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

OBJECTIVES: To implement and assess a rules based computerised prescribing system with the aim of improving the safety of prescriptions and the administration of drugs. DESIGN: Analysis of performance of computerised system plus questionnaire survey of users. SETTING: 64 bed renal unit in a teaching hospital. INTERVENTION: : Introduction of the system into routine clinical use. MAIN OUTCOME MEASURES: Number of attempted prescriptions cancelled by the system; proportion of warning messages overridden; users' comparisons of the system with conventional procedures. RESULTS: Between October 1998 and August 1999 the system cancelled 58 (0.07%) out of 87 789 prescriptions on the grounds of clinical safety. In addition, 427 (57%) attempted prescriptions generating high level warnings and 1257 (8%) generating low level warnings were not completed. In a user survey 82% (31/38) of doctors and nurses considered the system to be an improvement on conventional procedures. CONCLUSIONS: The system has contributed to safety and patient care. All prescriptions are complete and legible, and transcription errors have been eliminated. The system assists clinicians when they are writing a prescription by making available information on patients. The system supports clinical decision making and has been well received by doctors, nurses, and pharmacists.