The use of computers in pharmacy have changed both institutional and community practices dramatically. Computers have automated many of the traditional paper based prescription functions of pharmacists, enabling them to increase their clinical activities. Generally, the Electronic – Prescription System is a system that consists of data entry, retrieval and stock monitoring facility, tracking drug dispensing pattern, it is meant to do away with a paper based prescription.
The Electronic Prescription System is a technological invention that allows physicians and other medical practitioners to write and send prescriptions to a participating pharmacy electronically instead of using hand written or faxed prescriptions. (TechTarget, (n.d))
The system keeps track of patient, doctor, drug and prescription records per visit. It also reflects available drugs in terms of quantity and quality (expiry date) so that the doctor may know either to suggest an alternative medication if there is a shortage of the suggested drugs to avoid the patient from having to go all the way to the dispensary and finding that the prescribed medication is out of stock. In a situation whereby there is no alternative drug the system will provide an alternative to several local pharmacies which may have the drug available in stock, system will pull out a list of all pharmacies and pick a suitable one for the patent.
It will also reflect the patient prescription history, which will in turn eliminate the problem of patient drug prescription abuse and also having to prescribe one and the same medication for the same patient while it’s quite clear that the previously prescribed medication doesn’t respond to the patient’s illness.
Traditional paper based or hand-written prescription is too slow due to using of pen and paper. The paper-based prescription process is inefficient, expensive and resource-intensive. This approach has several other limitations such as high rate of human errors in manipulating data, and documentation errors which are inevitable. However, it is so hard to overcome the limitations of paper prescription that arise due to the growing number of pharmaceutics and complexity of medical care. Most of the limitations of paper based prescription could be eliminated or minimized by the use of electronic prescription system.
The Health Management Information System, review of, 2013 findings revealed that systems and practices are not standard across all seven government hospitals in the Kingdom that were under the study, it also stated that there is not enough room for filing as caseload of patients was increasing. The hospitals under this review also mentioned that these hospitals lacked standard national confidentiality guidelines and also that there was an inconsistence supply of data collection tools, standard registers and forms.
There is a need for introduction of proper filling management and security procedures that will ensure proper storage and retrieval of patients’ files, (Simplifying Swazi Health With IT, 2012). National Pharmaceutical policy augured that a comprehensive review of the country’s medicine procurement, supply and management system is necessary (March 2011) and that is what Electronic-Prescription System aims to achieve as it maintain an appropriate constant supply of drugs across all the health facilities.
The Electronic Prescription and Monitoring System will consist of data entry, retrieval and monitoring stock facility, alert of expired drugs, minimum quantity of each medication and auto ordering of medication in need through an automated email. The system will also apply string searching technique.
Purpose of the Study
The main purpose of the study is to increase patient safety that will improve quality of health for patients and also improve the hospital service by developing an Electronic Prescription and Monitoring System to help improve prescription monitoring.
Project Aims and Objectives
The main aim of this study is to develop an Electronic Prescription and Monitoring System, they can be further categorized into three different but similar points
I. Patient safety
II. Improved service
III. Improved Prescription monitoring
Objectives of the Study
I. This study will reduce redundant paper work and efficiency delivered as paper, it will provide a single view of historical patient prescription record. The system will improve quality care as medication transcription errors and prescription fraud are greatly reduced.
It will also provide legibility and complete prescription to reduce drug prescription abuse
I. The system will provide the prescriber with necessary patient history to help improve prescription decision. It will also prevent the patients from altering with the prescriptions since it is handwritten. It also provides confidentiality on the patient’s prescription and also monitor prescription fraud by using an integrated prescription form.
II. The system will provide a complete trace of patient prescription record history. It will also provide improved management of drug dispensing through the tracking of dispensary unit stock. This system will save a lot of time for patients, prescribers and dispensers since it is faster than the paper based prescription. It will also provide improved data quality due to improved storage methods by providing historical data for hospital auditing since the data will be readily available in the system.
Significance of Research
This system is entirely meant to ease up the work for doctors since they have the patient’s prescription history, readily available in the system, then having to prescribe the same medication for the same patient or spend more time trying to find the patient prescription history than with the patient.
The system will help the patient because they would not have to go all around carrying papers which contain their medical history since the system will capture the patient’s history on its own.
The patient is also saved from the trouble of having to queue in the dispensary unit only to find that the prescribed medication is not available in the dispensary unit stock. The system will prevent that by alerting the doctor while heshe is prescribing the medication that the prescribed medication is not available in the dispensary and the doctor might prescribe an alternative. The system also provides a suggestion of other local pharmacies which might have the needed prescribed drug in stock.
“Prescription drug abuse affects hospital practice in ways you wouldn’t have predicted five years ago,” says David W. His comment underlines the fact that hospitals and their pharmacy departments are, in many ways, at the epicenter of the prescription drug-abuse tsunami. Drug abusers arriving in the hospital’s emergency department (ED) with an overdose and others with infections from needles must be admitted as inpatients.
Electronic Prescription has been around for decades, but has mostly been popular in the developed countries. Electronic prescribing became legal nationwide in 2007 (Skelton, Surescripts, 2015). Also in 2008 where it became easier for the industry to adopt critical information exchange and electronic prescription routing. It is in that same year when the Drug Enforcement Administration (DEA) proposed a rule that allowed the electronic prescription of controlled substances (EPCS), a very important milestone to improve care and reduce fraud related to highly addictive drugs (Skelton, Surescripts, 2015).
There have been various developments of management system in recent years before, unfortunately there are still some problem facing it. A study was conducted at Raleigh Fitkin Memorial (RFM) in Manzini, where 300 patients diagnosed with diabetes, hypertension or asthma were conducted through interviews to assess the availability of a selected basket of medicine. The outcome of the study confirmed 71% of the patients not receiving all of their prescribed medication for the last past six months at each visit to the hospital. Stock-outs at the Central Medical Stores were reported ranging from 30 days to over 180 days during the course of the assessment period, and were recorded to continue to inconsistent availability of medicines in the health facility (Shabangu & Sulemane, 2015). The electronic – Prescription System also focuses on medicine availability as one of its major objectives is to constantly monitor point of sale (POS) on prescription databases in health facilities and automatically order new stock through an automated email sent to Central Medicine Stores inventory system if current stock gives a shortage warning.
Prevention of medication errors has been recognized as a priority in health care systems worldwide. Introducing of integrated prescription forms and national implementation in individual countries is one of the recommendations for reducing the risks of medication error (Clin, 2009). The electronic – Prescription System provides prescribers with an interface catering integrated prescription forms, therefore cutting down prescription error.
According to data from the Centers for Disease Control health care providers wrote 259 million prescriptions for painkillers in the year 2012. But these medications carry with them the risk for addiction. Death tied to overdoses from pain killers rose to nearly 17000 a year in The United states in 2012 (Nicole, 2015). The system aims in monitoring prescription abuse by using an integrated prescription form which will trace patient’s history of prescription by so doing, it monitors drug prescription abuse which has spread across local pharmacists.
However, due to the huge amount of workload in the dispensing unit, the pharmacist may enter or update the database with inconsistencies due to the huge amount of paperwork, thus have to enter into the database which could lead to wrong information being reflected in the drugs database.
The Old Paper Based Prescription System
The currently employed system uses the A4 cards for clinic and patient held records which line up perfectly for carbon paper to be used to store two records at the same time (Ingrid & Jonathan, 2010). Even though the carbon paper captures both records this system can be inaccurate and time consuming both for the patient and the physician. A sturdy card is being used for the paper based patient record history and a lighter paper is used for the clinic record making it easy to file.
During the consultation the nurse also uses carbon paper to write down the vital signs. The doctor records the examination on the back of the clinic record which later serves as a prescription form, using carbon paper he or she records, diagnosis, management and treatment on the same clinic form (Ingrid & Jonathan, 2010).
Later that day or that week the nurse enters the information from the clinic held record, including demographic information if new or if there were changes and the data from the consultation, into the computer database. The clinical notes are not taken and this process takes about two minutes per new record, or less in cases of follow up consultation.
Limitations of old paper based prescription:
- The paper-based prescription process is inefficient and resource-intensive, for example, in an environment where about 300 patients come in everyday that could be exhausted paper work.
- It has been reported to consist of the high rate of human and documentation errors in data manipulation which are inevitable especially in paper work
- Prescription abuse as it is easy to manipulate
- Lacks integrity since its hand written
Strength of Electronic Prescription and monitoring System:
- Reducing prescription, medication and transcription errors and prescription fraud
- Proving a more secure way of accessing updated information and patient prescription history at the point of care
- Receives prescription electronically from physicians and refilling the medication prescriptions by the pharmacy
- Reduce redundant paperwork
- •Uncreases legibility, preciseness, correctness, and completeness of prescriptions
- •Easing the sharing knowledge for better patient care and reduced verbal relationships
The tendency to use advanced technology in healthcare and the governmental policies have put forward an electronic prescription. Electronic prescription is considered as the main solution to overcome the major drawbacks of the paper-based medication prescription (Iran, 2013), such as transcription errors. There are many problems with the paper prescription system which, according to studies have jeopardized patients’ safety and negatively affected the outcomes of medication therapy. All of these problems are remedied through the implementation of electronic-prescriptions.
The system will reduce drug expiring because of overstocking and drug stock outs since it will record each and every activity in the dispensary unit all the way to the doctor prescribing the drugs. The pharmacist will record how many drugs have been received in the database, while the system automatically subtracts the number of drugs being handed out as the pharmacist hands out the medication according the prescription to the patient.
This is the most important chapter in the entire study, its outline why the study uses the chosen methods in order to solve the problems faces by the current system. It also outlines the plan of how the data will be collected and analyzed.
Systems development is the process of defining, designing, testing, and implementing a new software application or program (System Development, 2007). For the system to be complete a front end is needed, Microsoft Access 2016, and back end, MS SQL Server which will be most effective during the development of the system. The system is meant to cover a small population of users, doctors, nurses, pharmacists and the system will be overlooked by an administrator.
The participants that will be engaged are healthcare providers, i.e. doctors, nurse, pharmacists, and healthcare consumers, i.e. patients. All the categories of the individuals involved are people believed to be relevant to the greater medical community, doctors that prescribe medication and have access to the system of electronic-prescription. Pharmacists who manage the dispensary and attend prescription forms and patients who are dependent on the system to get the medication they need. The doctors that will be interviewed work in the public-sector health care, they are individuals in our social circle. These interviews will be conducted via Skype or phone calls and will be recorded as per the interviewees’ consent. These observations will take place mainly in the government hospital (Mbabane branch).
Data Collection Methods
The methods that will be used are semi structured interviews, observation and thinking aloud. As the research is a qualitative one, these typical methods will help understand how the stakeholders view the research questions.
The semi structured interviews are selected as a way to gain the advantages of both types of interviews, for example both structured and unstructured. Even though structured interviews are usually employed when looking for quantitative and statistical responses (Bodker, Kensing, & Simonsen, Participatory IT design, 2009) however, same questions were planned to be asked to all participants. These questions aimed at getting a feeling of what each interviewee’s background is with the hopes of better understanding their opinions.
The course of action to follow will be to first interview two doctors and a pharmacist in three different interviews in order to get the basis of the situation. The reason behind this choice is to gather sufficient facts from the professionals and then, based on their concerns develop the electronic-prescription and monitoring system.
Observation as a data collection method can be structured or unstructured. Unstructured observation is conducted in an open and free manner in a sense that there will be no pre-determined variables or objectives (Observation, 2018), the study will employ th