Implementation of rules based computerised bedside prescribing and administration: intervention study

doi:10.1136/bmj.320.7237.750

BMJ 2000;320:750-753 ( 18 March )

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Implementation of rules based computerised bedside prescribing and administration: intervention study

P G Nightingale, statistician, ^a D Adu, consultant physician and nephrologist, ^b N T Richards, clinical director, renal and urology services, ^b M Peters, director. ^a

^a Wolfson Computer Laboratory, Department of Medicine, University of Birmingham, Queen Elizabeth Medical Centre, Birmingham B15 2TH, ^b Department of Nephrology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham B15 2TH

Correspondence to: P G Nightingale P.G.Nightingale{at}bham.ac.uk

Ojectives:: To implement and assess a rules based computerisedprescribing system with the aim of improving the safety of prescriptionsand the administration ofdrugs.
Design:: Analysis of performance of computerised systemplus questionnaire survey ofusers.
Setting:: 64 bed renal unit in a teachinghospital.
Intervention:: Introduction of the system into routine clinicaluse.
Main outcome measures:: Number of attempted prescriptions cancelledby the system; proportion of warning messages overridden; users'comparisons of the system with conventionalprocedures.
Results:: Between October 1998 and August 1999 the systemcancelled 58 (0.07%) out of 87 789 prescriptions on the groundsof clinical safety. In addition, 427 (57%) attempted prescriptionsgenerating high level warnings and 1257 (8%) generating low levelwarnings were not completed. In a user survey 82% (31/38) of doctorsand nurses considered the system to be an improvement on conventionalprocedures.
Conclusions:: The system has contributed to safety and patientcare. All prescriptions are complete and legible, and transcriptionerrors have been eliminated. The system assists clinicians whenthey are writing a prescription by making available informationon patients. The system supports clinical decision making andhas been well received by doctors, nurses, andpharmacists.

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