Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Efficiency of electronic insulin prescribing at Princess Alexandra Hospital. Early experience (#257)

Benjamin P Sly 1 , Faseeha C Peer 1 , Cindy H Yu 1 , Anthony W Russell 1 , Clair M Sullivan 1 2
  1. Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
  2. Clinical Excellence Division, Queensland Health, QLD

Introduction

 

In March 2017 the Princess Alexandra Hospital (PAH) commenced inpatient electronic prescribing (e-prescribing) within the pre-existing electronic medical record. Numerous studies have shown a reduction in medication errors with use of e-prescribing systems1.  Systematic reviews of prescribing efficiency have also found increased time spent using e-prescribing compared with paper based medication charts2.  There is no published data on the effect of e-prescribing systems on the efficiency of inpatient insulin prescribing.

 

Aim

 

To evaluate the time taken to access and analyse the insulin/glucose chart and prescribe insulin before and after the implementation of e-prescribing system at the PAH.

 

Method

 

Three doctors (two registrars and a resident) independently reviewed the insulin/glucose chart of 20 inpatients at PAH at three time points; before implementation of e-prescribing and at one and six weeks after implementation of e-prescribing system.  The time taken to access and analyse the insulin/glucose chart and prescribe insulin was self reported.

 

Results

 

The total time to access and analyse the insulin/glucose chart and prescribe insulin was significantly longer at 1 week and 6 weeks post implementation of the e-prescribing system (146 vs 274 vs 210 seconds, p <0.0001).  The significant difference was maintained irrespective of degree of glycaemic control or complexity of insulin regimen.  Each doctor improved from week 1 to week 6 post e-prescribing but remained significantly slower than before the e-prescribing system.

 

Conclusion

 

There is evidence that e-prescribing reduces errors compared to paper based medication charts.  Early experience, however, shows that electronic prescribing systems increase the time taken to analyse the insulin/glucose chart and prescribe insulin.  Further assessment will be undertaken to determine the degree of efficiency improvement achieved with more e-prescribing experience and also to assess insulin prescribing safety.

  1. Nuckols T, et al. The effectiveness of computerised physician order entry at reducing preventable adverse drug events and medication errors in hospital settings. Syst Rev 2014; 3: 56.
  2. Poissant L, et al. The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review. J Am Med Inform Assoc. 2005;12:505–516