| Abstract [eng] |
Background. The increasing burden of chronic diseases, polypharmacy, and antimicrobial resistance pose significant challenges to the healthcare system. Therefore, the digitalization of the healthcare system in Lithuania is becoming increasingly important in order to ensure safety and reduce medication related errors. Electronic prescribing and Medicine administration systems (EPMA) are one of the tools that can optimize medication prescribing and administration processes in inpatient care. However, the effectiveness of these systems depends on the functionality implemented in them and their practical application. Aim. To evaluate the applicability of electronic prescribing systems currently used in Lithuanian hospitals for safe medication prescribing in inpatient settings. Objectives. 1. To identify the functions of Electronic Medication Prescribing Systems currently used in Lithuanian hospitals. 2. To assess the significance/benefits of electronic prescribing systems in the medication prescribing process. 3. To determine the significance/benefits of electronic prescribing systems in the medication administration stage. Methods. The object of the study are Lithuanian public health care institutions, where the Ministry of health implements the rights and obligations of the state as a co-owner together with other entities. The study employs a mixed-methods design, combining quantitative and qualitative approaches. Interviews with responsible persons are conducted remotely in order to identify the functionalities of EPMA systems in use. The quantitative study is conducted in Lithuanian healthcare institutions where EPMA systems are applied in clinical practice. During quantitative phase of the study, physicians and nurses who use inpatient EPMA systems in their practice are surveyed. Qualitative data are transcribed and analyzed using data coding, categorization and interpretation methods. The quantitative data analysis is performed using MS Excel and R programs. Results. Out of the fourteen Lithuanian healthcare institutions included in the study, three apply EPMA system in clinical practice, and one institution is in the pilot study stage. Interviews revealed that the functionalities of EVSS-1 and EVSS-2 are limited – important safety functions such as drug interactions, contraindications or dosage control are missing, and the existing possibility of marking allergies is not used. 338 healthcare professionals participated in the quantitative part of the study, including 103 doctors and 235 nurses. The majority of doctors (84,2%) and nurses (63,8%) consider EPMA system to have more advantages compared to paper-based prescribing. The most frequently identified benefits for doctors are improved documentation and traceability (64,8%) and time savings (64,8%). The challenges experienced by physicians are related to technical system failures (46,3%), limited medication list (46,3%) and lack of functionality (45,3%). Nurses believe that EPMA system has reduced the risk of errors (84,7%). According to nurses, the errors that have been reduced include incorrect dosage (59,3%) and duplication of medications (54.6%). Conclusions. 1. The functionality of EPMA implemented in Lithuania is focused on the registration and administration of medication orders. These systems lack important medication safety features. 2. In the medication prescribing process EPMA is perceived as a useful tool associated with improved documentation and time saving. However, the system’s contribution to safe medication prescribing remains limited due to the lack of clinical decision-support functions, technical issues, and errors related to dosing regiments and allergy management. 3. In the medication administration stage, EPMA reduces the risk of medication-related errors; however, nurses’ evaluations on error reduction are not unequivocal, and medication errors therefore remain a relevant issue. Nurses’ EPMA use skills are associated with the training received. |
