The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [519]
Box 13.3 Benefi ts of e-prescribing systems
The Connecting for Health programme has outlined the benefits of e-prescribing systems as:
computerized entry and management of prescriptions
knowledge support, with immediate access to medicines information, for example British National Formulary
decision support, aiding the choice of medicines and other therapies, with alerts such as drug interactions
computerized links between hospital wards/departments and pharmacies
ultimately, links to other elements of patients’ individual care records
improvements in existing work processes
a robust audit trail for the entire medicines use process
a reduction in the risk of medication errors as a result of several factors, including:
– more legible prescriptions
– alerts for contraindications, allergic reactions and drug interactions
– guidance for inexperienced prescribers
– improved communication between different departments and care settings
– reduction in paperwork-related problems, for example fewer lost or illegible prescriptions
– clearer, and more complete, audit trails of medication administration
– improved formulary guidance and management and appropriate reminders within care pathways.
(www.connectingforhealth.nhs.uk/systemsandservices/eprescribing)
A growing number of hospitals in the UK have introduced e-prescribing systems. One major motivation for introducing them is to improve the safety of medicines used and reduce the current and unacceptable levels of adverse drug events. In a systematic review, nine of the 13 studies demonstrated a significant reduction in prescribing errors for all or some drug types when electonic prescribing was used (Reckmann et al. 2009).
‘Verbal orders’
The NMC (2008a) clearly states that a verbal order is not acceptable on its own. ‘In exceptional circumstances, where the medication (NOT including controlled drugs) has been previously prescribed and the prescriber is unable to issue a new prescription, but where changes to the dose are considered necessary, the use of information technology (such as fax or e-mail) may be used but must confirm any changes to the original prescription’ (NMC 2008a, p. 32). This should be followed up by a new prescription confirming the changes, signed by the prescriber within a maximum of 24 hours. The changes must be authorized before the new dosage is administered (NMC 2008a).
Nurse prescribing and patient group directions
As nurses have undertaken increasingly specialized roles, the need for them to have powers to prescribe has become more apparent. The report of the Advisory Committee on Nurse Prescribing (DH 1989) initially recommended a limited nurses’ formulary for district nurses and health visitors. The Medicinal Products: Prescription by Nurse, etc. Act (1992) granted the statutory authority for this to occur. The Crown Report (DH 1989) also recommended that doctors and nurses collaborate in drawing up local protocols for the administration of medicines in situations that would benefit specific groups of patients, for example those requiring vaccinations.
The practice of prescribing under group protocols became widespread across the NHS, and they were used to support initiatives such as nurse-led clinics (Laverty et al. 1997, Mallett et al. 1997). The legality of this practice was then questioned. Section 58 of the Medicines Act (1968) states that ‘no one should administer any medication (other than to himself) unless he is the appropriate practitioner or a person who is acting according to directions from an appropriate practitioner’. The terms direction and administration were open to interpretation and how they were used varied across the country (McHale 2002).
Nurse prescribing was therefore reviewed and two further reports were published:
Review of Prescribing, Supply and Administration of Medicines. A Report on the Supply and Administration of Medicines under Group Protocols (DH 1998)
Review of Prescribing, Supply and Administration of Medicines. Final Report (DH 1999).
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