Avoid errors with e-prescriptions
Electronic system can facilitate medication management and improve patient safety
SCORES OF Jamaicans facing psychological pressure are avoiding the professional counselling they need because of fear that they could be labelled mentally ill or mad.
“Counselling is talk therapy, and you try to restructure mental processes and understanding and get the person to internalise another way of doing things.
“But because people usually associate counselling at the extreme end with somebody who is mad, somebody who is insane, somebody who has really had what we call a nervous breakdown, persons do not seek treatment,” psychologist Leahcim Semaj told The Sunday Gleaner.
“We have not yet fully understood the construct in Jamaica in terms of what we call the “walking wounded”, that many of us have deficits in our life and we go through experiences that cause imbalances,” added
Semaj.
He argues that within the context of Jamaican and Caribbean culture, the closest thing that persons have come to accept as a form of counselling is what happens when they sit and talk to the hairdresser, the barber, or to a bartender.
Counselling psychologist Joan Pinkney says that unlike other parts of the world, Jamaica doesn’t have a culture of formal counselling, but she believes that people are now recognising its importance.
“A lot of us consider ourselves private and ... apart from that, we are supposed to be a ‘Christian country’, and so the dependence on God is perceived as how we should deal with things,” argued Pinkney.
VIEWED AS WEAKNESS
She was supported by clinical psychologist and president of the Jamaican Psychological Society Kai Morgan, who told The Sunday Gleaner that for some persons, having to seek help through counselling can be seen as a sign of weakness.
“For a lot of persons, you should be able to deal with this on your own. You are supposed to be able to figure this out, whether you, as the child, can figure it out or we can figure it out as a family.
“They don’t want to feel like, mentally, there is something wrong with them, and that is the perception that something is For Semaj: “Whatever the problem that was seen, chances are it is more likely the problem will get worse than to spontaneously fix itself. So a child who is having behavioural problems, it could easily morph now into a violence problem, a truancy problem, and the behaviour becomes worse than being able to get fixed and getting the person back on track.
“It is said that many times, couples seek counselling six years after the problem has started. By then, the problem has got so much worse. If you had nipped it in the bud early, you could have got back on track,” said Semaj.
That was endorsed by Pinkney, who warned that issues such as rape, if not treated, can manifest themselves in other ways such as homosexuality or promiscuity. “Getting treatment is important, and it can’t be just that ‘the Lord bless and keep you’. It has to be looking at the issues, and seeing how best they can be worked through one by one,” said Pinkney. The psychologists agree that even though we are not where we need to be as it relates to counselling, it can be fixed by educating the masses. “We need all hands on deck. We need a media approach to help people to understand what counselling is. We need to popularise it,” said Semaj.
PINKNEY
mentally wrong with you if you have to seek counselling and that, basically, it’s a sign of weakness,” said Morgan.
She cautioned that persons run a huge risk if counselling is recommended and an individual decides not to get help.
“A lot of the time what will happen, especially in the case of trauma – which we have a lot of in our country – is that it will stay there, and believe me, it does not go away, and so 10 or 20 years down the road, you are recognising the impact that it has had on their relationships,” added Morgan.
COULD GET WORSE
ELECTRONIC PRESCRIBING is much more than it appears. While the basic definition speaks to the technology framework that allows doctors and other prescribers to electronically write and transmit prescriptions to patients and pharmacies, the system as a whole can achieve much more. One general benefit of e-prescription is that it assists with eliminating prescription errors in several ways, but importantly, it can be used as part of a system of medication management.
There are many problems associated with the current paper-based prescription system, which presents major risks to patients’ safety and negatively impacts medication-therapy outcomes. These include illegibly written prescriptions; missing prescriber or patient data; risk of losing or damaging paper prescriptions; rewriting of prescriptions by prescribers and pharmacies; slow prescription processing – long wait times; failure to identify drug interactions, causing the potential for adverse reactions; possible prescription fraud; no standard drug-coding system; and the high cost of handling prescriptions.
The most common drug dispensing error is due to the misinterpretation of handwritten prescriptions. E-prescriptions eliminate this issue because information would be clearly typewritten. Such a system can store prescriptions for patients in a database, and over time, compare current prescriptions with those of the recent past to check for interactions before dispensing.
This would be part of the patient’s overall electronic medical record, providing caregivers with holistic information from which to determine the best course of action for treatment regimes.
Any effective e-prescription system needs to have several other elements to enable optimum medication management, including the capacity to quickly undertake drug-drug interaction, drugallergy, and drug-food checks during prescription preparation.
This information for every ‘prescribeable’ drug would be registered in the database. A plus to the system is also its ability to provide direct information to patients in a form that they can understand. The best systems would include this in their make-up, providing patient education leaflets via email or in an app to ensure that patients are part of their health management. This would improve health literacy and invariably result in better health outcomes.
FIGHT AGAINST FRAUD
E-prescriptions can also be a vital tool against fraudulent prescriptions and the hoarding of drugs, especially for the public health system. The use of the Caribbean Drug Codes (CDC) can assist with this aspect of dispensing.
The CDC codes drugs based on formulary, and so the dispensing person would be alerted if a patient is trying to get the same medication in a different brand before the prescriptive time has passed. In addition, if such a system is connected to pharmacy inventory, the prescriber can check for availability, interactions, and substitutes.
Apart from the obvious system benefits, another plus is that the e-prescription can be dispensed before the patient gets to the pharmacy, and so a lucrative delivery service could be developed.
Medication management facilitated by the use of e-prescription and using the right combination of technology can significantly improve the prescriber, dispenser, and patient experience. Most importantly, this approach can save lives and improve health.
Jamaica has not yet decided on whether and in what format the country will move forward with e-prescription. However, the world is moving at such a fast pace with health technology that we cannot afford to be left behind.
Once we start viewing e-prescribing as bigger than just an electronic means of sending a prescription, like “faxing” for example, then, perhaps, we will have a better appreciation for the fact that this is something that requires almost immediate action.
E-prescription represents an entire medicationmanagement system rather than just an alternative means of sending a prescription from doctor to pharmacy.
The University Hospital of the West Indies, which is almost completely digitised, has seen major improvement in the area of pharmacy as it has been able to use the features of the e-prescription component of the health information management system within the hospital. I am told that patients have been very happy about the improved efficiencies.
My recommendation is for us to swiftly put in place the required policy for the use of eprescription and adopt the Caribbean Drug Codes nationally for use as part of the system. Delays in this regard could have adverse consequences to you and me – the patients.
Doug Halsall is chairman and CEO of Advanced Integrated Systems. Send feedback to doug.halsall@gmail.com.
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