Helle Ølgaard McNulty
Head of Clinical Pharmacy Services
Copenhagen Hospital Corporation
In 2002, Copenhagen Hospital Corporation (H:S) began the development of an electronic prescribing/dispensing and administration system (EPM). The aim was to develop a system that could replace the paper-based system in use. This EPM system is now fully implemented at all five hospitals in H:S, and it is possible to prescribe, dispense and administer medication to patients with full electronic traceability. In addition, the EPM system can send electronic prescriptions to pharmacies in the primary care sector for collection by patients on discharge.
The development of this EPM system has been challenging and has also taken longer than initially planned. The H:S Pharmacy has been involved in the project from the very beginning, when the specifications for the EPM system were decided. In the development phase, two pharmacists were involved; later, during test and implementation, a larger number of both pharmacists and pharmacy technicians were involved.
The role of the pharmacy was to advise on all issues on medication use, including all legal aspects. Now that the EPM system is in full use, it is an integrated part of working as a clinical pharmacist or pharmacy technician at ward level.
The primary role of the H:S pharmacy in the EPM system is as follows:
- Supply of all data on medicines for the EPM system.
- Building and developing a central catalogue for IV preparations.
- General problem-solving on medication issues in relation to the use of the EPM.
The EPM and the pharmacy technician
The H:S Pharmacy has a number of ward-based pharmacy technicians. This group of people became involved very quickly when the ward was preparing to receive the EPM system. They took part in workflow analysis and very often had a central role in advising on the alterations that needed to be made to the medication room on the ward before
implementation of the system. They also took part in the various training sessions held before implementation. All this made them valued partners during the implementation of these major changes to the way medicines were handled at ward/patient level. Postimplementation, the pharmacy technicians are competent users of the system, which assists them in their daily work.
The EPM and the clinical pharmacist
Equally, the H:S Pharmacy has a number of clinical pharmacists who all have become trusted partners in the implementation of EPM. Main roles involve:
- Development of the central catalogue for IV medicines.
- Development of standardised treatment plans.
- General troubleshooter on EPM/medicine issues.
An issue that became very visible is the need for barcodes on all medications. This is much needed to harvest the full benefits of the EPM. There is also potential for benefits in the area of patient safety by implementing barcode technology on medicines.(1)
The number of reported adverse events in relation to patient safety issues reported in Denmark in 2005 was 11,401 and, of these, 3,666 events were in relation to the medication process.(2)
Potential benefits from implementing the EPM in relation to patient safety the pharmacy perspective
The issues in the following list all add to improved patient safety:(1)
- Electronic prescribing with decision support.
- Daily prescription validation.
- Sensitivity recording in the EPM.
- Dispensing via barcode.
- One-stop dispensing and administration via EPM PDA.
- Double-checking administration of high-risk drugs (eg, cytotoxics).
- Adherence to drug administration policy.
At the moment, it is possible to create standardised treatment plans in the EPM, such as digoxin and cytotoxic treatments. The dose of digoxin or cytotoxic is then calculated by the EPM when the patients weight or surface is entered. The formula to calculate this dose is entered by a physician or a pharmacist, so a ward is capable of making plans for any treatment. So far, not many plans have been made, but many are imminent.
It is possible to prescribe cytotoxics in the EPM; at the moment, wards only prescribe per oral (PO) cytotoxics. In the near future, the physician will be able to access a standardised cytotoxic regimen in the EPM, where all medications for a treatment will automatically follow, including, for example, antiemetics. When the cytotoxic dose is administered, it is possible to use the EPM to double-check the dose, patient name, etc.
Today, there is an increase in resistance to antibiotics.(3) There is growing evidence that, for example, E coli resistant to third-generation cephalosporins might be caused by inappropriate use of cephalosporins.(4,5) By using a standardised antibiotic treatment plan, it will be possible to limit inappropriate use. These plans will make it easier for the physician to apply the department’s antibiotics policy and, thus, minimise the risk of generating more resistance.
A goal for the future is to be able to get statistics from the EPM (eg, length of antibiotic treatment or how many of a ward’s patients were receiving anxiolytics in a given period). The EPM could also give easy access to statistical data on opioid use.
- Miller J, Cross M, Gerrett D,Webb D. A prioritisation of the most effective interventions for reducing medication errors in UK hospitals as perceived by senior pharmacists.EJHP 2006;12:23-8.
- Årsrapport 2005 fra Dansk Patientsik kerhedsdatabase.
- DANMAP 2005. Use of antimicrobial agents and occurrence of antimicrobiel resistance in bacteria from food animals, foods and humans. Denmark, Statens Seruminstitut. Available from: http://www.ssi.dk
- Pfaller MA, Segreti J. Overview of the epidemiological profile and laboratory detection of extended spectrum beta-lactamase.Clin Infect Dis 2006; 42 Suppl 4:S153-63.
- Ramphal R, Ambrose PG.Extended-spectrum β-lactamases and clinical outcome: current data.Clin Infect Dis 2006;42:S164-72.