Electronic Prescribing

Conclusion

Apart from a system that must be in place by 2005 what is electronic prescribing? I hope the previous pages have made a start. In all of the above it is important to bear in mind that Electronic prescribing like manual prescribing is part of a larger process. This process is the end of a chain of decsions made with support from a number of different sources. Obviously it does not stop there, once precribed, a medicine/course of medicines has to be supplied, administered, effects monitored and adjustents made as required. The patient improves gets, discharged/deteriorates, remains in situ - more prescribing, more supply and eventually onto thier GP where a week later the whole process is repeated again... If one were to map out this process, even briefly, it would be complex and dynamic and you would soon get an appreciation of the part Erx plays and how it is linked to the many other processes in the care pathway.

In seeking to implement an electronic prescribing system it is important to approach it with an open mind. The current system has evolved to what it is over 30 years how can we improve? Transferring it as is (in our case, all five of the drug charts, plus sundry attachments) to an electronic system direct will not confer the potential benefits we envisage.

So what are the potential benefits?

Improved access to information

Validated, prospective, On line clinical decision support:

Checking of doses as prescribed

interaction checking

checking microbial sensitivities when prescribing antibiotics

checking biochemical parameters when prescribing

drug monographs (inc Trust's IV drugs guide)

Active links to local formularies

Active links to the WeBNF and from there to paediatric formularies, renal formularies e.t.c.

Avoidance of unnecassary therapeutic duplication

Instant TTAs (which can be transmitted electronically to GPs)

Instant out-patient scripts arriving @Pharmacy in advance of the patient

Repeat prescriptions (e.g. for clozapine)

Clear legible prescriptions

No transcription of prescriptions

Personal formularies

Order sets/protocols(e.g. Chemotherapy/TPN)/group protocols

Readily accesible information for audit(NICE), research, national requirements (Calman-Hine), prescribing purposes

Prospective allergy checking

The secure facility to prescribe for any patient anytime, from anywhere linked to the system

The facility to selectively review patients' present/past, received/missed medications(medication histories) anytime, from anywhere linked to the system

The chart never 'goes missing', gets stuck in Pharmacy

Vastly improved administration management for nursing staff

Improvement in supply of medicines to the ward by automating the process of order

Improvement in usage of Clinical Pharmacists time through improved access to information

Improvement in communication between prescribers and Pharmacy for specialist therapies e.g. chemotherapy where use of a scheduler will lead to an improved supply chain

Streamlining the discharge process (e.g. by tracking TTAs through Pharmacy)

Improvement in dissemination of information (e.g. stock shortages, urgent drug recalls, caution in use notices)

This is a long list, that is achievable.

Please feel free to E-mail me any comments/contributions or questions

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