Prescription of medication is an essential part of the health care service delivery process. As part of the diagnosis and treatment procedure, physicians are required to provide medication to their patients. Prescription medication account for approximately 13% of the United States health care expenditure. Annually, about 65% of Americans rely on prescription medications for their health and wellness ( Patel, Ogletree, Sutterfield, Pace, & Lahr , 2016). This depicts the importance of prescription drugs in health care delivery. The dosages and type of the drugs are contingent on the type and severity of the condition. Prescription of appropriate dosages and compliance with the prescribed regimen significantly influence the clinical outcomes.While clinicians strive to ensure that they provide the most appropriate and effective prescriptions for the amelioration of the patients’ symptoms, incidences of errors in the prescription still occur. There is a high prevalence of prescription medication errors, which often have undesirable outcomes to the patients. Health practitioners and policy makers have attempted to adopt the use of technology in practice to curtail these errors. Computerization of the prescription process is one of the essential health information technology components that enhances efficiency in care delivery (Patel et al., 2016). Electronic prescribing (e-prescribing) is the application of a computerized software in the ordering of medication dosages for the patients.
Background of Prescription Medication Errors
Federal laws on the prescription of medication provide that only licensed practitioners are mandated to dispense medication. These laws are aimed at curbing the potential dangers of medication and complications related to prescription errors. Despite the safety nets and regulations put in place, patients are still highly susceptible to the potential harm of medication and dosage errors. Adverse drug events (ADEs) are the complications that arise from the erroneous administration and use of prescription medication ( Tariq & Scherbak, 2019). Often, patients and practitioners may be ignorant of the potential problem following a prescription. This is because some of the errors are caused by negligence of the practitioners or misunderstanding between the physician, pharmacy, and the patient. There are approximately 6,800 prescription medication in the US, with a further thousands of health supplements, portions, and herbs ( Tariq & Scherbak, 2019). Given the large number of substances available at the public’s dispensation, it is possible for the practitioners to lose tract of the correct medication they should prescribe to a particular patient. Furthermore, the high interaction of these substances and the probability of concomitant administration further complicated the role of physicians and pharmacists.
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The process of medication administration involves prescribing, documentation, transcription, dispensation, administration, and monitoring. These six steps require the involvement of the practitioners. Patient compliance is an issue of concern that necessitates the involvement of practitioners, as incidences of non-compliant patients requiring close monitoring have been recorded. Medication errors can occur at any of the six points. However, prescription errors are the most common, accounting for approximately 50% of medication errors. These often involve ordering the wrong medication, dosage, or route of administration. Human problems contribute significantly to these errors. Distractions, for example, account for about 70% of medication errors ( Tariq & Scherbak, 2019). Under-staffing and high work loads make physicians engaged in a number of duties in a hospital. In the middle of one duty, they may be required to write a prescription. Lapses during drug ordering is not a factor of competency, as it may happen to the best physicians. Distortions also contribute to medication errors. These involve misunderstanding and misinterpreting the prescription due to illegible writing, improper translations, and use of inappropriate or foreign symbols and languages ( Tariq & Scherbak, 2019). In some instances, a physician may order a drug that is not available, necessitating the substitution of the drug with a similar and available option. In these instances, the nurse or pharmacist may provide a drug with a different composition. Prescription errors is prevalent, but the ADEs due to these errors are preventable.
Electronic Prescribing
E-prescribing is the computerized ordering of medication, replacing the traditional paper and fax prescriptions. A computer software is applied in the generation, transmission, and filling of the prescription. The physicians input the the required drugs and dosages in their systems, which are them relayed to the pharmacy computers. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 stimulated the adoption and growth of e-prescribing. MMA set precedence for further legislation on the adoption of information technology in health care to improve patient safety. E-prescribing solutions form part of the clinical decision support (CDS) functions that are used to enhance the effectiveness and efficiency of service provision (Patel et al., 2016). They can be used as stand-alone systems or infused into the electronic Health Record (EHR) systems in line with other CDS programs. Incorporation into the EHR system allows the care providers to access all the patient information and make informed decisions for optimum clinical outcomes. E-prescription incorporated into the EHR is thus more beneficial for both the practitioners and the hospital. Ordering a prescription requires the physician to have a better understanding of the patient’s condition and medical history. This information can easily be accessed from the patient’s chart in the EHR system. The physician may then easily add a prescription or adjust a previously prescribed drug in the patient’s chart. As a stand-alone system, e-prescription only allows the physician to make entries of new prescription orders for the patient without reviewing their medical charts (Patel et al., 2016). The Centers for Medicare and Medicaid Services (CMS) set operational standards for medical practitioners. These standards resulted in the enactment of the Health Information Technology for Economic and Clinical health (HITECH) Act of 2009, which required that medical practitioners needed to adopt EHRs in their practice (Patel et al., 2016). Nevertheless, the stand-alone system is less intricate and easier to manage in comparison to the EHR incorporated system. This means that health professionals may opt for only the e-prescribing systems if installation and operational costs become an hindrance.
There is a concern of safety when using e-prescription solutions. To limit the number of people with access to the information, an advanced electronic signature may be appended on the prescriptions. This enhances the validity of the order, as it identifies that a particular physician made the order. Besides the signature, the script much contain pertinent information such as the name and address of the prescribing physician, date, type of practitioner, name and address of the patient (Patel et al., 2016). Other requirements of e-prescriptions require that the electronic script must only be sent to the person intended to dispense the drug. Another safety concern is the type of drugs that can be prescribed electronically. The Misuse of Drugs Regulations Act of 2001 provides that e-prescriptions are not permitted for schedules 1, 2, and 3 controlled drugs. Other regulations involve the dispensation of repeatable prescriptions (Patel et al., 2016). This regulation limits the number of times that a drug(s) may be administered, prompting the need for further physician evaluation before prescribing.
The E-prescribing Solution
The e-prescribing solution to be developed will be linked to the EHR systems of the health facilities. The primary functions of the solution will be to allow the physicians to make computerized entries and manage prescriptions, decision support in the choice of appropriate drugs, and support in the patient’s administration of the prescribed drugs. To perform these functions, the solution will require electronic links between the hospital departments, robust firewall and threat protection, access protocols, and user interfaces that can be customized to suit the preferences of the users. A simplified conceptual model of the solution involves a prescriber, transcription hub, and the pharmacy. The transcription hub forms the link between all the components of the solution. This hub has the processor and master patient index, which matches and verifies all queries from the physician before relaying them to the recipient (pharmacy) ( Jakubowski, Romaszewski, Gajda, Wypyszewska, & Kielar, 2018) . In essence, the transcription hub monitors all the transactions of the e-prescribing system.
Advantages of E-prescribing
Electronic prescribing improves patient safety by curtailing medication errors and associated ADEs. Incorporating medication prescription into the EHR systems allows the health care practitioners to evaluate the prescription in relation to the patient’s presenting condition, medical history, and hypersensitivity reactions. Most e-prescribing systems are embedded with medication support systems (MDS) which allow the physician to cross check the pharmacodynamics and phamacokinetic of the drugs they intend to prescribe ( Porterfield, Engelbert, & Coustasse, 2014). This helps in making better recommendations on dosages and co-administration of drugs, thus improved patient outcomes. Porterfield, Engelbert, & Coustasse ( 2014) also point out that e- prescription has also been noted to increase patient compliance. This is achieved through timely prescription refills and prescription of less costlier formulations. The MDS-enabled automated search enables the physicians to provide generic and cheaper drug alternatives, thus making the treatment costs manageable for the patients.
E-prescribing improves efficiency and limits the errors caused by distortion. Electronic scripts are legible and require less clarifications. Besides, the nurse or pharmacist can use the MDS to cross check the drug information and determine the most appropriate substitute drug. Although making the electronic entries take more seconds than scribbling the prescription on paper, this time is compensated by the efficiency and reduced distortion of the prescription ( Porterfield, Engelbert, & Coustasse, 2014). Automated processing and paperless dispensation makes it easy for the pharmacist to match up the names of the drug and the patient details.
Limitations of E-prescribing
The e-prescribing system needs to be designed properly to prevent the possibility of errors due to alert overload ( Porterfield, Engelbert, & Coustasse, 2014). When the physician enters and sends a prescription script to the dispensing person, an alert is generated to indicate that a new prescription order has been received. Alert overload may lead to overlooking of some important information, thus increasing the chances of dispensing the incorrect medication. The type of software and hardware used in the system determines the effectiveness of the design and the prevention of alert overload.
According to Porterfield, Engelbert, & Coustasse ( 2014) , p atient confidentiality and privacy is another limitation of e-prescribing systems. Like all internet-based software, EHR is vulnerable to threats and risks of attacks, which might result in the lose or disclosure of patient information. Without robust firewalls and intrusion protection mechanisms, it may be difficult to safeguard the data in the system. This risk predisposes the practitioner and health facility to legal issues. Also, legal issues may arise due to the misuses of e-prescribing. Regulations on the prescription of scheduled drugs, in line with the requirements of the Drugs Enforcement Agency (DEA) have to be adhered to.
References
Jakubowski, S., Romaszewski, A., Gajda, K., Wypyszewska, J., & Kielar, M. (2018). E-prescription. Selected legal and functional aspects. Zdrowie Publiczne i Zarządzanie , 2018 (Numer 3), 137-148.
Patel, J., Ogletree, R., Sutterfield, A., Pace, J. C., & Lahr, L. (2016). Optimized computerized order entry can reduce errors in electronic prescriptions and associated pharmacy calls to clarify (CTC). Applied clinical informatics , 7 (02), 587-595.
Porterfield, A., Engelbert, K., & Coustasse, A. (2014). Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting. Perspectives in health information management , 11 (Spring), 1g.
Tariq, R. A., & Scherbak, Y. (2019). Medication errors. In StatPearls [Internet] . StatPearls Publishing.
