While reading around issues of drug safety and electronic prescribing I found this article in Archives of Disease in Children entitled “The pros and cons of electronic prescribing for children”, it caught my attention as electronic prescribing is now being developed in a number of local hospitals. This review article by a team from the Liverpool area looks at the practicalities, pros and cons and some of the statistics around electronic prescribing.

A study across 5 London hospitals showed a 13.2% error rate in prescriptions for children. This is an unacceptably high rate of prescription errors, but when you consider than paediatric prescriptions are complicated, compared to adults, by dosings calculated on age, weight and even body surface area calculations, with different formulations being licenced for different age groups you can start to see how errors can occur.

Perhaps electronic prescribing is not all its cracked up to be… If I prescribe 300mgs of amoxicillin then the nurses can select from strength and formulations in the drug cupboard. But if I prescribe a particular formulation, and it’s unavailable, should an equivalent dose of an alternative strength be given, or should the child miss their dose? The child may be asleep, off the ward, or simply refuse their medciation at the time it is prescribed, and so the dose is given later to catch up – currently the nurses can hand annotate the drug card to indicate this, but would electronic prescribing permit this? For a child with intermittent vomiting I may prescribe 2 formulations – one to be given if the child is not vomiting, the other for if they are – would the computer detect this as a double dose and not allow my prescription?

But then consider the potential of an electronic system… the potential for automatic safeguards on dosages (for example to prevent prescribing of massive overdoses), No more problems with reading doctors handwriting or misreading of numbers leading to dosing errors, the opportunity for the system to flag up known interactions between drugs that the doctor may be unaware of or have overlooked, the ability to prevent prescription of drugs to which the patient is allergic (the classic example being the patient with anaphylaxis to penicillins and the doctor who doesn’t realise that Tazocin contains a penicillin based drug), No more missing drug cards because its lost into another patients notes or borrowed by a student writing a coursework piece on the patient.

The full text of the article contains further information on the pros and cons as well and some interesting statistics about reduction rates in errors before and after systems are introduced (interestingly one study showed a reduction in outpatient but not inpatient errors!)

·         Where do you stand on electronic prescribing? – is it the future of medicine, or simply another gimmick?

·         Is it already in place in your place of work? – if so how do you find using it?

·         Should electronic prescribing be rolled out across the country as standard?