The impact of an electronic prescribing and administration system on the safety and quality of medication administration

Abstract

Objective: To assess the effect of an electronic prescribing and administration system on the safety and quality of medication administration in a UK hospital. Setting: Surgical ward in a teaching hospital. Method: Data were collected before and after introducing a closed-loop system comprising electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration records (ServeRx, MDG Medical). We observed medication administration during drug rounds and assessed medication administration error (MAE) rates for ward-stock and non-ward-stock drugs, accuracy of medication administration documentation, timeliness of administration, administration of medication from unlocked areas and supervision of patients taking oral medication by nursing staff. Key findings: Pre- and post-intervention MAE rates were 6.4 and 2.3% respectively for ward-stock drugs (95% confidence interval for the difference (CI) -5.8 to -2.4%), and 14.6 and 13.7% for non-ward-stock drugs (CI -6.5 to 4.7%). Excluding omissions due to unavailability, pre- and post-intervention MAE rates were 6.2 and 2.2% respectively for ward-stock drugs (CI -5.7 to -2.3%), and 9.2 and 3.5% for non-ward-stock drugs (CI -9.3 to -2.1 %). Pre-intervention, 2086 doses (96.3%) were documented correctly and 1557 (95.9%) post-intervention (CI -1.6 to 0.8%). There were five clinically significant documentation discrepancies pre-intervention (0.2%), and 33 (2.0%) afterwards (CI 1.1 to 2.5%). Timeliness of administration improved post-intervention (P < 0.001; Chi-square test), as did administration of medication from unlocked areas (CI 4.7 to 7.3%) and supervision of patients taking oral medication (CI 17 to 23%). Conclusion: Reductions in MAEs, excluding omissions due to unavailability, occurred for both ward-stock and non-ward-stock drugs. The system also improved timeliness and security of drug administration. However, there was an increase in potentially significant documentation discrepancies.