Human error removed from equation

Doctors' scrawl could be thing of the past

MARYKE PENMAN
Last updated 05:00 03/12/2013
Waitemata  District Health Board

MOBILE MEDS: Waitemata District Health Board e-prescribing project leader David Ryan, left, with nurse Anne Leightonusing a Computer on Wheels at North Shore Hospital.

Poor Handwriting
SHODDY STUFF: Some examples of doctors’ prescriptions with poor handwriting.

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All it takes is shoddy handwriting on a prescription to cause serious injury or even death.

But a shift to computerised prescribing at Waitemata District Health Board is improving patient safety by taking human error out of the equation, project leader David Ryan says.

"One case we've seen was when a doctor had prescribed 2.5mg of a medication, but when the nurse read it she saw 25mg," he says.

"The decimal point was barely legible.

"When you are potentially administering 10 times the prescribed dose because of poor handwriting that's a huge concern," Dr Ryan says.

Doctors and nurses are using mobile computer stations across 210 beds throughout the Waitemata health board.

North Shore Hospital first introduced the Computers on Wheels or "CoWs" in November last year as one of three hospitals in a national pilot.

Dr Ryan says the system will be rolled out to Waitakere Hospital by early next year.

The investment has ultimately saved lives.

Waitemata health board alone prescribes 4.7 million doses of medicine a year, Dr Ryan says.

"With that level of workflow you are bound to see some human error creep in.

"Since bringing in the CoWs we have seen a significant reduction in the reporting of incidents."

Medication errors were the third leading cause of death or injury in New Zealand hospitals in the year ending June 2012, according to the Health Quality and Safety Committee. There were 91 reported deaths and a total of 360 serious incidents across the 20 health boards in New Zealand. 

"The big thing is it has increased legibility of prescriptions. Doctors' handwriting in general is atrocious," Dr Ryan says.

The e-prescribing software allows streamlined sharing of patient information between wards, departments and pharmacies.

Red flags are raised to warn if a patient has an allergy, of potentially harmful drug combinations and if a dose exceeds the safe range.

It also allows doctors to prescribe from anywhere in the health board, not just the patient's bedside.

Nurses say the CoWs have enabled them to spend more time with their patients as a result of less paperwork and travel between workstations.

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- © Fairfax NZ News

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