fire and ice - new zealand formulary - bryan simpson, sarah homan)
TRANSCRIPT
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The NZF
• An independent resource providing healthcare professionals with clinically validated medicines information and guidance on best practice, enabling healthcare professionals to select safe and effective medicines for individual patients.
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The NZF
• Developing a range of data sets aligned with SNOMED CT to support system interoperability to enable alerts and reminders
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Problems in Health Care
• Patient Harm
• Unnecessary Care
• Waste
• Lack of Transparency
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Problems in Health Care
Adverse events reported for 2012–13 include:
• 179 clinical management events, including delays in treatment, concerns about the accuracy of diagnoses, inadequate patient monitoring in hospital, and near misses
• 24 medication events, with 11 of these related to administration of an incorrectly prescribed drug or drug dose.
Making health and disability services safer—Serious Adverse Events report 2012–13 (HQSC)
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Meaningful Objectives
• Improve quality, safety, efficiency and reduce disparities
• Engage patients
• Improve coordination of care
• Improve population health and interact with public health programs
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Alerts & Reminders
• May reduce errors through timely information about– Indications– Contra-indications– Drug-Drug interactions– Appropriate dose ranges– Drug-Food interactions– Precautions for specific drug-disease combinations– Relevant abnormal laboratory test results (e.g. rising
creatinine levels)– Drug allergies
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Alerts & Reminders
• Alerts and reminders must be– Specific– Useful– Timely
• Otherwise they will create noise that will be– Ignored– Overridden
• Clinicians override drug alerts 49% to 96% of the time
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Alerts & Reminders
• Highest potential for reducing & preventing errors
• Difficult technology
– Labour intensive
– Still evolving
• Lack of CDS standards
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SNOMED CT Integration
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SNOMED CT Integration
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SNOMED CT Integration
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Shrimp Terminology Browser: SNOMED Clinical Terms Australian extension
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Alert Examples—Indications
• Diagnosis: Acute Gout (SCTID: 24595009)
• Rx: Colchicine (SCTID 387413002)
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Alert Examples—Contra-Indications
• Diagnosis: Acute gout (SCTID: 24595009)
• Rx: Colchicine (SCTID 387413002)
• Previous Clinical Finding: Sickle Cell Anaemia (SCTID 127040003)
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Unintended Consequences
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• Found that a widely used CPOE system facilitated 22 types of medication error risks from mis-design
JAMA. 2005 Mar 9;293(10):1197-203.
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Summary
• The NZF can support system interoperability to enable alert and reminder development
• Alerts and reminders must be– Specific– Useful– Timely– Fully validated and tested
• Needs to be a collaborative approach to development
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