3.37 Preventing errors by the appropriate use of information technology is well established. The Institute of Medicine in the United States of America advised that moving from a paper to an electronic based patient record system would be the single step that would most improve patient safety28. The National Programme for
Information Technology in the NHS being delivered by the Department’s agency, NHS Connecting for Health, has begun to roll out its National Care Record system and expects it to have full functionality by 2010. Most trusts foresee that this will help them in ensuring that patient records are no longer lost and there are better controls over prescribing (both issues have led to significant numbers of patient safety incidents).
Connecting for Health and Patient Safety
A compelling case for investment in information technology to improve patient safety was made in the Audit Commission report: A Spoonful of Sugar, (December 2001):
“Complications arising from medicines treatment are the most common cause of adverse events in hospital patients…Most errors are caused by the prescriber not having immediate access to accurate information about either the medicine (its indications, contra-indications, interactions, therapeutic dose, or side effects); or the patient (allergies, other medical conditions, or the latest laboratory results)... Computerised prescribing linked with electronic health records will radically alter the way in which care is provided and will deliver significant improvements in the quality of patient care.”
The Connecting for Health Business Plan re-iterates the NHS National Programme for Information Technology’s commitment to patient safety:
“Critically, all the new systems will contribute to ensuring safety and quality of care while helping to improve efficiency... Our cluster teams coordinate the implementation of many thousands of IT installations designed to improve the safety, efficiency and quality of patient care.”
Action: The Electronic Transmission of Prescriptions
Research has highlighted both the potentially fatal consequences of adverse drug reactions and the avoidable nature of many such events. The Electronic Prescription Service will contribute to patient safety in two ways:
n It will provide both prescribers and dispensers with more information about what medication a patient is taking. This will be achieved by populating the patient’s medication record on the NHS Care Records Service with information about what has been prescribed and dispensed for the patient. This will allow those healthcare professionals with approved access and within appropriate care settings to view a patient’s medication history, supporting the decision on what further or alternative treatment should be provided in the light of what the patient has already received.
n By using electronic systems and communication, patients’ demographic and medication details will not have to be interpreted from hand writing, or re-keyed, reducing labelling errors and the times when medication information, such as dosage or strength, is missing.
Connecting for Health Service Implementation seeks to ensure that the potential of this technology is achieved in the Service: Its stated aim is to connect with the people who will, in their day to day work, use the technology to improve patient safety and clinical governance - for example through the electronic transmission of prescriptions and the NHS Care Record. Connecting for Health aims to provide the Department and the NHS, with support, based on best practice, to enable all local health communities to produce robust service improvement plans that include evidence-based projections of the quality, safety and productive time benefits to be realised from the deployment of the National Programme, by the March 2006 deadline.
ILLUSTRATIVE EXAMPLE 8
3.38 One of the most robust methods for identifying unreported incidents is through retrospective audits of patient records. Electronic patient records will enable trusts to quickly identify unreported incidents, monitor trends and promote learning through clinical audit. However clinicians will still have an important role to play in improving patient safety. For example, although there will be automatic identification of adverse drug reactions, the Medicines and Healthcare products Regulatory Agency will still need detailed reports of clinicians’ suspicions as an early warning and to be able link them to reactions which emerge at a later date.
3.39 Knowledge management is a key element of successful healthcare delivery. Our report on clinical governance4 highlighted that knowledge management
was one of the least developed components. In our visits to trusts we found ward staff had problems accessing guidance and information on good practice. The
Commission for Health Improvement reviews highlighted similar concerns9. Although the Department has already
established the National Electronic Library for Health, it plans to make full use of the new NHS information technology system to improve access to learning from patient safety incidents and near misses.
3.40 NHS Connecting for Health is working to optimise the management of risk in the health service and in partnership with the National Patient Safety Agency, is developing a range of interventions to reduce such risks as the incorrect identification of a patient or the prescribing of the wrong drug or dose (Illustrative example 8).