Background Drugs continue to be prescribed manually for hospitalised patients, despite the existence of high medicines error rates and a subsequent transcription to pharmacists and nurses being required which is also subject to errors.
Purpose To describe the implementation of a pharmacotherapy management system (from prescription to confirmation of administration) in a tertiary hospital and to make an initial evaluation.
Materials and methods Phases:
Installation and adaptation of master files for managing pharmacotherapy – Silicon v.8.65 -and initiating connectivity with Mercurio v.2.12 – management of automatic picking cabinets and Gacela v.1.18 – nursing module, to evaluate incidents and areas for improvement;
Creation of the working team, implementation of pilot ward and expansion. Evaluation: percentage of beds included in the system and impact of implementation on drugs requested but not sent to the clinical unit in unit doses. Data sources: Silicon and application computer recording entry to the pharmacy service.
Results Period: January/2012–March/2013.
Phase 1) January–September/2012. Training given to pharmacists. Adaptation of files. Verification of operation during pharmaceutical transcription, monitoring connectivity with Gacela in pilot wards with electronic confirmation of administration by nursing staff
Phase 2) October/2012–March/2013: The multidisciplinary team defined the responsibilities in the configuration of access to the system, user support, contingency plans and a time schedule for the implementation process. Pilot ward: training of practitioners with classroom sessions (+quick reference manuals) over two consecutive days, followed by full time support by 4 pharmacists. During this period, all prescriptions were done electronically between 8.00 am-3.00 pm, with manual prescriptions using the printed sheets during the on-call schedule (with transcription and validation by the duty pharmacist). At the same time, the nursing management was in charge of providing training in the Gacela system. After one week, the administration of medicines was prescribed and confirmed electronically over the entire 24-hour period, eliminating the unit dose prescription sheets and the nurses’ record book on ward. This implementation schedule was then passed on to other clinical units.
Five months after implementation, 258/981 beds have been included in the electronic prescription system (31%). The average number of drugs requested but not sent to the clinical unit in the initial phase was 448.13/month, compared to 333.2/month during the implementation phase (p = 0.045).
Conclusions The implementation process took place smoothly and was well accepted, improving communication between the multi-disciplinary team responsible for the patient. The electronic prescription and elimination of paperwork has improved the quality of prescriptions in qualitative terms, preventing errors due to omission and misinterpretation by optimising doctor-pharmacist-nurse communication. There has been a significant decrease in drugs requested but not sent to the clinical unit in the pharmacy service.
No conflict of interest.
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