Unleashing the protective power of health informatics in pharmacy
Vigilant, patient-centred medicines management is the backbone of high-quality pharmacy practice.
In a contemporary healthcare environment, with an ever-expanding array of treatment options and new challenges in infectious diseases, lifestyle-related diseases and cancer, clear communication among multidisciplinary care teams, and with patients and their carers, has never been more important.
There will always be human error, but utilising health informatics — technologies to improve health and healthcare — can be a powerful weapon in reducing this risk before and during episodes of care, after patient discharge or as patients move between care episodes.
For the true potential of health informatics to be unleashed, there are three elements critical to its success.
Improve provision of information at transitions of care
The ineffective transfer of clinical information after an episode of care is a common cause of treatment disruption, leading to confusion among community‑based prescribers and pharmacists, and uninformed or misinformed patients not taking the right medicines at the right time.
In the Australian Commission on Safety and Quality in Health Care’s e-Discharge Literature Scan from 2010, one paper from New Zealand identified a total of 222 medication errors across 100 discharge summaries; 13% of the errors were serious enough to cause harm or readmission to hospital.
The transition from hospitals to community-based care is a particular concern; a common complaint among GPs is that discharge summaries arrive by post after a patient’s follow-up appointment — a frustration that is more frequent in rural and remote areas — and discharge summaries are often not posted to the patient’s community pharmacy.
Well-implemented digital health platforms — such as the encouraging but not fully realised MyHealthRecord, which received $374.2 million in further funding over the next two years in the 2017 federal Budget — give healthcare professionals real-time access to discharge summaries and clinical information regarding episodes of care, wherever they are. On-the-spot updates ensure care teams or GPs are equipped from day one to provide excellent medicines management while avoiding unnecessary and costly processes such as repeated pathology tests.
Reduce transcription errors that result in avoidable patient harm
Transcription from paper to electronic systems, and between devices, also carries high risk of error that can result in avoidable patient harm. An Australian research study showed 12% of handwritten discharge summaries and 13% of electronic discharge summaries contained an error.
A proven safeguard is a ‘closed loop’ medicines management system, which reduces the possibility of errors by removing the need for manual entry and ensuring complete interoperability of all devices. St Vincent’s Hospital Sydney saw prescribing errors reduced by 58% and serious medication errors reduced by 44% after implementing electronic medication management systems.
While requiring significant health sector investment, a closed loop electronic medication management (eMM) system allows clinicians to make decisions after reviewing total, up-to-date information on a patient’s episode of care in one place, avoiding precious time spent chasing medication charts, patient folders and ward station computers.
Assist improved clinical decision-making
A third success factor is effectively harnessing digital health platforms to trigger ‘checkpoints’ that alert specialists to prescriptions outside usual protocol, informing better shared decision-making.
In one example, as recommended following recent inquiries into inappropriate chemotherapy dosing in NSW and South Australia that potentially led to patient deaths, oncology pharmacists and heads of medical oncology would be required to review and approve off-protocol chemotherapy prescriptions, with the appropriate approval lines to override treatment protocols before treatment can be administered.
These types of time-critical clinical decision support tools will greatly improve medication safety and are better to implement than paper-based systems due to criticality of time, while providing hospital pharmacists a better platform to influence and advise on the starting, adjusting or stopping of medicines.
Even the smartest technologies need intelligent human design; focus on these three aspects of health informatics will optimise the way hospital pharmacists practise, casting an even stronger safety net around patient-centred care.
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