Similarly, medication errors in community settings can contribute to patient harm and hospital admissions.
Unclear, incomplete or confusing presentation of medicines information can increase the opportunity for health practitioners to make errors and cause patient harm. Some of these errors can be serious (i.e. likely to lead to permanent reduction in body functioning, increased length of stay, a surgical intervention or death).
Error-prone abbreviations occur in 8.4% of in-hospital medication orders and at a considerably higher rate in outpatient prescribing. A large proportion of error-prone abbreviations occur in handwritten prescriptions (61%); 27% involve medicine name abbreviations.
Providing clear, standardised medicines information in electronic medication management (eMM) has the potential to reduce errors, including procedural errors and error-prone abbreviations. Patient safety and quality use of medicines may also be improved as a result.
The design of clinical information systems is a rapidly evolving discipline, and these guidelines will require ongoing evaluation and iterative review as experience grows in the use of eMM.
Some recommendations will have only weak published ‘healthcare-based’ evidence to support their use. Their inclusion is based on ‘human factors’ evidence, consensus and consultation.
Consistency of presentation to support a given recommendation is of utmost importance. This approach will allow evaluation where evidence to support use is lacking. Moreover, these efforts to develop consistent display standards will be enhanced by the consistent use of medicines terminology in these systems.
Healthcare providers are encouraged to seek and procure software systems that work towards implementation of the standard formatting and terms set out in these guidelines. This is expected to be an evolving process, acknowledging existing system capability and current limited clinical evidence associated with medicines information presentation.
The National guidelines for on-screen display of clinical medicines information were developed by the Australian Commission on Safety and Quality in Health Care (the Commission) with funding support from the Australian Government Department of Health.
The guidelines are part of an ongoing commitment to quality use of medicines described in the National Medicines Policy (and associated guiding principles), which form the platform for safe medicines use in Australia. They are also consistent with the Commission’s goal of improving the safety of Australian digital health records.
The aim of these guidelines is to describe consistent, unambiguous terms and processes for on-screen display of medicines information in clinical information systems.
The Commission is responsible for maintaining these guidelines and for reducing national barriers to implementation during their introduction and ongoing use.
These guidelines can be downloaded for free from the Commission website - National Guidelines for On-Screen Display of Clinical Medicines Information.