Background
Patient safety, and the reduction in medication errors more particularly, is a topic of interest, both for Government and public alike. Information technology has been highlighted as potentially improving patient safety by avoiding prescribing and medication administration errors^1. Although there are many potential safety features of electronic patient records (EPRs), relatively little attention has been paid to their relative importance in the UK. The objective of this study was to assess the perceived importance of some potential safety features, related both to prescribing and to general computer interface issues in secondary care.

Method
A two stage Delphi questionnaire was piloted and used to reach agreement on the perceived importance of 43 potential features of the EPR that focused on patient safety. The questionnaire was divided into two sections: prescribing safety features and general safety features, based on a previous study in primary care². The first stage of the questionnaire was electronically distributed amongst an expert panel of judges recruited from the Information Technology Special Interest Group of the Guild of Healthcare Pharmacists (n=32). Respondents were asked to rate the importance of the features on a five point scale, ranging from ‘irrelevant’ to ‘very important’. Respondents were also encouraged to write additional comments for each of the issues. The second stage questionnaire was supplemented with the qualitative comments for each issue in the first stage. The aim of the second stage was to achieve a 75% consensus in the group on the importance of the safety features.

Results
In the second stage, the response rate was 87.5% (n=28). Over 70% of the panel judged 11 (26%) of the 43 features to be very important. Seven were within the prescribing safety and four within the general safety features. The most important features included appropriate alerts when contraindicated drugs, hazardous drug combinations and inappropriate dosage regimens are to be prescribed. Different levels of decision making support within the IT system, interface functionality, reporting and clinical audit were also considered most important.

Discussion
The higher level of agreement amongst the panel members in this secondary care study, contrasts with the much lower higher level of consensus on safety features within the study in primary care, where over 90% of the expert panel agreed that 58% of the features were very important². This suggests that there is less consensus about the need for certain automated safety features for EPR systems highlights the greater importance placed on safety features by those working in secondary care. The reason for this is unclear, but it may reflect the expectation of prescribing for a more complex patient group.

References

1. Bates DW, Gawande, AA. Patient Safety: Improving Safety with Information Technology. New England Journal of Medicine 2003; 348: 2526-2534.
2. Avery A, Cantrill JA, Sheikh A, et al. Realising the Potential of GP Computer Systems to Improve Patient Safety. Report to the NPSA, December 2003.