The learning curve of electronic prescribing.

INTRODUCTION: Medication errors are a potentially avoidable source of harm to patients. The authors' hospital has introduced electronic prescribing in an attempt to reduce these errors. A prospective quality improvement project was performed to assess both the impact of this change on prescribing errors and to see if there was a learning curve associated with prescribers using the new system. METHODS: A simple prescribing task was created in which study participants were asked to prescribe a set list of medications for a fictional patient. The participants were timed first using paper drug cards, and then using the prescribing function on iSOFT's iClinical Manager. The prescriptions were also assessed for legibility and errors. This was done within 1 week of the participants starting in the department, and then 2 and 4 months later. A total of 25 junior doctors completed the task. No participant had prior experience of electronic prescribing in a clinical setting. RESULTS: During week one, the task took a longer average time to complete using electronic prescribing compared to paper (323 seconds vs 290 seconds, P<0.01). After 2 months the mean time to complete the task was shorter with electronic prescribing compared to paper (261 seconds vs 306 seconds, P<0.01). There was therefore a significant mean reduction in the time taken to complete the task using electronic prescribing of 62 seconds (P=0.01). There were fewer illegible entries or drug errors using electronic prescribing compared to paper prescribing (2.7% vs 5.3%, P=0.68). CONCLUSIONS: Electronic prescribing appears to reduce prescribing errors. However, there is a learning curve for new doctors using electronic prescribing. Training and support is vital during this period in order to reduce prescribing errors.

Thrombosis of the external jugular vein: a rare complication of a proximal humerus fracture treated with collar and cuff immobilisation.

We report the case of an 87-year-old woman who developed a thrombosis of her external jugular vein after sustaining a proximal humerus fracture managed nonoperatively with a collar and cuff. At review in fracture clinic she was found to have an enlarged external jugular vein which was subsequently found to be thrombosed. Her collar and cuff had been applied very tightly and it was felt by the ENT team to be the cause of the thrombosis of her external jugular vein. She was fully anticoagulated with warfarin after subsequently developing a deep vein thrombosis in the subclavian and axillary veins. She made a full recovery following anticoagulation. In this case, we review the potential causes of this rare and underdiagnosed condition, as well as the usual investigations and treatments. We also review the common complications of this fracture and the alternative treatment options available.