Are we setting about improving the safety of computerised prescribing in the right way? A workshop report

Abstract

Background Prescribing errors are common and costly. Technology should enable safer prescribing. The two main current methods of doing so are computer initiated clinical support software (CDSS) and the user initiated information retrieval (IR) systems. However, despite the near universal availability of computerised prescribing support in the UK, errors continue. Objective To evaluate the experience of UK primary health care professionals using CDSS and to consolidate current technical opinion and literature in this area with the aim of creating useful hypotheses for guiding future academic investigation and industrial development. Study design The study was a synthesis, drawing together a literature review and views from experts in the field to explore from a qualitative perspective where and how CDSS and IR could be used to improve prescribing safety in primary care. We conducted a literature review, held a workshop to explore issues in practice and had a follow-up expert panel meeting to confirm the findings. The workshop was recorded, transcribed verbatim and analysed thematically. Participants and setting The study involved primary care practitioners, system developers, information suppliers and academics.

Using information to deliver safer care: a mixed-methods study exploring general practitioners' information needs in North West London primary care

“…Other studies have also highlighted the consequences of communication breakdowns on prescribing and patient monitoring in primary care 6, 22, 27, 28. A UK study assessing quality and safety in chronic obstructive pulmonary disease (COPD) pathways with secondary care staff found that often GPs do not receive discharge summaries due to communication failures.…”

Quality assessment of information about medications in primary care electronic patient record (EPR) systems

“…To be helpful, such alerts should be selective and based on a quantitative risk assessment to avoid GPs cancelling or ignoring them. 3 A large consensus on the most important safety features of EPR systems for GPs, like that proposed in the UK, 4 is greatly needed in Italy. Besides this, information on the prescription rules currently in force in Italy is also deficient in the EPR systems assessed.…”

Incidence of potential drug interactions in a transplant centre setting and relevance of electronic alerts for clinical practice support

“…As widely addressed by Vaziri et al, 29 the prescribing alert systems used in primary care practice often have low specificity and low utility. In fact, alerts are often ignored, or viewed uncritically by physicians, who rely on their experience, and on a careful monitoring of patients.…”