Authors (including presenting author) :
Lui CT(1), Poon KM(2), Ching WM(3), Yu WH(1), Chan CC(1), Wong SY(2), Lam WM(2), Lai SO(2), Chan WL(2), Tang H(2), Leung WY(3), Wong WM(3), Lee LY(2), Lau CL(1)(2)(3)
Affiliation :
(1) Department of Accident and Emergency, Tuen Mun Hospital
(2) Department of Accident and Emergency, Tin Shui Wai Hospital
(3) Department of Accident and Emergency, Pok Oi Hospital
Introduction :
Medication prescription had been traditionally handwritten in emergency departments (ED) in the Hospital Authority and checking of drug interaction & allergy was manually by ED staffs. Medication incidents had been recurrent in ED. For medication related serious untoward event (SUE), 12% occurred in ED from 2010-16. Within, one-third are drug-allergy related.
Objectives :
To implement an e-prescribing system along with standardized workflow for universal drug prescription in triage category 3 to 5 patients in emergency departments
Methodology :
The e-Prescribing system, AMOE, was implemented sequentially in TSWH, POH and TMH in March, November and December 2017 respectively. AMOE interfaced in the Clinical Management System for prescription. It provides allergy and drug interaction real-time automatic cross-checking with the patients’ profile. Standardized medication administration record (MAR) would be printed upon completion of prescription. Standardized drug templates were set up for common prescriptions in ED to reduce prescription errors. All drugs prescription for patients of triage category 3 to 5 would be mandatory to use the system. An audit was carried out before implementation of AMOE (pre-AMOE period, Jan 2015 to the month before implementation), and after implementation (post-AMOE period, from date of implementation to October 2018). Data was retrieved from the NTWC Q&S registry for both periods with same methodology. All incidents of near-miss, reached patients and SUE were recorded and compared.
Result & Outcome :
The number of patients of triage category 3-5 in pre-AMOE and post-AMOE period were 920,583 and 374,849 respectively. The number of medication incidents per 100,000 patient attendances reduced from 3.0 to 2.4 after implementation of AMOE while that of medication-related SUE dropped from 0.74 to 0.26. Further breakdown analysis revealed elimination of incidents of drug allergy, adverse drug reaction and prescription error, while the incident rate of missing dose, wrong route and patient misidentification remained unchanged. Implementation of AMOE as e-Prescribing system could effectively reduce medication incidents related to prescription error, drug allergy and adverse drug reactions. Further system enhancement to cover patient identification and closed-loop communication to prevent missing dose would be warranted. The current e-Prescribing system is considered not suiting the requirement and workflow in resuscitation room for triage category 1 and 2 patients which would require a standalone consideration for probable solution.
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