Authors (including presenting author) :
Ip CH(1), Law KM(1), Leung YS(1), Ng TM (1), Chu KY (1)
Affiliation :
(1)Department of Pharmacy, Queen Elizabeth Hospital
Introduction :
In-Patient Medication Order Entry (IPMOE) is an electronic system that interfaces prescribing, order verification and drug administration. The system had been newly launched in Queen Elizabeth Hospital since 2017. Electronic prescribing of medication may reduce errors from poor handwriting or incorrect transcription. The IPMOE system itself may also introduce new errors. However, the impact on medication errors remains uncertain despite several years of IPMOE implementation across Hospital Authority.
Objectives :
This study aims to identify the characteristics of drug related problems (DRP) and evaluate the extent of medication safety improvement after IPMOE implementation.
Methodology :
It was a retrospective observational study, consisting of two parts. The first part started from 1st September 2017 to 31st January 2019. Measured outcomes included types of prescribing errors and types of drugs involved in prescribing errors in IPMOE. The second part of the study compared the characteristics of DRP before and after IPMOE implementation in one medical ward. DRP from 19th September 2017 to 18th September 2018 (post-IPMOE) were compared with DRP from 19th September 2016 to 18th September 2017 (pre-IPMOE). DRP were categorized using PCNE classification (Version 6.02). Problems and causes of the DRP were analysed. The incidence rates of DRP were also compared.
Result & Outcome :
The leading three common types of prescribing errors were therapeutic duplication (39.5%), wrong dosage or strength (18.2%) and inappropriate infusion rate (12.6%). Most typical therapeutic classifications of drugs involved were drugs used in gastro-intestinal system (26.7%), infections (25.7%) and nutrient and blood (11.6%). An insignificant reduction of total DRP was shown after implementation of IPMOE. (RR=0.98, 95% CI: 0.83-1.16) Analysis of causes based on PCNE classification showed reductions in ‘drug dose too low’ group (RR= 0.50, 95% CI: 0.26-0.96) and ‘inappropriate drug form’ group (RR= 0.46, 95% CI: 0.26-0.80) with IPMOE. However, increases in ‘no indication for drug’ group (RR= 9.69, 95% CI: 1.24-75.68) and ‘pharmacokinetic problem requiring dose adjustment’ group (RR= 2.09, 95% CI: 1.08-4.03) were reported with IPMOE. Analysis of problems based on PCNE classification showed reductions in ‘wrong effect of drug treatment’ group (RR= 0.45, 95% CI: 0.24-0.85) and ‘unclear problem/complaint’ group (P< 0.05) while an increase in ‘toxic adverse drug-event’ group (RR= 5.81, 95% CI: 1.30-25.97) with IPMOE. In conclusion, IPMOE insignificantly reduces overall DRP. A few types of errors were reduced but new errors were also introduced. Clinical decision support features and alert prompts incorporated into the system are some possible ways to facilitate prescribing in IPMOE.
