Background It has been demonstrated that assisted electronic prescription (AEP) is an effective measure of reducing medication errors. It is necessary to correct parameterisation of the system, adapting it to the peculiarities of each clinical unit.
Purpose To establish parameterisation requirements of an AEP tool, prior to implementation in a psychiatric service (PS).
Material and methods From the AEP (Mira) programme, we proceeded to make decisions for adaptation of the PS; 30 beds belonging to a reference hospital area acted as a pilot for the implementation of the AEP in all of the hospital. Firstly, we performed an analysis of service needs according to consumption of drugs during the previous year (class of drugs, routes and hours of administration). Later, we took parameterisation decisions: (1) to facilitate prescription/administration, such as regular dosing schedule, preconfigured protocols, information about restrictions drugs and administration instructions; (2) to provide safe prescriptions, such as, maximum dose alerts, drug interactions (DI), high alert medications (HAM) and narrow therapeutic margin (NTM).
Results During the previous year, the PS had used 151 active substance, 487 products and 73 699 dispensation units. 85% of the prescribed drugs belonged to 3 therapeutic groups according to the ATC classification: N-nervous system (43%), C-cardiovascular system (23%) and A-digestive system (19%). 76.3% of drugs were administered orally, followed by intramuscularly (7%). It was possible to parameterise default regular dosing schedule in 59% of medicines. Most administration instructions were related to oral administration: 25.3% with food and 16.3% without food. Furthermore, 3 protocols for clinical condition were created: ‘if agitation’, that included haloperidol, biperiden and clonazepam. Finally, to improve safety, we selected 6 DI considered clinically relevant and established maximal doses in 70.2% of active substances according to the technical data sheets. We discarded incorporation of all alerts of HAM or NTM to reduce saturation and increase effectiveness of those selected.
Conclusion We consider that parameterisations can facilitate previous work on implementation in other units, adapting the tool to the peculiarities of each service. PS benefits from the existence of a regular dosing schedule for most drugs. However, their prescriptions are not easily protocolised. We have highlighted a large number of drugs with maximum established dose, which can be useful to the prescriber who caters for chronic patients, whose reason for hospitalisation is often therapeutic failure which could lead to an excessive increase in doses.
No conflict of interest