ePrescribing and administration

The roll out of electronic prescribing and administration (ePA) is continuing.

• Waitemata (979 beds), Canterbury (1354 beds), South Canterbury (120 beds) and Southern (667 beds) DHBs are fully rolled out across adult wards and rollout continues across more specialist areas such as the intensive care unit, paediatrics and the emergency department.
• Taranaki DHB has rolled out to 65 beds.
• Auckland DHB has rolled out to 102 beds
• Counties Manukau DHB is on schedule to implement in late 2017.

ePA covers the entire hospital medicines cycle including prescribing, review and dispensing of medication orders, and administration of medicines.

It reduces medication errors through improved prescription legibility, dose calculation and clinical decision support. It enables best practice information to be more readily available to prescribers, dispensers and administrators and improves the flow of medicines information across clinical information systems.

Safety improvements

Electronic medicines management systems have been shown to significantly reduce the number of patients harmed by medication errors and adverse drug events, through:

• eliminating illegible, ambiguous or incomplete prescriptions
• providing a single and comprehensive view of a patient’s current and historical drug record
• providing real-time decision support to guide and improve the appropriateness and accuracy of prescribing
• providing real-time view of medicines administration.

Quality and clinical governance

• The New Zealand health strategy is seeking to improve the patient experience for both inpatients and outpatients, including their involvement and management of their own medications
• The use of ePA systems will help to improve availability of medicines information for the whole care team
• Better reporting will enable clinical teams and patients to improve the management of their medications.

Sustainable health system

Electronic solutions have the potential to improve productivity across the health sector by refocusing health care workers from administrative tasks to patient centred care.

The use of electronic medicines management systems:

• reduces the number of medication errors
• improves communication of real-time information between prescribers, pharmacy and nursing
• removes paper
• streamlines operational and clinical processes
• provides more effective control and management of drug expenditure.

Reduction in wastage

A reduction in medication errors and improved systems protocols will allow for a reduction in wastage. This is particularly important with expensive or complex drug combinations where decision support guidance can recommend specific advice.

It is expected that large procurement and budget management benefits will be derived from national standardisation and data collection.

Transformation potential

The infrastructure and data provided by electronic medicines management systems offer a platform for learning, improvement and innovation, to raise the efficiency and effectiveness of health care across the whole of the New Zealand health system.

Integrated medicines management, including allergies and adverse drug reactions (ADR) information provides a foundational component of a successful electronic health record.

Anti-microbial stewardship

“Antimicrobial resistance poses a fundamental, long-term threat to human health….it is not that it may happen in the future. It is a very present reality – in all parts of the world, in developing and developed counties, in rural and urban areas, in hospitals and in communities” .

A recognised intervention for addressing anti-microbial resistance is the development of evidence-based optimal standards for routine antimicrobial use, eg, correct selection of agent, dose, route of administration and duration of therapy. Establishing effective monitoring and reporting systems to promote more appropriate use of existing and new antibiotics is essential to reduce the use of antibiotics across the New Zealand health system.