Standardising on-screen medicines information for safety

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Medication errors are a common type of healthcare incident in Australian hospitals and can contribute to patient harm and serious adverse events.

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Electronic health systems provide opportunities to improve patient care. However, medicines information in electronic health systems must be clearly presented to realise the benefit of clinical information systems.
Prescription information is relayed via several steps through to the administration of medicines, and the language and presentation of this medicines information is critical. Providing standardised and consistent medicines information in electronic medicines recording and management systems (EMM) has the potential to reduce medication errors and minimise patient harm.
EMM offers many benefits to patient care, including legibility, auditability, dosing and decision support. However, one of the most challenging aspects of EMM is the transfer of existing medication management processes to the digital space. New types of errors can result from problematic on-screen presentation following the implementation of clinical information systems. The benefits of EMM can only be realised if the medicines information is relayed precisely, without ambiguity.
The Australian Commission on Safety and Quality in Health Care (the Commission) provides a number of standardised tools to support medicines management in hospitals. These include the national inpatient medication chart, Tall Man lettering and standard terms and abbreviations, as well as a guide for the safe implementation of EMM in hospitals.
In March 2016, the Commission published the National guidelines for on-screen display of clinical medicines information. These evidence-based guidelines were developed with the support of the National eHealth Transition Authority (NEHTA) and the Australian Government Department of Health.
The guidelines form a platform for health services and clinical information system suppliers in their continued implementation of electronic medication management. This consistent national approach seeks to reduce duplicated implementation effort across health services.
The guidelines apply to the display of medicines information in clinical information systems across the healthcare continuum: acute health services; general practice prescribing; aged care electronic medication charts and ordering systems; community health services; mental health services; hospital and community pharmacies; and dental and allied health services.
The guidelines include recommendations to:

• specify test display


• use full medicine names


• display prescription elements in a consistent format and standard order


• avoid abbreviations


• use spacing and labels to differentiate display elements.

The latter is particularly important in presenting numbers on-screen, as a prescription, or medication order, regularly contains at least three numbers) strength, dose and supply quantity).
The commission drew on national and international evidence in developing the guidelines. Human factors research and testing, which examined the way in which clinicians interact with a system, was a key component in determining a preferred solution.
An addendum to the clinical guidelines for on-screen display of consumer medicines information will draw on the recommendations and rationales within the clinical guidelines, and is expected to be published mid-2016.
For further information on the Commission’s work on electronic medication management as part of medication safety visit www.safetyandquality.gov.au/our-work/medication-safety/electronic-medication-management-systems/

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“Human factors research and testing, which examined the way in which clinicians interact with a system, was a key component in determining a preferred solution.”

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FAST FACTS

• Electronic medicines recording and management systems (EMM) has the potential to reduce medication errors and minimise patient harm.


• There are challenges related to EMM and the benefits can only be realised if the medicines information is relayed precisely, without ambiguity.


• The National guidelines for onscreen display of clinical medicines information forms a platform for health services and clinical information system suppliers in their continued implementation of electronic medication management.


• This consistent national approach seeks to reduce duplicated implementation effort across health services.