The importance of using digital drug-charts

Tablet pc on a drug trolleySince November 2007’s debacle at Whitehall when two CDs with the bank details of 25 million people went missing we have seen many examples that demonstrate just how important the security of sensitive information should be in large organisations.

Despite this, arguably the single most important document for providing treatment in hospitals throughout the UK, containing highly sensitive patient information, is still kept freely accessible by any passer-by.

I am of course referring to drug-charts, used on the ward both day and night in hospitals of every size and specialty. And while the information security issue may be one argument for computerised medication administration, there is a second, even more compelling, argument.

The need for computerising medication administration, and indeed all of medicines management as a healthcare discipline, derives from one all important fact: the prescribing and administration of drugs is a potentially risky undertaking where errors can kill.

The information held within a drug chart affects everyone – especially patients – because the simple fact is that not everything that is prescribed is administered, and not everything that is administered has the desired effect.

There are a myriad of reasons why doses are not administered, and when doses are given the unpredictable nature of life on a ward means that doses are altered and may be administered at a different time to that prescribed.

With an almost infinite number of variables relating to groups of people interacting to co-ordinate the usage of medicines, this last link in the drug supply chain to the patient contains the highest number of potential risk-points for things to go wrong.

One of the key targets of the health service’s modernisation drive is to do away with hand written paper documentation. The endless opportunities for introducing errors by having to transcribe information by hand, working with multiple or dated versions of documents, analysing dense tables of signatures and crib-notes is enough to give any hospital legal advisor sleepless nights.

Despite the known benefits, the glaring safety risks and the fact that drugs make up the 2nd largest NHS recurring cost to any hospital, organisations with comprehensive strategies on using IT for end-to-end medicines management are few and far between.

Properly used, electronic administration systems provide an immediately accessible record of treatment that reflects what has actually happened, at the time it happened, with legible notes and identifiers of staff involved. Electronic administration can also pro-actively advise on the doses that need to be administered at any time rather than relying on a human to search and decipher the chart to determine the needs for an individual patient.

In today’s information sensitive, risk averse and safety focussed world, this situation is far too important to be ignored and yet, is still mostly overlooked. A state of affairs even more inexcusable considering the technology for capturing and securing the information and doing away with all these issues exists and is readily available.

Massive resources and effort have been put into providing the usual building blocks for hospital computerisation: creating electronic patient-records, deploying order-communications for pathology, imaging and e-prescribing requests, refreshing various departmental systems for key services, and developing a data warehouse for somewhere to store it all.

And all this is happening while one of the most detailed and intensely personal sources of patient and drug information, which forms a rich and regularly used part of the clinical record, is still left freely available at the end of a bed to be updated with a scribble.

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