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Three years ago, Fredriksberg Hospitals (Denmark) started a pilot project to find out how to improve the safety of patients as they received medication during their stay in hospital. This year, the new system will be rolled out through all the wards in the hospital, and has been such a success that they have been receiving enquiries from other hospitals wanting to know more about the benefits of electronic prescribing.
Past errors cause for concern
Unfortunately, mistakes and errors do happen in patient care. Cases of mistaken identity can occur when people have similar names or because the patient does not understand the local language well enough. Other problem areas are with small children or elderly patients who have difficulty communicating.
Handwritten prescriptions can be misread due to bad handwriting, leading to the wrong medication being dispensed for a patient, often with potentially fatal consequences.
This is all set to change with the adoption of barcoding and wireless technology.
Positive patient identification
Under the new system, when patients enter the hospital they are given a wristband, printed on a Zebra(®) printer, which contains a barcode that acts as an electronic key to the patient’s record, which is stored on the main hospital information system. At every point of care, the wristband can be scanned and accurately identified.
When a patient meets with a doctor who prescribes medication, the doctor records all details of the type and dosage electronically, directly onto his or her portable computer. This can be done at the patient’s bedside, and it is recorded immediately into the patient’s EPR (electronic patient record) via a wireless network.
When the nurse administers the medication, the drug container is scanned to verify that it is the correct one. Should the incorrect drug be about to be given, the software would inform the nurse, thus preventing errors from occurring. When nurses give the correct medication to the patient, they first identify themselves by scanning their personal ID card, and then scan the medication and patient. The handheld computer records all key information: right patient, right drug, right dosage, right route, right time, providing a complete audit trail of the process which is then stored in the main system.
“Both hospital staff and patients have been positive about this new system,” says Jeppe Hansen, Director of the Electronic Prescription project. “Doctors and nurses appreciate this new, safe way of working. Doctors no longer have to dictate prescriptions into a tape recorder; now, instead, they write the prescription directly into a computer at the patient’s bedside. All prescriptions are transferred electronically, so no more paperwork is required. Furthermore, all information is immediately available to everyone via the wireless network.”
Patients feel safer once they understand how the new system works. There is no longer the need to worry about mistakes in their care because the system verifies via barcodes and handheld computers that the patient receives the correct medication.
Barcodes are also used in the laboratory to identify samples received for testing, blood bags for transfusions and organs for transplant. Previously, the doctor would receive laboratory results by fax but now the results are delivered directly onto the handheld computer, which the doctor has with him on his rounds. This makes all test results available immediately, allowing him/her to treat the patient more efficiently.
“I am very happy with electronic prescribing because it improves patient safety and helps hospital staff to give patients the right dosage of the right medicine. The use of paper within medication management will disappear totally, little by little. I believe that all Danish hospitals will move to electronic prescribing in the next five years,” says Jeppe Hanse.