Right patient Right drug Right dose Right route Right time
+ How does EMM improve patient safety? Right patient Part of an integrated system (with PAS) so avoids transcription Lots of ‘face up’ prompts to patient ID Bar coding reduces identification errors BUT still requires some care on the part of the clinician
+ How does EMM improve patient safety? Right drug Tall man lettering for similarly spelt or similar sounding medications Automatic conversion of trade names to generic names
+ How does EMM improve patient safety? Right dose Order sentences Built in calculators (weight based, TBSA) Dose range checking Paediatric Geriatric Renal Hepatic
+ How does EMM improve patient safety? Right route Legibility Order sentences
+ How does EMM improve patient safety? Right time Automatically aligns with standard hospital or NIMC administration times, but can also be customised if required The MAR (medication administration record) makes it easy to see what is due now / soon alerts if medications are overdue
+ How does EMM improve patient safety? Other Drug / allergy checking Drug / drug interaction checking Caresets (groups of orders) to support agreed protocols Related results: Passive display of lab or vital signs information at the point of medication ordering Prompted entry of lab / vital sign information Rules can be written to prompt users to critical information Ordering potassium in hyperkalaemic patients Ordering digoxin in hypokalaemic patients Cumulative paracetamol calculations Minimum interval dosing for analgesia / sedatives, etc, etc Customised flowsheets Diabetic – displays BSLs, HbA1c, insulin and oral hypoglycaemics Anticoagulation – displays INR & APTT results, and anticoagulant medications
+ Conclusions Introduction of EMM leads to a profound reduction in patient harms from medication errors The reasons are multifactorial and will differ somewhat with different builds Quality takes time EMM forces us to address a range of areas where we have become complacent with medication safety Continued customisation of the software in response to clinician feedback and innovation will progressively reduce the additional time required Clinicians generally strive for the best outcome for their patients. Therefore, despite its challenges to ‘us’, we must embrace EMM for the sake of our patients.
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