The Electronic Prescribing Risk and Safety Evaluation tool, known as ePRaSE, is an online NHS-sponsored self-assessment tool developed to help trusts learn about how well their electronic prescribing systems have been configured and maintained to mitigate against known prescribing risks to keep patients safe. The results will allow trusts to look at their individual performance immediately and learn from annually reported national benchmarking data. The national results will also be used by the ePRaSE team to build a Learning Lab toolkit to support users in taking the next steps in optimising their systems.
The tool provides a set of 15 fictional 'patients', which users set up in their live or test ePrescribing environments, and then provides a set of 45 prescribing test scenarios to challenge their system responses to risk. There are some additional direct configuration questions to assess basic safety features in the build of the user's ePrescribing system. The performance of the ePrescribing system to both the risk scenarios and configuration questions is provided in real time with a text-based report and accompanying visuals. The report is intended to guide and assist ePrescribing system users and new implementers in the optimisation of their systems.
The main adult version of ePRaSE is suitable for all acute and mental health NHS trusts using or implementing ePrescribing across England who have access to the Health and Social Care Network (HSCN). Users can only register using their nhs.uk or nhs.net email accounts. Up to four users per trust can register to set up and execute the assessment or to view the final reports.
The web-based ePRaSE application is compatible with all modern browsers: Google Chrome, Mozilla Firefox, Opera, Safari, and Edge.
ePrescribing is the utilisation of electronic systems to facilitate and enhance the safety and efficacy of prescribing medicines to patients, and to provide a robust audit trail for the entire medicines use process. Implementation of ePrescribing with clinical decision support (CDS) has been extensively researched; many studies have shown reductions in medication error rates and preventable adverse effects. Following implementation of ePrescribing with CDS, medication errors tend to decrease over time as system configuration is optimised for local use and users adapt to the system. Greater patient safety benefits are documented with experienced users rather than new implementers. However, upgrades and system modifications can also introduce new safety risks, such as incompatibilities with legacy software. Detecting and managing safety risks can be difficult due to the complex nature of potential errors relating to not only the system itself, but also the behaviours of users and characteristics specific to organisations.
In the UK, before ePRaSE there was no standard method of evaluating the effectiveness of ePrescribing systems in preventing medication errors or potential adverse drug events. NHS England has commissioned the continued development of ePRaSE to assist trusts in continuous improvement and optimisation of electronic prescribing systems.
The programme started as a pilot in 2019 with the second iteration of the tool rolled out in 2022. The 2022 findings suggested that on average only 50% of potentially unsafe prescription orders were being mitigated appropriately by the EP systems tested. Further details can be found in the open access publication titled "A simulation study to quantitatively assess the performance of electronic prescribing systems in English NHS Hospital Trusts", accessible through this quick link https://rdcu.be/d6nGu.
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