P32 Pre-go-live simulation testing of new electronic prescribing systems in a specialist paediatric hospital
Authors: Rajudin Nazurah Liyana , Sourour Kirollos , Huynh Chi , Sinclair Anthony , Terry David 
Published: January 2018

Aim

Single-site cross-sectional evaluation of a specialist paediatric hospital electronic clinical systems designed to support the medication process. This included simulation testing and evaluation of three electronic systems: PICS an electronic prescribing system designed in an adult hospital and being adapted for paediatric use; BDD an in-development electronic drug dictionary database that will serve as a clinical decision support tool; and Ascribe the existing pharmacy dispensing and management system (used to provide target levels). Simulation testing is used to assess the utility of the systems in the local (paediatric hospital) setting and gauge readiness for use in the live environment.

Methods

Unique drug regimens from consecutive hand written outpatient pharmacy prescriptions and the hepatology ward paper drug charts were harvested and used as the simulation test. Each regimen was therefore in current use at the study site. The test prescriptions were used to identify each systems’ ability to accommodate that regimen, such that:

PICS (electronic prescribing system) – can the regimens be prescribed on PICS?

BDD (drug dosing database) – are these regimens held within the database?

Ascribe (hospital pharmacy system) – can the regimens be recorded on Ascribe to facilitate medication supply?

The system tests were undertaken in early July 2015 following suitable training on how to use each of the three systems. Trained researchers attempted to enter the regimens into PICs and Ascribe; and to identify if the regimens were available within the BDD database.

Approval was granted by the study site, and Aston University Ethics Committee.

Results

Outpatients (89 unique regimens)

PICS: 74% (66/89) of drug regimens could be completely reproduced electronically, with 34% (30/89) matching default dosing regimens.

BDD: 40% (36/89) of drug regimens were found in the database (drug name, indication, route and dose in relation to the age of patient)

Ascribe: 77.5% (69/89) of drug regimens were reproducible and had labelling templates that existed on the system, a further 17% (15/89) drug regimens were available but required some amendment to existing templates.

Hepatology ward – (126 unique regimens)

PICS: 71% (90/126) could be prescribed as written on the drug charts.

BDD: 58% (73/126) of drug regimens were found in the database (drug name, route and dose in relation to the age of patient)

Ascribe: 94% (118/126) of drug regimens were reproducible and had labelling templates that existed on the ascribe system, a further 18% (23/126) drug regimens were available but required some amendment to existing templates.

Conclusion

Overall, at the time of testing, the electronic prescribing system (PICS) could accommodate approximately 72% of drug regimens, the BDD database could accommodate approximately 51% – compared to the Ascribe (target figure) of 87%. The findings suggest that further work is required to ensure the systems in development (PICS and BDD) are ready for use.