Outpatient anti-epileptic drug prescriptions in a Children’s Hospital: a review
Introduction from Dr Markus Reuber, editor-in-chief of Seizure
Many of the processes which make up the totality of healthcare delivery make liberal use of human resilience. Patients have to survive challenges like waiting times, the loss of clinical data, or the imperfect transfer of information from one healthcare professional to another on a daily basis. Most do, but serious errors and adverse outcomes are much too common. Not all health professionals are willing to perceive the full extent of the shortcomings of the services they work in.
My editor’s choice from the present issue of Seizure, an audit and narrative review by Murphy et al. explores the area of prescribing (1). The authors are based in a paediatric hospital setting where the transmission of accurate and sufficiently comprehensive information between prescriber and pharmacist is arguably of particularly great importance. The findings of their local audit were disconcerting: less than one third of all prescription proformas were complete, over two thirds contained omissions, illegible or inaccurate information. Almost one in five prescriptions were lacking key pieces of information, so that the pharmacist had to contact the prescriber to check what pharmaceutical intervention was intended.
Murphy et al’s review of the literature about prescribing practices and prescribing errors suggest that there is no simple solution to the problems uncovered. Electronic prescribing abolishes problems related to illegible handwriting but it is not certain that it significantly reduces prescription errors – especially errors with significant clinical consequences.
At present, patients often get annoyed by the number of times they have to give the same piece of information to different healthcare professionals during a single clinic attendance. At the same time many healthcare professionals feel overburdened by formulaic information gathering procedures which they have to run through. However, whilst so much information is given and collected, it may still be missing at the point where it actually matters.
It may be that many of us can improve their services (and reduce the risk of errors) by tinkering a little with current arrangements. However, I suspect that more thorough re-engineering is required in many places to make most healthcare delivery really safe and efficient (2).
 Murphy AP, Bentur H, Dolan C, Bugeme T, Gill A, Appleton R. Outpatient anti-epileptic drug prescribing errors in a Children’s Hospital: an audit and literature review. Seizure 2014;23:786-91.
 Hoffman A1, Emanuel EJ. Reengineering US health care. JAMA 2013;309:661-2.