Abstract
Background Anticoagulant drugs are the leading cause of medication harm in hospitals and prescribing
errors are common with traditional paper prescriptions. Electronic medicines management
can reduce prescribing errors for many drugs; however, little is known about the impact
of e-prescribing on anticoagulants. Our case study reports on the lessons learned
during conversion from paper to e-prescribing and the ongoing optimization process.
Methods The iterative implementation of an anticoagulant prescribing platform in an integrated
electronic medical record (ieMR) and ongoing continuous enhancements was applied across
five digital hospital sites utilizing a single domain. The collaborative management
of each class of anticoagulant, optimization strategies, governance structures, and
lessons learned is described. An analysis of the rate of errors and adverse events
pre- and post-go live is presented.
Results The transition to e-prescribing relied on a strong inter-disciplinary governance
framework to promote the safe management of anticoagulants. There was no increase
in overall prescribing errors, however unfamiliarity with the new system caused a
transient increase in errors with unfractionated heparin (1.8/month pre-ieMR vs. 5.5/month
post-ieMR). A dedicated real-time surveillance dashboard was introduced. The iterative
nature of changes indicated the complexities involved with anticoagulants and the
need for an interactive, optimization approach. This led to a significant decrease
in anticoagulant related hospital acquired complications (12.1/month pre-ieMR vs.
7.8/month post-ieMR, p = 0.01).
Conclusion Digitizing anticoagulant prescribing led to an overall reduction in errors, but a
continuous iterative optimization approach was needed to achieve this outcome. The
knowledge presented can help inform optimal therapeutic anticoagulation ieMR design
strategies.
Keywords
electronic medical record - clinical decision support - order entry - medication management
- iterative improvement - anticoagulation
