DECEMBER 2024LIFE SCIENCES REVIEW8AIN MY OPINIONTECHNOLOGY INNOVATIONS IN HOSPITAL MEDICATION MANAGEMENT utomated pharmaceutical technology innovations for medication management are well documented and commonly used nowadays to reduce medication errors, improve efficiency and quality of care. However, these innovations have led to new and unforeseen challenges. Various computerized processes are implemented at different points of the medication-use pathway and these are divided into the following care points:- - Computerized prescription order entry systems (CPOE) - Hospital / Pharmacy information system (HIS) - Automated dispensing cabinets / machine (ADC) - Medication repackaging system (unit dose packaging) - Barcode medication administration (BCMA) - Computerized medication administration records (CMARs) -`Smart' infusion pumps, with drug libraries information on common concentrations, dosing units and limits.Despite how pharmacy departments have worked with technology vendors and the information technology sector to improve the usability of systems, it is still not error-proof. In this article, I shall focus on medication management from the pharmacist's perspective and will discuss the first four points above. Let's begin with CPOE and HIS. When these two systems are directly interfaced, they should be capable of issuing medication safety alerts, supporting drug-drug and drug-disease interactions and providing a basis for clinical decision making. One of the first challenges lies in the prescribers' adoption rate, especially for individuals who are not as computer literate, requiring extensive training to become familiar with HIS. Secondly, prompts that alert against drug interaction, allergy or overdose often lead to alert-fatigue and eventually become easy to ignore. One recent case involved one of the drugs known to induce Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) ­ Allopurinol. Proactive measures were taken since 2008 to perform mandatory Human leucocyte antigen-B (HLA-B)*5801 gene testing before prescribing some main causative drugs like allopurinol. The prescription was issued via CPOE, the system was designed to alert prescribers to order the HLA-B*5801 allele test and to educate patients on early signs of hypersensitivity reaction. Sadly, a 73 year old woman passed away in November 2022, since the involved HIS generated too many alerts. "Alert fatigue" in this case, caused the alerts to become a distraction which prescribers unconsciously ignored. This illustrates the importance in striking the correct balance of alert frequency in order to achieve patient safety. By Carol Chow, MPharm / RLSGB, Head of Pharmacy & Research, Gleneagles HospitalCarol Chow
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