Page 142 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F4.2 Clinical Safety and Quality Service II 16:15 Room 421

To Safeguard Unintentional Repetition of Drug during Transition of Care in Medication Order Entry
Chan JKY, Pang JYW, Cheung NT
Health Informatics Section, Information Technology and Health Informatics Division, Hospital Authority Head Office, Hong Kong

Introduction

There was a number of medication incidents related to unintentional repetition of drugs during transition of care. Hospital
Authority Clinical Management System (HA CMS) Medication Order Entry (MOE) provided the flexibility of repetition of drugs
in busy clinical environment. However, the convenience also created unintentional prescription of drugs and medication
incidents.

Objectives

To mark discontinuation in corresponding drug item explicitly in MOE in order to avoid unintentional repetition of drugs in next
consultation or transition of care.

Tuesday, 3 May Methodology

When doctor decided to discontinue a particular drug explicitly due to whatever clinical reason, the corresponding drug item
in previous prescription history was allowed to mark discontinuation in MOE. The drug item with strikethrough effect would
be shown in both MOE and Electronic Patient Record (ePR) with reason of discontinuation shown. The corresponding drug
item would not be allowed to repeat automatically in next consultation or during transition of care. Moreover, the discontinued
drug item in all CMS printout with medication included would also be shown with strikethrough effect.

Results

Explicit discontinuation of medication was piloted in Kowloon East Cluster in August 2015 and further rollout in remaining
six clusters in November 2015. There were t512 drug items in total marked discontinued explicitly as of 4 January 2016.
Nine drug items (1.76%) were discontinued explicitly by Accident and Emergency Department; 15 drug items (2.93%) were
discontinued by Community Geriatric Assessment Team; 234 drug items (45.7%) were discontinued by General Outpatient
Clinic; 61 drug items (11.9%) during in-patient management while 193 drug items were managed in Specialist Outpatient
Clinic. Case examples for illustration: Patient with multiple medical problems - presented with retrosternal chest pain with
cardiac catheterisation done in August 2015 was managed by family physician (FM). Elantan was off and changed to ACEi
by cardiologist. He explicitly discontinued Elantan which was prescribed by FM on last FM follow-up (25 June 2015) so that
FM would not repeat Elantan during the next FM follow-up. Patient with percutaneous cardiac catheterisation (PCI) done
and planned to have one year Clopidogrel with the whole course, Clopidogrel was marked discontinued in order to prevent
unintentional repeated prescription in subsequent follow up. Solely discontinuation to prevent unintentional repetition of
drugs was the first step of medication reconciliation. Safety message for doctor upon prescription of a drug item marked
discontinued explicitly would be included in next phase of enhancement.

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