An electronic prescribing (EP) system within an intensive care unit (ICU) requires a lower level of clinical pharmacist input compared to a paper-based system, according to a recent prospective, longitudinal UK study.
Although EP systems are designed to reduce medication errors, the quality of evidence on their effectiveness is variable. Nevertheless, within an ICU setting, the use of commercial computerised provider order entry systems led to an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. However, few studies have focused on whether EP systems optimise medication therapy, reduce costs, improve the quality of prescribing and patient outcomes.
In the current study, published in the International Journal of Medical Informatics, researchers compared the clinical significance of pharmacist contributions in two ICU departments to understand the impact of an EP system on the quality of patient care.
The team chose one department that used an EP system and compared the extent of pharmacist input with a second department using a paper-based prescribing (PBP) system. The primary outcome was the distribution of clinical significance levels of pharmacist contributions. This was assessed using a tool that assigned a clinical significance rating to pharmacists’ contributions based on the mitigation of risk or negative outcome for the patient and ranged from I (low level) to V (high level).
Impact of electronic prescribing on pharmacist input
A total of 303 patients were included, with EP used in 171 patients. Overall, 1,658 contributions were analysed.
The median number of patient reviews in both groups was similar, as was the proportion of reviews with no change (49.3% vs 48.5%, PBP vs EP). In addition, there were 14.9% highly clinically significant pharmacist contributions (levels III and above) with EP compared to 44.6% with PBP.
The EP group had a lower odds for a higher clinical significance contribution compared to the PBP group (Odds ratio, OR = 0.05, 95% CI 0.02-0.12). However, over time, there was a lower odds of a higher level contribution from the PBP group (OR = 0.57, 95% CI 0.42 – 0.78, p < 0.001).
Based on these findings, the researchers concluded that the clinical significance of pharmacist contributions remained both low and stable in over time in the EP group. Moreover, while initially higher, pharmacists in an ICU using a PBP system actually reduced over time.
Taken together, the study suggests that the use of an EP system required significantly less pharmacist input to maintain patient safety, possibly because the EP system enables access to data to improve decision-making at the point of prescribing.