ePMAs are crucial to tackling overprescribing in the NHS
When the government challenged all trusts to implement an ePMA system by 2024, the main focus was ditching paper and reducing medication errors. However, the benefits need not stop there. Find out how ePMA systems can contribute to achieving several improvement targets linked to overprescribing leading to better, safer patient care.
The benefits of ePMA systems are well documented - a reduction in medication errors, better oversight of medication history, continuity of care as a patient moves around a care setting, and elimination of common issues around legibility of patient records and missing charts.
There are thought to be around 237 million medication errors per year in the NHS in England, with 66 million of these potentially clinically significant, so it is little wonder that digital prescribing is a strategic focus for NHS England and Improvement.
It is less than two years until the NHS Long Term Plan (LTP) commitment to introduce digital prescribing across the entire NHS passes by. Significant progress has been made against this target, with many trusts having implemented an ePMA system, or are in the process of doing so. However, this isn’t the only target that trusts should be focusing on when introducing an ePMA system. It can also help to tackle other targets linked to the government's bid to reduce over-prescribing.
The LTP and the subsequent ‘Good for you, good for us, good for everybody’ review into overprescribing in the NHS highlights several priority areas, including the need to reduce the prescription of medicines that can cause dependency, a reduction in the prescription of higher-carbon inhalers, a continued focus on reducing inappropriate prescribing of antimicrobials, and the use of social-prescribing rather than antidepressants amongst others.
While it is true that not all ePMA systems are equal - some provide simple electronic versions of the traditional paper drug chart, while others offer fully integrated systems that seamlessly connect with patient records and dispensing software - most can support the reduction of overprescribing practices around certain medications. It is certainly an area that trust chief information officers and digital transformation leads should consider when selecting a new ePMA system.
For example, University Hospitals Plymouth NHS Foundation Trust is using the reporting capabilities within its Better Meds ePMA system in order to support its Antimicrobial Stewardship Team. There are hospital-wide restrictions in place to support efforts to reduce antibiotic use in situations where it would not be beneficial. The Antimicrobial Stewardship Team uses the reports in order to review prescribing practices and to access laboratory data to understand the decision-making regarding particular antibiotic prescriptions.
A core benefit of many ePMAs is the ability to view laboratory data from within the ePMA system, in order to assist decision-making and avoid inappropriate prescribing practices. In some scenarios, this integration can be crucial, as it enables full prescribing history of a patient to be visible and can have alerts set up to warn when high-risk medications are to be prescribed.
For example, the regulatory authority in the UK requires trusts to give particular care when it comes to managing adolescent girls and women of childbearing age if they are taking sodium valproate to treat epilepsy. Prior to the implementation of an ePMA, it would have been very difficult to identify these patients and it would solely rely on doctors to identify the risks and ensure that the appropriate procedures are followed. If an ePMA is in place, warnings can be set up within the system and audits can be carried out to make sure that the right procedures have been followed in terms of education, consent, and testing and that the national safety standards guidelines are followed.
Many of the government targets associated with over prescribing will require the combined efforts of the health care system, with integrated care systems working to support the efforts across primary, secondary and community care. The integration of ePMAs and electronic care records in general will play a key role in this, ensuring that all medical professionals involved in prescribing have a full understanding of the patient’s needs and history.
One challenge has been the complexity of creating complete medication reconciliation in hospitals. This is due to a lack of connectivity between patient records kept by GPs and secondary care providers and differences in medication lists within different hospitals. This can cause problems if a patient has been admitted to more than one hospital and leads to issues of linking community pharmacies and secondary care.
At Better, our development team has been working to break down these barriers and is now able to offer Better Meds integration with the NHS Electronic Prescription Service (EPS) enabling prescribers in integrated, urgent care settings to send electronic prescriptions to the community. We have also integrated with GP Connect, which makes patient medication history from primary care directly available to hospital prescribers in Better Meds.
Although still in the development stage, once rolled-out, these integrations will enable users of the Better Meds system to carry out these tasks from within the Better Meds interface, be that the standalone Better Meds solution or via a trust’s EPR if Better Meds has also been integrated into an existing system. This leads to a faster more efficient service and also a better experience for the clinical teams. It can also signify progress towards establishing fully integrated record sharing between primary, secondary, and community care - a goal that we can all agree will lead to better health care satisfaction and improved patient outcomes.
 Elliott, R., Camacho, E., Campbell, F., Jankovic, D., St James, M., Kaltenthaler, E., Wong, R., Sculpher, M., Faria, R. (2018) Prevalence and economic burden of medication errors in the NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK (PDF, 2.3MB). Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York.