Unity – A prescription for safer care
December 31, 2018
By Dr Roger Stedman, Consultant Anaesthetics and Critical Care Medicine
The chain of events that starts with a decision to treat, through the writing of a prescription, dispensing of medication and administration to a patient is fraught with risk. This risk is manifest on a daily basis at SWBH as is evidenced by the number of reported medicines related incidents – over 1,200 a year at this trust with 28% of these resulting in some degree of harm to the patient.
When this process is managed by the traditional paper based work flow – underpinned by the drug prescription chart – we know that it is subject to errors due to: Illegible prescriptions, wrong drug / dose prescriptions, inappropriate drug combinations, inadequate allergy recording and absence of the chart altogether. The standard paper based prescribing workflow demands a minimum of two manual transcription tasks (admission drugs to inpatient prescription, inpatient prescription to TTO prescription) for every admission. However in addition to this the average medical inpatient will have 2 – 3 re-writings of the drug chart during their stay. All of this results in a prescription error rate of 15%.
When it comes to administering medicines from a paper chart the story isn’t much more cheerful. The drug administration error rate is in excess of 10%; including wrong drug, wrong patient and wrong dose errors. This rises significantly if you include late and missed dose errors.
The paper prescription chart is without doubt the weak link in the inter-professional communication required to safely deliver medical treatment to our patient’s. Not only that – it fails to tell us how we are doing in this critical task – the laborious job of auditing prescribing and administration processes giving us late, inadequate data on the safety and efficacy of our medicines management practice.
When Unity goes live the EPMA (electronic medicines and administration) functions in Unity will almost completely eliminate these errors. The EPMA has the entire hospital formulary built into the system, with ‘order sentences’ for the commonest doses and routes for most medicines. Not only that the system has an interaction checker that will ensure that serious drug incompatibilities will be highlighted immediately to the prescriber. The system mandates that allergies are recorded and verified on a regular basis, and that goes for patients’ weight as well. When the same system was implemented at another major NHS hospital the result was astonishing:
- Incomplete prescriptions fell from 62% to 0%
- Weight based dose calculation resulted in inappropriate doses falling to 0%
- Legible prescriptions and signed prescriptions 100%
- Allergy recording increased from 80% to 100%
The other major advancement that comes with Unity EPMA is the ‘Closed loop’ medicines administration system. The use of barcode scanning of both the patient and the medicine and triangulating this with the electronic prescription results in dramatic falls in drug administration errors as well. The same trust implementation saw the prevention of over 2,000 wrong drug administrations and nearly 400 wrong patient administrations in a 12 month period.
Users of the system also reported the following:
- No missing drug charts
- 8 hours a week in trainee doctor time saved rewriting drug charts
- Ability to prescribe remotely, no more telephone orders
- Ability to screen drug charts remotely
- Improved audit trail – ability to feedback errors directly to individual users
- Standardisation of complex prescribing (e.g. insulin, anticoagulation)
- Formulary adherence
- Improved antibiotic stewardship
- Electronic ordering of drugs and ward stock control
- Safer and faster dispensing
- Improved surveillance and reporting
The case for EPMA is so compelling that many trusts have implemented it even before a full EPR. Trainee doctors rotating to SWBH from other organisations that already have EPMA report that it is like returning to the dark ages having to write (and re-write) prescription charts.
The introduction of EPMA at SWBH will bring about a step change in the safety of patients cared for at SWBH – and it cannot come soon enough.
#hellomynamesis… Roger
#Unity – releasing time to care