Preventing Medication Errors: Importance of Electronic Prescription Software in Clinical Decision Support

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1.0 Introduction
The main purpose of the case study of Zoya is to underscore the significance of electronic
prescription software as a clinical decision support tool in the deterrence of errors in
medication and the subsequent colossal consequences. Furthermore, the case study aims at
examining the role of patients and consumers in the process of care delivery and in
preventing any occurrence of medication error, and to ascertain the likely threats of hybrid
paper and electronic medical records. The case study, therefore, seeks to offer solutions to
problems associated with errors in medication. For instance, the use of existing guidelines by
general practitioners while providing drug prescriptions, the quality of patient records kept in
healthcare centers and the effectiveness during retrieval, procedures in the adoption of hybrid
and paper medical records, and issues with the decision support in the clinical software
package.
2.0 Description
Zoya was an employee of a factory for five years. One Monday morning after a night shift
she felt ill and had a sore ear and therefore went ahead to make an appointment with the
doctor on the same day after consulting her partner (lover). Zoya had experienced the issue
for three days. She wanted to be attended to by the family general practitioner who was in
another clinic, 2 kilometers away and could only be available in three days. As a result, she
made an appointment with Dr. Stanley; an experienced 70 year old doctor on the very same
day. Dr. Stanley worked at Get Well Clinic; a local clinic, fully credited with several
physicians, and he was a registered GP with 50 years’ experience in the medical profession
and much respected by his colleagues and patients. Zoya had also visited the Get Well Clinic
for the last 10 years on a frequent basis Britt et al. (1).

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During the consultation with the doctor at around 11: 00 am, Zoya narrated her scenario to
the doctor who noted down her medical history and assessed her ears using an otoscope. The
doctor then found out that the right side of her outer ear canal was severely inflamed, but the
middle ear was in good condition, thus making him diagnose her of otitis externa, which is an
inflammation of both the ear canal and outer ear. The doctor never ascertained any
abnormalities in the patient’s abdomen, heart, lungs, and throat while on the examination
table. The doctor was accustomed to using topical antibiotic ointments or oral medication as
an alternative. Ceclor, an oral antibiotic was prescribed by Dr. Stanley due to the seriousness
of the ear infection. Dr. Stanley had a practice of examining the records of a patient for
information regarding any registered allergies by making three inquiries: whether the patient
was under any medications, was allergic to anything, and any allergic reactions to any
medications. If the patient's response were on the affirmative regarding any of the questions,
then the doctor would go ahead to determine the specific medications that caused the allergic
reaction. However, Dr. Stanley could neither remember detailed information of the
consultation with Zoya nor the conversation with the patient on allergy matters but later
proved that it was not his usual practice to go through previous records of the patient before
consultation (1).
At the time of consultation with Zoya, the Get Well Clinic maintained medical records using
an electronic system with no paper records. During the visit of Zoya, 77% of the GPs used
the electronic system to give medical prescriptions while 54% kept electronic medical records
supplied by commercial clinical software packages with the capability of entering progress
notes, offering prescriptions, and request for various tests in the clinic laboratory (1). Zoya
received printed copies of the prescriptions which were formulated electronically.

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The doctor’s consultation room was equipped with a desktop computer of which he was not
well conversant with its use. But the clinic had made efforts to offer him basic training on the
use of electronic medical records. Thus, he was conscious of the procedure of keying in data
during a consultation. The GP was aware that he could review records of the previous
consultation using the electronic record and any possible medical contraindications such as
allergies could be retrieved. After consultation, Dr. Stanley could make a note of the outgoing
patient before the incoming one.
Zoya was given a handwritten prescription for Ceclor to be taken twice for each day in five
days in addition to a certificate for one day off work. Dr. Stanley keyed in the consultation
note just after the patient had left the room but did not see the note on allergy when entering
the data. Furthermore, against his routine practice, the doctor failed to review his notes to find
out any reference to allergic reactions to specific drugs.
Zoya went directly to a local pharmacist with the prescription and was given the drugs
without any question from the pharmacist. After which she went home and took the initial
dose as prescribed. Her partner, John came back home around midday and found her lying
unconscious on her side across the bottom of the bed with limbs stretched to the edges of the
bed, with welts on her body and swollen face with no signs of breathing. John called an
ambulance, and the paramedics observed complete cardiac arrest and initiated CPR and were
transferred to a local hospital after one hour. She was admitted in ICU with continuing life
support, but still, her condition became worse in two days. On the third day at 9:59 a.m. a
perfusion scan showed that her brain had no blood perfusion and was pronounced dead at
1:07 p.m. and her life support turned off Magrabi et al. (2).
3.0 Discussion