In the quest for more efficient healthcare systems, the adoption of electronic prescribing has become a priority for many healthcare providers. However, as we delve into the potential risks associated with this transition, a critical question arises: are we inadvertently creating new avenues for medication errors?
The Rise of Electronic Prescribing
The shift towards electronic prescribing and medicines administration (ePMA) systems began in the 1990s, with a more significant push by NHS England to go paperless, initially targeting 2018 and later extending the deadline to 2024, and then again to 2025 due to COVID-19 delays. The UK government touted the benefits of electronic prescribing, claiming a 30% reduction in medication errors.
Look-Alike Sound-Alike (LASA) Errors
One of the most concerning aspects of electronic prescribing is the potential for LASA errors. These errors occur when medications with similar names or sounds are confused, leading to potentially fatal consequences. The tragic case of Sidra Aliabase, who died after being prescribed the wrong medication, highlights the devastating impact of such errors.
Incident Data and Reporting Challenges
Obtaining accurate data on LASA incidents is a complex task. The transition from the National Reporting and Learning System (NRLS) to the Learn from Patient Safety Events (LFPSE) service created a period of dual reporting, making it difficult to ascertain the true extent of LASA errors. Additionally, the lack of a specific category for LASA incidents in reporting systems further complicates data collection.
Replacing One Error with Another
Experts like Professor Bryony Dean Franklin and Julia Scott, a pharmacist and chief information officer, suggest that while electronic systems may reduce certain types of errors, they introduce new ones. With paper prescribing, errors often occurred at the dispensing or administration stage due to illegible handwriting. Now, with electronic systems, errors are more likely to occur at the prescribing stage, as prescribers select from drop-down menus.
Mitigating Errors with Technology
To address LASA errors, tactics such as 'tall-man lettering' have been employed in paper-based prescribing. This technique involves capitalizing certain letters in drug names to distinguish them from others. However, as Scott points out, while it helps, it doesn't eliminate the risk entirely.
The integration of clinical decision support AI is another potential solution. Scott believes that AI could provide sophisticated prompts, especially when integrated with electronic patient records. However, she also warns of the 'flip side' - the potential for errors with ambient voice technology (AVT), also known as 'AI scribes'. AVTs, which generate transcripts and clinical summaries from patient-healthcare professional conversations, could introduce a new category of sound-alike errors, similar to the days of verbal orders.
Other Methods to Reduce LASA Errors
Franklin highlights the potential of a system called 'Touchdose', which allows prescribing by indication, matching doses to indications and performing sensitive checks. This approach could reduce LASA errors by making prescribers link the drug to its clinical indication.
Under-Reporting and the Role of AI
The limited data available on LASA errors is a concern, as Franklin notes that only a tiny fraction of prescribing and administration errors are reported. She believes that AI could make a significant difference in analyzing LASA error reporting, especially with the new LFPSE system, which is more amenable to analysis.
Scott agrees, emphasizing the importance of capturing near-misses in reporting. She envisions an ideal ePMA system where staff can easily report near-misses, with AI support to narrate and analyze the incident quickly.
The Future of LASA Error Reduction
While LASA errors are unlikely to be fully eliminated, the hope lies in the potential of AI and the LFPSE system. NHS England's website highlights the improved capabilities of the LFPSE system for analyzing patient safety events and utilizing machine learning for deeper insights.
As we navigate the complexities of electronic prescribing, it's crucial to strike a balance between technological advancements and patient safety. The challenge lies in harnessing the benefits of technology while mitigating the risks it introduces. The journey towards safer healthcare systems is ongoing, and the role of experts like Franklin and Scott is invaluable in guiding us through these complexities.
