OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• prescribing medications in Australia

• the computer program will restrict access to the prescription printing module to authorised persons
• prescriptions will be generated only by authorised persons
• prescription will either be printed with the prescriber's name, practice address and contact telephone number
• prescription will be personalised to the prescriber by the addition, at the time of printing, of the name of the prescriber below the last prescribed item when the prescription is being generated
• the prescriber will sign, in his or her own hand writing, the prescription form beneath and as near as practicable to the last item on the form.
• the prescription will not be pre-signed
• the total number of items prescribed on the prescription will be either stated on the prescription, or the area on the prescription below the prescriber's signature will be scored, hatched, or otherwise marked in some way to prevent any other item being printed in that area
• the particulars of any prescription issued will be included in the clinical or medication record of the person for whom the prescription was generated
• the clinical or medication record of the person for whom the prescription was issued will be preserved for at least one year from the date on which the prescription was generated and will be capable of being accessed when required.
• alterations will not be made to the printed prescriptions - if alterations are needed, a new printed prescription will be generated and the old one destroyed.

• only one item appears on the prescription
• prescriber will write in their own hand writing all particulars required by Regulation (other than the date, patient's name and address), including:
  • name of the substance or product containing it
  • the strength
  • the quantity being prescribed in both words and figures
  • adequate directions for use
  • the number of repeats authorised in both words and figures
• the software program will automatically indicate that such hand writing is required

• legibility of prescriptions
• ability of the software to alert the prescriber of relevant allergies, drug interactions, current medications and medical conditions.
• ability of the software to rapidly provide PBS prescribing information, available strengths, repeats, etc, as well as the need for PBS authority.
• improved documentation of current and past medications on medical referrals or discharge letters.
• improved pharmacy efficiencies
• potential to incorporate care plans and best practice information
• potential for improved auditing and research

• accidentally selecting the incorrect strength or medication - it is the prescriber's responsibility to ensure it is correct!
• accidentally prescribing for the wrong patient on the computer system - a particular risk in hospitals where doctors are managing a number of patients concurrently
• need for contingency plans for system outages such as by viral attack, computer system failure or power outages.
  • this is not insignificant if there are no paper records for prescribing such as may occur in an hospital environment where patients are needing ongoing medication administration which is dependent on electronic data.
• change management risk
  • introduction of ePrescribing into a hospital environment has massive change management issues
    • will there be sufficient computer terminals located where needed for both doctors and nurses to function efficiently
    • will there be an efficient manner of logging a user on and ensuring the user is logged off to prevent unauthorised prescribing, and will this system function 24×7?
    • staff will inevitably be required to change how they work
• potential inefficiencies in medication prescribing and administration
  • no longer will a nurse be able to bring a medication chart or iv fluid order chart to a doctor and have him quickly write an order - this is particularly a problem with all those iv fluid orders
  • it is doubtful, ePrescribing will bring ANY benefits to the ED resuscitation room for patients requiring immediate treatment before they are placed on the computer system, and perhaps worse, all medications given during a resuscitation will need to be retrospectively entered into the computer system as well as manual recording on paper at the time.
  • nurses and doctors will need to access the computer system at the bed side to administer medications and iv fluid orders rather than just a piece of paper.
• expense of the software, its maintenance, the required hardware and its maintenance and timed replacement schedule.

• Med. Board Vic bulletin March 2009 (pdf)