Extension of Emergency Care Summary availability in Secondary Care
The authors of the article 'Perceived Causes of Prescribing Errors by Junior Doctors in Hospitals' published in the BMJ Quality & Safety on 30 October 2012 report that "the main task factor identified was poor availability of drug information on admission (often out of hours)" and "Systems which should aid prescribers were not always available (e.g. the Emergency Care Summary was available, but the doctor did not have a password for it)". The article postulates that had the information contained in the Emergency Care Summary (ECS) been available, it would have led to a decrease in errors.
The ECS is a national system of shared electronic records in Scotland which enables up to date prescribing information from Primary Care systems to be available to clinicians working in unscheduled care i.e. Out of Hours, Ambulance, Emergency Rooms and Acute Receiving Units(1). It was designed to improve the information available when GP practices are closed. At the time of the study, in 2011, ECS was not available for junior doctors dealing with scheduled admissions in secondary care.
The lack of access to ECS in secondary care has been identified as a critical patient safety gap and plans have been made to address this. New developments to make the medication information in ECS available for all patients in hospitals and out patients are underway. In 2011, a pilot project in Lanarkshire reported(2) that the use of ECS for medicines reconciliation in Medicine for the Elderly, Orthopaedic admissions and Surgical day cases was found to be helpful by all users. A review of 31 cases found 119 discrepancies, between medicines information in ECS and the referral letter, an average of 5 per patient, as the average length of time between referral and pre-assessment was 110 days. The ECS records were accessed by nursing staff and pharmacists carrying out medicines reconciliation and was felt to be so beneficial that it was agreed to extend the use of ECS within secondary care using the Clinical Portals(3) to provide secure identity and event based governance(4).
The article states that "problems with inadequate quality medicines information at admission to hospital were highlighted. It is disappointing to see that measures such as the ECS which have been designed to tackle this very issue by providing an up to date list of patient's medicines are not working (many doctors said that they did not have access to the Emergency Care Summary)" and we would like to correct this statement as since it's inception the ECS was specifically designed to improve care Out of Hours and was not available to hospital doctors for planned admissions. Medicines reconciliation (a process by which the most recent and accurate sources of information are used to create a full list of medicines for a patient) has been a major priority for the Scottish Patient Safety Programme and they have helped to make the case for extending use of ECS for this purpose.
Significant developments are underway to extend access to ECS for all clinical users and eHealth developments such as the Clinical Portals will mean that ECS accounts and separate passwords will not be required in the longer term.
(1) http://www.nisg.scot.nhs.uk/currently-supporting/emergency-care- summary
(2) http://www.scimp.scot.nhs.uk/documents/ECS-Lanarkshire-Final- Report-v-6.0.pdf
Dr Libby Morris, eHealth Clinical Lead, Scottish Government Health and Social Care Directorate and GP, Hermitage Medical Practices, 5 Hermitage Terrace, Edinburgh, EH10 4RP
Dr Ian M Thompson, Chair, Emergency Care Summary Service Board and GP, East Linton Surgery, Station Road, East Linton, East Lothian, EH40 3DP
Jonathan Cameron, Programme Manager/ Interim Head of Project Management, National Information Systems Group, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB
Conflict of Interest:
LM and JC were responsible for managing the ECS as a development project. IMT is the clinical chair for ECS as a business as usual service.