Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process

Abstract

BackgroundElectronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines.MethodsSoftware features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia.ResultsA list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases.ConclusionsThis study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries.

Use of the Delphi technique to determine safety features to be included in a neonatal and paediatric prescription chart

“…This is similar to the work done by Coombes et al [17] and Millar et al [22]. The safety features which have achieved consensus in this study to be included in a neonatal and paediatric prescription chart, can furthermore be investigated with regards to their implementation in electronic prescribing and medication administration systems, similar to the work done by Sweidan et al [68]. The authors of the report ''Standards for the design of hospital in-patient prescription charts'' describe the safety features to be equally applicable to paper and electronic charts [20].…”

“…The authors of the report ''Standards for the design of hospital in-patient prescription charts'' describe the safety features to be equally applicable to paper and electronic charts [20]. Sweidan et al [68] have identified features of e-prescribing that support patient safety and quality of care and have used the modified Delphi process to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. Further research would be required to investigate why 17 safety features such as height, and body surface area did not achieve consensus.…”

Patient safety and safety culture in primary health care: a systematic review

“…Two papers reported on adverse events with a focus on medication error [ 43 , 44 ]. Both the papers related to information technology to improve patient safety and quality of care.…”

The impacts of second generation e-prescribing usability on community pharmacists outcomes

“…Most of the past research on the outcomes and impacts of e-prescribing systems has focused on doctors and physicians as the samples. 9,22,29,30 However, the research on the effect of e-prescribing systems in community pharmacy practice is sparse, compared to that on physicians' use in hospital settings. 1,18 Community pharmacists in particular face more problems in adopting and using e-prescribing systems.…”