The scale of medication errors has long been recognised by the World Health Organisation, which says they are a leading cause of injury and avoidable harm to patients in healthcare systems. Globally, they cost providers an estimated $42 billion every year.
While many hospitals have invested in electronic prescription systems, their unaligned workflow and lack of EMR integration mean that they are rarely providing support at essential touchpoints throughout the patient journey.
A survey carried out among European hospitals by The European Collaborative Action on Medication Errors and Traceability (ECAT) discovered that while 94% have electronic prescription systems, only 20% of them are integrated with a Clinical Decision support system. This existing technology is not being used to address medication errors effectively.
A widespread problem
The problem of medication errors is far reaching, says Christian Cella, vice president, Wolters Kluwer Clinical Effectiveness. It exposes weak points throughout the patient journey, from sub-optimal automation to a lack of integration of comprehensive drug data within the EMR, which could help reduce alert fatigue and patient risk. It also has a negative impact on efficiency in the prescription workflow.
“In some geographies the problem is either under-estimated or not addressed at government level. But it should be mandated as part of the digitalisation of a country in public and private health,” he says.
According to Cella, even when digital solutions are implemented, they are inadequate for the task. “Sometimes they create what I call a ‘boomerang’,” he adds.
“They are so busy screening from multiple angles that they create too many alerts for doctors that are not specific, too generic, and physicians are getting annoyed by the information they are given. This can result in what we term ‘alert’ fatigue’, where clinicians start to override and potentially disregard critical alerts. These systems are contributing to burnout instead of supporting the clinician through the decision-making process. That is the opposite of how it should be.”
Hospitals can address one of the weakest links in patient safety and quality of care if they put advanced medication decision support at the heart of their digital maturity strategies. When they do, the benefits can extend well beyond immediate improvements in the patient experience.
If an advanced medication decision support system is fully integrated with the hospital’s EMR and prescription workflow, it will help clinicians to improve their decision making. It will also help the hospital to achieve greater efficiency and time-saving steps throughout the care continuum.
Cella says that integrating precision medicine with digital maturity models like EMRAM 7 will help to drive the adoption of technology to support clinical decisions. Crucially, it moves digital maturity assessment on from being a process audit check to measuring the impact of medication decision support through data tracking.
If hospitals can show how they manage patient risk effectively, prospective patients will feel more secure.
Rising to the challenge
Wolters Kluwer has built its Medi-Span® Clinical APIs drug data solutions and expert services around the quality and precision of alerts, and integration with workflow for decision support, ensuring that accurate information is available at key touchpoints rather than reported after the event.
National Cheng Kung University Hospital (NCKUH) in Taiwan has used Medi-Span Clinical APIs to overcome specific challenges faced by its clinicians and pharmacists. For pharmacists, one of the most significant tasks is the amount of time it takes to maintain and update a medication database.
This is eased by using a platform supported by a multidisciplinary editorial team that ensures the content is up to date with best-practice evidence and recommendations. Medi-Span’s databases are continuously updated so that all the system’s users have access to a global perspective on current regulations, medication use and safety advice.
For NCKUH, the use of advanced medication support technology has shown that, when led by a dedicated team and championed at all levels in the hospital, it will help prevent errors and increase operational efficiency.
The hospital found that since implementing Medi-Span the number of alerts has been reduced by 21%, and those alerts have captured more severe potential Adverse Drug Events (ADEs). This saved approximately NT$558,000 over a five-month period — equivalent to NT$1.39 million (US$39,200) a year. The reduction in ADEs also saved an estimated 111 bed days in the same period, equivalent to 266 bed days a year.
“The most important task for pharmacists is maintaining medication safety,” says NCKUH’s director of pharmacy Cheng Ching Lan. “With its advanced features and knowledge base, this system will become invaluable in supporting clinicians’ decisions, reducing alert fatigue, and improving clinical effectiveness. With successful implementation in NCKUH, I look forward to big improvements in the pharmacies across Taiwan.”
Improving patient care by giving system users access to a single information source to standardise drug administration, and customise and minimise alerts, has also been at the heart of the Ministry of National Guard Health Affairs’ (MNG-HA) digital health strategy in Saudi Arabia. This is an example of the best practice approach to digitisation and patient care which is informing the kingdom’s drive to reach HIMSS EMRAM 7 for all its hospitals.
Many healthcare providers including most of the leading private sector hospitals and over 30% of Saudi Ministry of Health hospitals are now using Medi-Span. The benefits of moving the complete prescription and drug administration process to a standardised cloud-based model are influencing strategy at hospitals and national levels.
A unified approach
“The system gives us a standardisation,” says Dr. Saad Daifallah Nofai, director, corporate clinical information management systems and acting director of health informatics development at the Ministry. “Medication, drug history, references and precautions come in a dynamic chain of information — and nobody can keep it all in their mind. This gives us a single trusted reference. We are trying to minimise the error to zero, and we are almost there.”
He advocates the committee-based approach to implementing an advanced clinical drug screening system, ensuring that it meets the needs of every clinical stakeholder — effectively creating a hybrid organisation between clinical speciality and IT speciality.
“This is not a matter of technology — it’s science,” he says. “It brings together the physician, the nurse, the pharmacist, the IT expert and the informatic professional, with the goal of covering every aspect of automation.”
Information for healthcare professionals only. Medi-Span® Clinical APIs is a CE-marked medical device. Before use, please carefully read the warnings and instructions for use. In Europe, Medi-Span Clinical APIs are only available in Belgium and Italy as of June 2022.