It's a familiar scene. An on-call doctor, exhausted at the end of a 12-hour shift, scribbles a prescription down. The script, for a premature baby, is for digoxin. Unused to special baby care, the doctor calculates the dose in his head, and writes down 0.6mg rather than 0.06mg. Receiving an i-m injection ten times the dose she should have received, the baby suffers a heart attack.
Sadly, similar situations occur in hospitals all over the world, every day. The US Institute of Medicine estimates that up to 98,000 Americans die every year due to medical errors - more than die from car accidents, breast cancer or AIDS. As the Institute's report stated, "to err is human" - but healthcare providers still have a responsibility to minimise the room for mistakes. And one of the root causes of preventable errors is faulty prescribing. Prescribing errors are common and are attributable to a range of factors.
Some of the most widespread include confusion over similar-sounding drug names, illegible handwriting, incorrect dosage or frequency, or a failure to check for contraindications or interactions with other drugs.
The problem has been well documented in the US and Europe and, as a result, many healthcare providers have installed drug databases, such as Micromedex, to offer decision support at the point of prescribing. To date, the most advanced system in widespread use across the UAE has been the British National Formulary (BNF), largely because no UAE-specific database has been available. But that is all about to change.
A new software company is launching a system that promises to bring up-to-the-minute drug information to the fingertips of doctors and pharmacists. Installed on desktops, the system will hold information on all the licensed drugs in the UAE region, prescriptive and consumptive, along with their active ingredient, any indications or contraindications, alerts for allergies or interactions with other drugs, and their minimum and maximum dosage.
Roman Konovalov is the managing director of Aroma Software, the company behind the launch. "It's the first drug database that is tailored for the local market," he says.
"This is a real innovation for doctors and pharmacists, because they won't have to search the internet or formularies for up-to-date drug information - it will be available right on their screens," Konovalov adds.
So how will the system work? According to Konovalov, users can either search by generic or brand name, active ingredient or pharmaceutical company. The system will then list all the available medications under each search parameter, along with all drug data.
By creating a system that can search by product ingredient, doctors or pharmacists can offer alternatives to EU or FDA approved drugs that are not yet licensed in the UAE. For a country with a majority expatriate population, Konovalov explains, it's a big benefit.
"Unfamiliar medication can be checked quickly and efficiently and a licensed alternative prescribed. It's much faster than looking up the options manually," he says.
This feature also lets pharmacists compare brands, form and price. "So if a patient asks for, say, 300 mg aspirin, but doesn't want to take pills, you can use the system to see what brands offer an alternative," Konovalov adds.
For a sizeable percentage of pharmacists in the UAE, any form of IT system would be a big departure from their current practice. George Varghese, chief pharmacist at Dubai's Welcare Hospital, estimates only 25 to 30% of pharmacists have computers.
"It's not like Europe," he explains. "The healthcare system is very different here and it may take some years to fully implement these systems. It would probably be most suitable for larger hospitals or pharmacy chains, who could bear the cost and training."
Despite this, Varghese says, pointing to Welcare's current IT overhaul, the health sector should look to develop more sophisticated systems, such as national drug databases.
"It is a great idea. These sorts of safety checks should be something all hospitals and pharmacies have in place. Prescriptions would be confirmed twice: once by the doctor and once by the pharmacy," Varghese says. There would be less room for mistakes."
But Konovalov argues that the system has been specifically developed to cater for all types of user, even very small operations. "We have a range of versions - the one installed would depend on the IT system already in place," he says.
"Single practices might want just a static database, one that just lists the drug information, whereas bigger healthcare groups might choose a more intelligent system that interacts with their current software."
For hospitals that already have their patient records online, Konovalov explains, the drug database has the potential to cross-reference the prescribed drug with the electronic records. "It would link into the HIS (hospital information system) via a software gate. So the doctor could write the prescription with their normal software and the database would analyse the patient's record and alert the doctor to any allergies or problems with current medications," he says.
"It would help support doctors in their prescribing decisions."
Konovalov says the cost of the database would depend on the number of uses, and the version installed. "It would be much cheaper for a single user, for example, than a major hospital. A one-year subscription for a small practice would probably be in the region of AED 500."
Included in that cost would be all drug and software updates. Should any new drugs come on the market, Konovalov stresses, the information would be automatically downloaded to your computer. These updates also have the potential to be hugely beneficial, should any drug alerts be issued by the pharmaceutical industry. "As soon as you start up the application, all new information will be delivered to your database," Konovalov explains. "If a pharmaceutical company needed to circulate urgent information about their product, you could access it almost immediately."
In the wake of high-profile scares, such as Vioxx or Seroxat, the updates could go some way towards allaying prescribing concerns. The training costs in terms of time would also be minimal, Konovalov adds.
"Our number one rule is to make the access as simple as possible. Training wouldn't take more than a few hours," he says.
"The user-interface will be designed for non skilled staff. They can print everything out, so if they prefer to work on paper or want to share the information with the patient, they can. There will be no complicated stuff."
There is certainly a lot to be said for desktop drug systems. Because the database red-lights allergies, or potential clashes with other medication, users are more likely to double-check their prescription. And because the drug's indications are clearly listed, including recommended dosages, the chance of confusing similar-sounding generic and proprietary names is limited.
In a study of automated prescribing systems, displaying similar safety features to the database, the software was found to reduce the incidence of medication errors by as much as 73%, prompting experts to label it a "wake-up call" to health professionals.
But it would be a mistake to view the system as a cure-all for prescription errors. No matter how advanced your IT system, mistakes can and will occur, as several studies have shown.
Konovalov is honest about technology's limitations. "It's not a panacea and there is always the possibility for error. But we are not saying that the system would replace a doctor's expertise and we're not saying what to prescribe.
"The database is there to offer support and as a reference guide. Having the information on your desktop makes it easy to double-check your work, and the easier it is, the more likely you are to catch mistakes before they happen," he says.
Interest in the database is already picking up, and Aroma Software is in talks with several drug companies that have expressed their desire to distribute the system to their customer base. While the Middle East has a notoriously slow curve in adopting new technologies, Konovalov is hopeful that the benefits of the database will outweigh any apprehension.
"Pharmacists and doctors need full information, at their fingertips," he stresses. "And this is what we're offering."
And compared to its biggest competitor - a hefty formulary - for time-short doctors, that could prove to be the biggest attraction of all.
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