Assessment of an electronic patient record system on discharge prescribing errors in a Tertiary University Hospital
| Autor: | Martina Hennessy, Cormac Kennedy, Michael J. Barry, Eileen Relihan, Kieran Harkin, Michael Patrick O'Shea |
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| Rok vydání: | 2021 |
| Předmět: |
Medical education
Computer applications to medicine. Medical informatics R858-859.7 Health Informatics Documentation Health informatics Drug Prescriptions Tertiary Care Centers 03 medical and health sciences Electronic Prescribing 0302 clinical medicine Medicine Electronic Health Records Humans Medication Errors 030212 general & internal medicine Medical prescription E-health Descriptive statistics business.industry 030503 health policy & services Health Policy Research University hospital Patient record medicine.disease Patient Discharge Computer Science Applications Discontinuation Prescribing Transition Discharge Health information Medical emergency Educational interventions 0305 other medical science business |
| Zdroj: | BMC Medical Informatics and Decision Making BMC Medical Informatics and Decision Making, Vol 21, Iss 1, Pp 1-10 (2021) |
| ISSN: | 1472-6947 |
| Popis: | Background Prescribing error represent a significant source of preventable harm to patients. Prescribing errors at discharge, including omission of pre-admission medications (PAM), are particularly harmful as they frequently propagate following discharge. This study assesses the impact of an educational intervention and introduction of an electronic patient record (EPR) in the same centre on omission of PAM at discharge using a pragmatic design. A survey of newly qualified doctors is used to contextualise findings. Methods Discharge prescriptions and discharge summaries were reviewed at discharge, and compared to admission medicine lists, using a paper-based chart system. Discrepancies were noted, using Health Information and Quality Authority guidelines for discharge prescribing. An educational intervention was conducted. Further review of discharge prescriptions and discharge summaries took place. Following introduction of an EPR, review of discharge summaries and discharge prescriptions was repeated. A survey was administered to recently qualified doctors (interns), and analysed using descriptive statistics and thematic analysis. Results Omission of PAM as prescribed or discontinued items at discharge occurs frequently. An educational intervention did not significantly change prescribing error rates (U = 1255.5, p = 0.206). EPR introduction did significantly reduce omission of PAM on discharge prescribing (U = 694, p p = 0.007). Survey results demonstrated that multiple sources are required to develop a discharge prescription. Time pressure, access to documentation and lack of admission medicine reconciliation are frequently cited causes of discharge prescribing error. Conclusion This study verified passive educational interventions alone do not improve discharge prescribing. Introduction of EPR improved discharge prescribing, but negatively impacted deliberate discontinuation of PAM at discharge. This is attributable to reduced access to key sources of information used in formulating discharge prescriptions, and separation of the discontinuation function from the prescribing function on the EPR discharge application. |
| Databáze: | OpenAIRE |
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