How to make electronic prescribing and medication administration a success

There is strong evidence on how electronic prescribing and medicines administration systems – also known as ePMA in the UK and a range of other acronyms across the world – can improve safety for patients, reduce the risk of harm and ensure high quality care.

From the moment a patient is admitted, ePMA can support a more accurate medicines reconciliation; initiate enhanced clinical decision support when prescribing; and support detailed administrations to make sure appropriate timing through to the complete discharge process.

Some of the other benefits of e-prescribing systems include:

• Reduction in drug prescribing errors potentially up to 50%
• Eradication of illegal prescriptions and transcription errors flowing through to reduction in the number of dispensing errors
• Increased compliance, formulary control and alignment with required local practice
• Automated adherence to allergy checking and consistent reference to allergy details
• Reduced duration for nursing medication rounds as current information will be available as and when needed
• Minimising missed doses through scheduling of administration events

While there are many benefits, ePMA projects can be difficult to deploy and many healthcare organisations still utilise a paper process. Some solutions do not allow for all medications and regimes to be addressed so clinical staff have to refer back to paper charts. Further, there needs to be an increase in the sharing of data between care settings, specifically Primary and Community.

For organisations at the beginning of an ePMA journey, there are some core principles that can significantly increase the likelihood of a successful outcome.

First, before you even start procurement, ensure that you have a project team and digital strategy for ePMA established.  The most successful implementations will involve an ‘ePMA Team’ made up of various members including nurses, senior clinical staff, pharmacy staff, ICT and integration specialists. They become the subject matter experts for the product but also champions for the successful roll out of the solution across the organisation.

Second, understand how e-prescribing fits in the organisation’s overall clinical digital strategy. ePMA implementation should be treated as a transformation program, not just a software installation. Recognise that unexpected challenges are to be expected for such a complex undertaking. Ensure broad ownership and early effective engagement. Establish the right infrastructure and change management processes so you are ready for the level of change the solution will bring.

Lastly, choose the right provider. There is so much choice when it comes to ePMA providers. Right now I can name over 12 different solutions ranging from standalone to those tightly integrated with an EMR / EMPR and open source.

These ePMA systems have various care settings including Acute, Mental Health and Community and many have their origins with the Dictionary of Medicines and Devices (dm+d) terminology. Ensure that you have a good level of value and cultural alignment with suppliers, so you can form a strategy and approach form. Effective collaboration is critical.

How to follow the “Five Rights” of medication management

To help reduce the risk of medication errors, nurses are taught the “Five Rights of Medication Administration”.  Here is how they can be applied and benefit from the use of an ePMA solution:

1. The Right Patient – There have been numerous papers showing that the wrong patient has received another patient’s medication. An ePMA solution that allows the wristband of a patient to be scanned and presents the correct patient record is a clear advantage.  In an Acute organisation this is now standard practice, however many challenges are faced in Mental Health. Service Users don’t wear wristbands and may not be favourable to having a personal photo stored on the system.
2. The Right Drug – Distractions and illegible hand-writing have caused many wrong drugs to be administered to patients. While ePMA brings the legibility and clarity of the prescription details, other factors can still get in the way.  Along with the scanning of the patient, scanning of the drug enables closed loop medications management.
3. The Right Dose – A clearer prescription helps the administering clinician along with the scan of the drug to see the correct dose. But ePMA can also help with more informed decision support both here and when prescribing. Users can check the appropriateness of the dose looking at clinical data that can be presented on the screen such as pathology results.
4. The Right Route – Prescribing by the correct route can be helped by only displaying the appropriate and licensed route available. This allows the prescriber to choose the appropriate route and minimises harm to the patient.
5. The Right Time – Administration charts will show the frequency of the doses and when previous/next doses are due. This is critical with PRN (as needed) and WEEKLY medications as administering clinicians can be sure appropriate frequency and that being the avoidance of adverse events.

The adoption of hospital-wide ePMA is arguably the most complex and challenging deployment of a clinical software solution.  However, it is one where the Return on Investment is clear from a patient experience, clinical outcome and cost performance perspective.  As healthcare organisations take advantage of funding available to start their ePMA journey, they need to consider how teamwork, mindset and partners are core components to get the most out of the project and to achieve the true potential of ePMA.

Nick Bigland, Implementation Lead, Alcidion