1. The Effectiveness Of Electronic Medication Management Systems And Their Impact On The Work Of Doctors And Nurses Centre for Health Systems and Safety ResearchProfessor Johanna Westbrook

2. To produce a world-class evidence base which informs policy and practice, focusing on patient safety and the evaluation of information and communication technologies (ICT) in the health sector Medication Safety and e-Health; Work Innovation and e-Health; Pathology and Imaging Informatics; Communication and Work Patterns; Continuity of Care across Health Settings 3. Can electronic medication management systems reduce medication errors? 4. 13 papers (US 6, UK 4, Europe 2, Israel 1) 9 showed significant decrease 2 decrease in some categories 2 an increase in errorsLimitations in study designs, eg only specific drugs Only 5 studies examined severity of errors Very limited evidence of effectiveness to reduce serious errors Reckmann, Westbrook et al (2009) Does computerized order entry reduce prescribing errors for hospital inpatients? A systematic review. Journal of American Medical Informatics Association. 16 (5) 613-623. 5. Controlled Before & After study to assess whether commercial e-MMS are effective at reducing prescribing errors2 Hospitals2 Systems6 wards 6. Daily chart review to identify prescribing Errors Average of 8 weeks per ward; Extensive inter-rater reliability testing; kappa 0.82-0.84Study sample: 3291 patient admissions reviewed Total 17,100 errors identified and classified 7. Procedural prescribing errors Unclear order Incomplete order Illegal orderClinical prescribing errors Wrong drug Wrong dose/volume Wrong rate/frequency Wrong route Wrong formulation Wrong timing Wrong strength Wrong patient Drug not prescribed Drug not indicated Drug-drug interaction Duplicate therapy Allergy Inadequate monitoringSystemrelated errors Errors related to the design or functionality of the system. Errors which would not occur in a paper-based system 8. 5. Insignificant Incident is likely to have little or no effect on the patient4. Minor Incident likely to lead to an increase in level of care eg investigations, review or referral3. Moderate Incident likely to lead to permanent reduction in bodily functioning, increased length of stay, surgical intervention2. MajorIncident is likely to lead to a major permanent loss of function1. SeriousIncident is likely to lead to deathTwo pharmacists independently rated the severity of all errors All errors rates 2 were reviewed by a clinical pharmacologist 9. Cerner Millenium PowerOrders CSC Medchart Differences in the general approach to prescribing Cerner - focus on the selection of pre-populated order sentences from drop down menus Medchart emphasis of construction of ordersentences from drop down menus 10. Total prescribing error rateProcedural error rate Clinical error rateErrors/admission N=number of errors Hospital A Hospital B 1045 admissions 878 admissions 7.65 3.62 (95%CI: 6.83-8.47) (95%CI: 3.30-3.93) N=7992 N=3176 5.63 (95%CI: 5.01-6.26) N=58882.66 (95%CI: 2.43-2.90) N=23372.01 (95%CI: 1.73-2.30) N=21040.96 (95%CI: 0.84-1.07) N=839 11. Hospital A 28 per 100 admissions (n=296, 22-35) Hospital B 26 per 100 admissions (n=226, 21-31) 12. Prescribing errors per hospital admission Intervention Pre Post P value Wards 1 6.25 2.12