+ Electronic Medication Management in EDs Richard Paoloni - - PowerPoint PPT Presentation

+

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

• f the clinician

+ How does EMM improve patient safety?

Right drug

Tall man lettering for similarly spelt

• r 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

• rdering

 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.