Electronic medication management systems are not a panacea for unnecessary hospital drug deaths, with poorly implemented systems creating their own errors, according to an updated guide by the Australian Commission on Safety and Quality in Health Care.
 
Launched today as part of federal and state government efforts to reduce drug deaths caused by clinical error, the third edition of the Electronic Medication Management Systems: A guide to safe implementation has looked into Australian hospitals using EMM to see quality isn’t guaranteed.
 
Medication errors are the second most common
 type of medical incident reported in health organisations, and omission or overdose of a drug is the most frequent type of medication error, the guide claims. 

 
Poor handwriting on prescriptions, inaccurate dispensing and inappropriate administration to patients are some of the causes of adverse drug reactions.
 
Effective EMM systems use IT to automate medication ordering processes and produce standardised, legible and complete orders, the Commission states. Combining EMM systems with clinical decision-support systems can lead to even fewer mistakes.
 
But the guide says systems that are not well planned, supported by appropriate governance and training, or linked to other clinical information systems can introduce new types of medication errors.
 
“Poorly implemented projects and systems in any sector can introduce errors. The guide draws attention to the importance of rigorous project planning and implementation to minimise the introduction of errors,” the Commission’s Senior Medical Advisor Professor Anne Duggan told Healthcare IT News Australia.
 
The guide claims poor implementations were caused by factors, including:
 

  • Insufficient involvement of CEOs and executive teams
  • Lack of engagement by senior medical staff, with many decisions left to EMM implementation teams 

  • A short-term focus on the EMM implementation with a tendency to ‘set and forget’ once the system had been implemented when that should be the starting point for systematic and ongoing improvements
  • Slow progress in linking medication data with electronic health records to support clinicians 

  • Underuse of analytics for continuous quality improvement
  • Insufficient funding for EMM systems, particularly ongoing maintenance, support, refinement, and ongoing education and training. 


 
Electronic Medication Management Systems: A guide to safe implementation includes guidance on scoping, system selection, configuration, implementation, training and ongoing operation.
 
“Hospital medication management is a complex process involving many steps – prescribing, dose calculation, dispensing, preparation and administration. In addition, hospital patients are often on multiple medications, and have complex conditions,” Duggan said.
 
“EMM can improve medication safety by enhancing legibility, traceability, reminders and decision support.”
 
She said successful EMMs significantly decrease prescribing errors for hospital inpatients related to incorrect documentation, but the transition away from paper-based systems will take years.
 
“Paper-based systems will remain a part of medication management in many Australian hospitals for some time. Replacing paper charts with well-implemented electronic medication management systems and electronic medical records is complex,” she said.
 
“It requires work practice and cultural changes, and has to be accompanied by significant investment in computers, training and in the hospital’s IT infrastructure. For this reason, the transition to EMM in Australia will take place over several years.”
 
The guide says the Australian Digital Health Agency’s My Health Record will contribute to the interoperability of medication information. 

 
“The complete exchange of structured and coded medication information between the My Health Record system and EMM systems is not yet fully functional. However, an EMM system can use the existing information in the My Health Record system to streamline and improve medication reconciliation,” the guide says.