Computerized prescriptions keeping residents safe from medication errors
System providing doctors with quick access to information to help make better prescription decisions
Thursday January 29, 2009 -- Deron Hamel
A computerized prescription system is proving to be a valuable asset, in terms of keeping residents at Baycrest Centre for Geriatric Care safe from medication errors, say practitioners connected with the north Toronto long-term care home.

Dr. Sid Feldman, program director of family and community medicine at Baycrest, says its computerized order entry (CPOE) system and electronic clinical decision support (CDS) system have been helpful in allowing him to make better prescription decisions, because of alerts which appear if a medication is incompatible with a resident's needs.

Working together, the CPOE and CDS instantly run a series of checks on a medication, once a physician has entered the prescription into the system.

If the medication prescribed could in any way be harmful to the resident, it alerts the physician immediately, rather than having to wait for the attending pharmacist to check the prescription.

For example, suppose a resident has a history of chronic depression that has been in remission for some time. If the resident suddenly relapses, doctors can instantly check the system to find out what medications have been used in the past.

“Because this is long-term care, people may have lived here for many years — in some cases over a decade — so I can very quickly call up the depression medication and have a quick list in front me of what drugs have been tried (and) what doses and combinations have been used,” explains Feldman.

“You’re very quickly able to access information that in the past would have taken a very long time.”

Another unique feature of the system is its ability to gauge kidney function, based on a resident’s age and body size, explains Feldman.

As the body ages, drastic changes to kidney function may occur, making it more difficult for the kidneys to process medications.

This system has the ability to calculate a creatinine clearance, which is an accurate measure of kidney function, notes Feldman. Creatinine is a by-product of creatine, a muscle metabolism excreted from the body by the kidneys.

“This (function) helps us adjust the dose of medication, based on the ability of the body to clear them,” says Feldman.

Dr. Paula Rochon, who formerly served as a senior scientist and a geriatrician at Baycrest, says the CPOE system is especially practical in a long-term care setting, because residents are more vulnerable than other parts of the population.

“I think (the system is) amazing,” says Rochon, who’s now vice-president of research at Toronto’s Women’s College Research Institute, adding the system has kept Baycrest ahead of the curve, since it was completley implemented in 2004.

“(Baycrest) is one of the first organizations internationally to have both the computerized record and the clinical decision support system.”

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