Assessing the safety features of electronic patient medication record systems used in community pharmacies in England

Abstract

AimsTo evaluate the ability of electronic patient medication record (ePMR) systems used in community pharmacies in England to detect and alert users about clinical hazards, errors and other safety problems.MethodsBetween September 2012 and November 2012, direct on-site observational data about the performance of ePMR systems were collected from nine sites. Twenty-eight scenarios were developed by consensus agreement between a general practitioner and two community pharmacists. Each scenario was entered into the ePMR system, and the results obtained from the assessment of six unique systems in nine sites, in terms of the presence or absence of an alert, were recorded onto a prespecified form.ResultsNone of the systems produced the correct responses for all of the 28 scenarios tested. Only two systems provided an alert to penicillin sensitivity. No dose or frequency check was observed when processing a prescription for methotrexate. One system did not warn about nonsuitability of aspirin prescribed to a child of 14 years of age. In another system, it was not possible to record a patient's pregnancy status. None of the six systems provided any warning for diclofenac overdose, high initiation dose of morphine sulfate or significant dose increase. Only one of the systems did not produce any spurious alerts.ConclusionsThe performance of the ePMR systems tested was variable and suboptimal. The findings suggest the need for minimum specifications and standards for ePMR systems to ensure consistency of performance.

Implementation status of safety measures to prevent errors with non-oncologic methotrexate: surveys in community and hospital pharmacies

“…Additionally, very specific alerts are rare. This is congruent with findings from a study in community pharmacies [21]. Unspecific alerts (after selection of a MTX product) are more often implemented in community pharmacy than in hospital, while it is vice versa for specific alerts.…”

“…Health care professionals are addressed by international recommendations, e.g., to implement IT-based measures or to adapt local working procedures [1,[12][13][14][15][16][17][18][19]. However, in the last decade, studies have shown that the implementation of safety recommendations in community and hospital care is limited [20][21][22]. In addition, clinical pharmacist services are-even if proven effective to detect MTX overdoses-not available in all hospitals [23,24].…”

A formative evaluation of the implementation of a medication safety data collection tool in English healthcare settings: A qualitative interview study using normalisation process theory

“…For the reasons highlighted above, it may be beneficial to redesign the community (primary care) version of the MedsST, and to combine use of the MedsST with the routine use of evidence-based initiatives currently used in primary care that are recommended by the National Institute of Clinical Excellence in the medicines optimisation guideline [ 28 ] in order to measure improvement over time. Many of these initiatives involve using electronic health records to identify the most prevalent potentially hazardous medication safety indicators that are specific to primary care [ 29 – 33 ]. Furthermore, sub-settings within primary care may require different sub-versions with specific measures.…”

The Impact of Provider Networks on the Co-Prescriptions of Interacting Drugs: A Claims-Based Analysis

“…Third, we may not have recognized other DDIs of drugs that were prescribed, but not filled, as a result of deliberate interventions by pharmacists, especially as pharmacy clinical decision-support systems are increasingly used for detecting the prescriptions of interacting drugs. However, studies have consistently shown that these systems are less than optimal in identifying potential drug interactions [42–44], with one study showing only 28% of commercial information systems in ambulatory pharmacies capable of identifying critical DDIs [42]. Lastly, many potential drug interactions never lead to an actual clinical effect.…”