Why is eMR important?
Traditionally, there is a relatively high rate of medication error when a patient moves from care settings, for example when the patient is admitted to hospital, when transferred between wards in hospital, and when discharged from hospital, and this can lead to unintended harm to the patient.
The potential for harm to patients has been highlighted by studies undertaken by Counties Manakau DHB (CMDHB) and Waitemata DHB. CMDHB studies showed that:
- most hospital patients are taking at least 5 different medicines
- 70% of patients had at least one medication error on their inpatient medication chart on admission to hospital compared with what the patient actually took in the community
- for each patient, on average 2 medicines are found to be different on admission compared to what the patient was actually taking
- for each patient, 7 medicines are changed during their hospital stay
Further research at Waitemata DHB, focused on the electronic discharge summary (EDS), showed that 20% to 43% of all Electronic Discharge Summary (EDS) documents had medication errors. These errors translated to errors in the prescription for patients and the errors were communicated to general practitioners (GPs).
What have we done?
Waitemata DHB joined with CMDHB in a collaborative to pilot eMR. An eMR system was developed, building on the success of a paper-based medicine reconciliation process.
At Waitemata DHB, paper-based medicine reconciliation is currently undertaken for nearly all patients on admission to North Shore and Waitakere Hospitals. This is resource intensive involving clinical pharmacists collecting information about the patient’s current medications and any allergy/adverse drug reactions (e.g. asking the patient, looking at what the patient brought into hospital, ringing the patient’s GP and patient’s community pharmacy), comparing this information with the medications recorded in the patient’s paper medication chart, and reconciling any differences.
The electronic medication reconciliation (eMR) process
The eMR system helps hospital clinicians build accurate medication lists by importing electronically an updateable list of the patients medications straight from sources such as TestSafe, which holds community pharmacy dispensing information.
When a patient is ready for discharge, the eMR system list generates a summary table within the patient’s electronic discharge summary (EDS). A traffic light colour coding system is used to indicate any changes made to a patient’s medication during the admission, and the reasons for any change must be documented. The traffic light colour coding system is:
- green / go = new medications have been started
- amber / change = a dose change
- red / stop = a medication has been stopped
- purple = medications that have been withheld
The same colour coding is used to communicate electronically changes to a patient’s medications when the patient is transferred from one ward to another.
Electronic discharge summary medication changes table
A copy of the EDS is provided to the patient and a copy is sent electronically to the GP’s patient information management system. The eMR system also generates detailed discharge prescriptions for community pharmacists.
eMR was introduced in four Health of Older Adult wards in March 2010. Information handouts and one-to-one training was provided to prescribers from pilot areas prior to go-live, although training requirements were minimal as users found the software was easy to use and reflected the paper-based MR process.
Where to from here?
eMR has been successfully implemented in the four Health of Older Adult wards and in our renal inpatient services, amounting to approximately 140 beds. Plans to implement eMR in our cardiology services have been delayed while we await the release of updated software. We anticipate eMR will be implemented in the cardiology services during October 2013.