Electronic tool could transform drug prescriptions

IV fluids

Significant improvements in treating paracetamol overdose patients have been made thanks to an electronic prescription tool developed by University Hospitals Birmingham NHS Foundation Trust (UHB) staff.

The tool, recognised nationally by Health Data Research UK, has reduced the number of errors when prescribing a drug for paracetamol overdoses to zero.

The algorithm automatically provides the correct doses for doctors to treat patients after an overdose, simply by entering the patient’s weight into the PICS system along with the name of the treatment – NAC.

Adam Seccombe, Acute Medicine Consultant, said: “The drug used to treat paracetamol, NAC, is a complex drug to prescribe. It requires three bags of the drug to be given, with each bag having a different weight, volume of fluid, and delivery speed. As a result, we found there was a 25% chance of error when it was prescribed.

“If NAC is prescribed too quickly or the doses are excessive, patients are more likely to experience adverse effects which might stop the treatment working, but if it’s prescribed too slowly or the doses are too low, then it increases the risk of further liver damage.

“We were delighted to find that our tool reduced the number of prescription errors to zero, significantly improving care for patients coming in with paracetamol overdoses.

“I would like to thank everyone involved with the project, in particular Adam McCulloch, a gastroenterology consultant who had the initial idea for the project and led data collection and analysis. I would also like to thank junior doctor colleagues Tom Bate, Qamar Sharif and Patrick McDowell, pharmacist Asif Sarwar, and Dave Thompson in the Prescribing Information Communication System (PICS) team.”

New drug prescription researchers (L-R) Asif Sarwar, Adam Seccombe, Patrick McDowell

A report on the tool, which was introduced into the QEHB A&E department in July 2018, shows that similar tools could be used for other complex drug prescriptions, potentially transforming the way drugs are prescribed across the NHS.

UHB is currently the only acute NHS hospital in the Health Data Research UK network. It is hoped that the electronic prescribing tools will act as an exemplar for a range of future developments that could have a significant impact on improving patient care.