Healthcare Assignment: Issues in E- prescriptions services in New Zealand

Question

Task: Healthcare Assignment - Opportunities and purpose Drawing on relevant literature and the material about human factors and system factors, consider a system failure you have recently experienced personally. The system could be technological or also involve other people (hence sociotechnological). It may involve potential risk to you, although this is not necessary for this assignment – it may simply be an annoyance or inconvenience.

Answer

Introduction
It is stated herein healthcare assignment that technological innovations have been part of almost every industry in the world. However, many developed countries have been working hard for creating several devices and mechanisms for the health industry. The disruptive and incremental technology will improve the health services in developed countries while also inspire developing countries for enhancing their public health systems.However, the digital health strategy is in the developing stage thus, many serious issues have been encountered in the past and present scenarios due to this. In this view, e-prescription services in New Zealand have been a major part of health care units including pharmacies (1,para 1). This report will provide a detailed description of a human and technological factor in this system failure.

Digital Health Strategies
In New Zealand, the health care and the pharmaceutical industry had approximately spent $243 million in IT services in the year 2015. It was estimated that by 2019, this industry would grow by $300 million (4 paras 1-5). Thus, the technological development will provide several opportunities like reduced cost of sensors, enhanced data analytics power, and advancement in the robotics and genomics. ePrecription services are developed by a software company named SimplHealthwhich provides secure channels for prescription and dispensing medicines through information technology (1 para 1). This system has been beneficial in reducing errors in dispensing, supervision in patient's adherence while also improving the overall medication history of the patient. The e-prescription system is simpleasthedoctors just need to enter the script, select the appropriate pharmacy, and send the prescribed medicines electronically (3 p.1). However, this arisen issues as many pharmacists might provide wrong medicines to the patients due to unclear understanding of generic name or the medicine combination given.

Part 1
The pharmacists often commit errors while reading e-prescriptions like look-alike and sound-alike medications. The pharmacist also conducts self-checks that should be replaced with fresh eye checks. Not all pharmacies in New Zealand conducts patients counselling due to which discrepancies occur in the prescribed medicine with those that are provided to the customers. In the current systems barcode verification, accurate checking techniques are absent due to which severe accidents of wrong medicines given to the client can occur.

I am Pharmacists a work under renowned pharmacy that is located in Auckland. I had experienced a major system failure when one of the staff had given the wrong medicines to an elderly customer due to this old aged man had to be admitted in the hospital. The elderly customer lives near to the pharmacythus, he often purchases his medicines from our store. This has given us a brief understanding of what kind of drugs is needed for him according to his health condition. He is several health issues, type 2 diabetes being one of them. One day he visited us for new medicines that were prescribed for him as conditions of his health had changed. The staff serving him was new and forgot to conduct counselling for better understanding. He gave him wrong medicines on high blood pressure and type 2 diabetesas he also misunderstood the generic name of the medicines prescribed by the doctors. There was a technological error as the practitioner prescribed different medicine with a similar name of earlier medications.

The customer did not cross-check and went home. I was not available at that time as I went out of the store for some work and left him with more than 2 experienced workers. We were lucky that the customer did not consume the medicines as soon he found the discrepancy but due to a gap in medication dose, he was primarily hospitalized. The doctor gave him the appropriate medicine after which he felt relief was discharged the next day. The new worker was immediately fired as he did not follow the SOP, nor consulted any of the experienced seniors working in the store.

I visited the old man in the hospital and his home after he was discharged and seek sincere apologies from him. The man was considerate as such incidents had never occurred in the past whenever he visits our store. When I had a close view of his prescription, I noticed that he had been prescribed new medicines with the same name which confused the staff. He is an ardent purchaser, and the system recognizes his prescribed medicines as he frequently purchases them. His medicines were costly than the old ones but as a matter of the system failure and human error, we replaced the wrong medicines with the right one without charging him any extra many for his new medicines.

Part 2
According to me, I presumed him a sincere professional, he had learned the skills quite quickly as compared to the freshers that had earlier joined. Since the morning, he was nervous that day might be due to his issues. I was assisting him to reduce his nervousness while eliminating errors. I guided him and though he would seek advice from his seniorswhen he requires. This was my mistake as I never felt he was hesitant with other members. Also, he was careless in misinterpreting the medicines as they look likes with earlier ones. He could have clarified the same with the patient or other workers. The outsider onlooking the situation would have also considered human and technological factors behind this system failure. The outsider would also conclude that it was a lack of technology and in human efficiencies for delivering the right products to the client. I also noticed that the errors in the prescription could not be identified easily. Pharmacies often face issues in understanding the dosing directions with medicines prescribed through e-prescriptions. Also, if a patient provides several e-prescriptions through the prescriber, errors on drug classes and dosing directions occur which impacts the health of the patients. Thus, it can be said that e-prescription errors had frustrated and confused the worker due to which he provided other class of the drug to the elderly patient.

Technological issues in e-prescriptions services
Technology is very crucial in health care as any lack or inefficiency can create greater havocs for the workers as well as for the patients. The e-prescription services also known as New Zealand Electronic Prescription services are developmental stage should be provided only to trained professionals. Odukoya et al (5) researched the 20 participants working in community pharmacies (428). The author collected data through direct observation of 45 hours and interviews. Thus, it was noticed that 75 e-prescriptions had errors relating to drug quantity, incorrect dosing directions, inappropriate therapy duration, wrong formulations of dosages, and others. It was then evaluated that every 5 out of 100 e-prescriptions had errors that would impact poor handling of disease for those patients while increased workload for the staff working in community pharmacy. Additionally, human errors also occur if appropriate strategies are not followed (5 p. 429). During peak hours or in the pharmacies located behind the hospitals often experiencing long awaiting customers, this makes it more challenging for conductingpatient counselling for understanding prescribed medicines. It is estimated that prescribing errors might originate from the office of the prescriber or the pharmacies itself.

As mentioned above, the e-prescriptions are in developing stage while it is also mandated by the government. It is often seen that restricted knowledge of the prescriber of time constraints leads to the commitment of errors in the drop-down menus due to incorrect drug or patient information (3 p. 2). This application should be made user friendly so both the prescribers and pharmacists commit fewer errors. Dropdown menus should be replaced with other IT tools that are user friendly and efficient (3 p. 3). The systems are also designed with auto-populated fields that result in selecting wrong patient information or incorrect dosing directions. It is also noticed that many of prescriber’s uses- old e-prescriptionsfor generating e-prescriptions refill. In this scenario, the pharmacists have verbally called the practitioner and advised a verbal changein the prescriptions.

Pharmacists have often encountered mismatch in the prescribed medicines by the doctors with that received at the pharmacist’s system (2 p 57). In this view, the pharmacist often encountered an inaccurate translation of the e-prescriptions that included the wrong drug quantity, drug name, and patient name. These challenges often result in severe errors in which the medications occur in different package sizes. The prescriber has little or no knowledge about the particular packages. The technological errors in the e-prescriptions services increase the costs and work burden of pharmacists and practitioners (2 p 56).

Additionally, the pharmacists have to pay monthly maintenance fees for vendors that have subscribed to e-prescription platforms while they also pay the cost of transaction costs on each e-prescription received (6 p. 7). Thus, if the practitioner has incurred mistake and provides improved medications through new e-prescription then the pharmacisthas to incur the additional costs as this be recorded as another transaction. This extra cost is incurred by the community pharmacies without any additionalITfinancial cover by the government. It is also seen that errors in the e-prescriptions often leads to incorrect billing and arise several other issues in the external audits(6 p.8). Each time error occurs in thee- prescriptions the pharmacists have resolved the issue by calling the practitioner and consulting verbally which further delays services and slows the work of the community pharmacies.

Strategies for the issues identified
After the personal experience in the community pharmacy, I have made several strategies that can be used by other pharmacists as well. The community pharmacies can devise several strategies that can resolve issues until the telehealth roll out by the government has been completely improved. The Pharmacists can place reminders on the computer systems about the look-alike/ sound-alike medicines. This will alert the pharmacists about the commonly confused drugs and package size. The pharmacies should also ensure that different medications' strengths should be stored separately. Similarly named medication should store in separate sections thereby reducing confusion (2 p.56). The “Tall Man” Strategies are often in New Zealand for distinguishing the same name medicines that have the same similar names. The barcode verification should be considered to be the final check, thus helping the pharmacists like us in mitigating wrong medication risks. We can also hire accuracy checking technicians who are trained and certified for checking accuracy on the dispensed medicines. This personal experience did impact as I became more cautious in my work and supporting newly recruited staff. It was good fortune that the elderly did not suffer from extreme health conditions.

Conclusion
The digital health strategy was implanted for improving the health of the patients however, in regions like New Zealand Telehealth has been in the developmental stage due to which several issues ahs arisen with dire consequences. I have a personal experience when an elderly patient was given wrong medications due to which he had to be hospitalized. The worker was relatively new in dealing the technological errors due to e-prescription services. The issues e-prescription services were discussed in the report while underpinning strategies. ?

References
1. Emerging technologies present the biggest opportunities for NZ healthcare. [Internet] 2020 [ Cited 21 August 2020]; para 1-5. Available from https://nztech.org.nz/2016/06/21/emerging-technologies-present-biggest-opportunities-for-nz-healthcare/

2. Health and Disability Commissioner. Medication Errors [Online PDF] 2009- 2016 [ Cited 21 August 2020] p. 56- 57. Available from https://www.hdc.org.nz/media/5052/medication-errors-complaints-closed-by-the-health-and-disability-commissioner-2009-2016.pdf

3. New Zealand electronic Prescription Service. MedTech [Online PDF] n.d.[ Cited 21 August 2020] P. 1-5. Available from https://www.medtechglobal.com/wp-content/uploads/2016/02/NZePS-Introduction-for-Prescribers.pdf

4. New Zealand On the Way to Digital Health. Healthcare assignmentThe Medical Futurist [Internet]. 22 February 2018 [cited 2020 Aug 21]; para 1-5. Available from https://medicalfuturist.com/new-zealand-on-the-way-to-digital-health/

5. Odukoya OK, Stone JA, Chui MA. E-prescribing errors in community pharmacies: exploring consequences and contributing factors. International journal of medical informatics. 2014 Jun 1;83(6):427-37.

6. Zadeh PE, Tremblay MC. A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks. Research in Social and Administrative Pharmacy. 2016 Jan 1;12(1):1-9.