The ePrescribing programme has published a range of advice, guidance and standards associated with the development and implementation of electronic prescribing in England.

Dose range checking guidelines (October 2009)

Dose range checking is a type of decision support functionality which, as part of an ePrescribing system, can support the prescription of appropriate doses of medicines and other therapies. It can be particularly useful when dealing with children and other patient groups where factors like age and weight introduce more complexity. 

Input gained from a range of NHS organisations and professional bodies has enabled the ePrescribing programme to develop some dose range checking guidlines.

The finalised guidelines (PDF, 95Kb) aim to:

• Define the background of dose range checking as a component that will be used nationally to support hospital-based ePrescribing.
• Scope the spectrum of concepts that could be considered in the implementation of dose range checking functionality in ePrescribing systems.
• Provide a framework for the prioritisation of dose range checking elements.

The guidelines will be of particular relevance to staff who have an involvement in developing ePrescribing systems, and third party data suppliers. However, they may also be of interest to those with an interest in ePrescribing and medication safety generally, including healthcare staff such as doctors, nurses and pharmacists; other NHS trust employees (e.g. IT staff); professional bodies and specialty-specific associations; and NHS agencies such as the NPSA.

Access the guidlines (PDF, 95Kb)

dm+d implementation guidance (updated October 2009)

This updated version of the dm+d implementation guide (PDF, 611Kb) explains how dm+d might be implemented in hospital-based ePrescribing systems and contains information about dm+d itself, the data files in which it (and supporting information) is published and a prescribing model which may be used to enable dose-based prescribing.

In order to implement the approach detailed within the guide, readers will also need to refer to a number of files available from the 'Terminology Reference Data Update Distribution' (TRUD) service. More information is contained within section 6 of the guide.

Feedback invited on hazard framework for ePrescribing related decision support (Sept 2009)

The ePrescribing programme is inviting feedback on a draft hazard framework for ePrescribing decision support.

Clinical decision support broadly refers to the provision of clinical and patient-related information to enhance patient care. Such information needs to be filtered intelligently and presented at the right time to the appropriate person. It can be as simple as the provision of a drop-down list to reduce selection errors to more complex information and support such as alerts for drug-drug interactions.

Clinical decision support can support improvements in patient safety but it may also have unforeseen limitations. The functionality therefore needs significant assessment prior to and during implementation to ensure that it does not increase rather than decrease  the risk of errors -  this is where the hazard review guidelines should prove useful.

The draft guidelines are published here and interested parties are being invited to review them and comment using a structured feedback form.

A wide range of groups and individuals may be interested in commenting, including: healthcare staff who prescribe, supply or administer medicines; senior managers and clinicians in trusts; professional bodies; other NHS agencies with an interest in patient safety; and ePrescribing system suppliers and knowledge providers.

Access the draft guidance (PDF, 65Kb) and feedback form (Word, 50Kb).  Feedback should be returned to eprescribing@nhs.net  by 5 November 2009.

Reducing the risk of mis-selecting opioid preparations in electronic systems (Sept 2009)

Mis-selection of medicines is one of the new risks associated with the move from paper-based to electronic systems for medicines management. And opioids carry particular risks as the doses at which they may be used can vary by 10 fold. This means that the preparations available may also vary by up to 10 fold in their concentration or strength, thus increasing the risks of a mistake being made if , say, a zero is not seen or the concentration is mis-read.

Reports of errors have identified the format in which the medicines were displayed for selection during the prescribing process as a probable contributory factor. Consequently  NHS Connecting for Health, working closely with the National Patient Safety Agency, has authored a paper which identifies lessons learned that might be applied to reduce the risk of mis-selection of opioid products. The paper is likely to be of interest to both individuals involved in the design and implementation of ePrescribing systems, and those who use them.

Lessons learnt on mis-selection of opioid products (PDF, 138KB).

Other documents

Identifying local minimum requirements for an ePrescribing system (July 2009)

This new guidance from the ePrescribing programme identifies key questions which trusts should ask when considering their minimum system requirements (PDF, 158Kb) for ePrescribing and highlights useful resources available on the ePrescribing programme's web pages.

Tall Man Lettering report (July 2009)

This report, entitled 'The Use of Tall Man Lettering to Minimise Selection Errors of Medicine Names in Computer Prescribing and Dispensing Systems' (PDF, 434Kb), explores whether the use of Tall Man Letter by ePrescribing system suppliers can help reduce the number of medicine selection errors.

ePrescribing in hospitals: challenges and lessons learned (June 2009)

A range of information resources commissioned by the ePrescribing programme about challenges and lessons learned, developed by an independent team of researchers, have been made available to help NHS staff who may be involved in the planning, implementation, development and use of ePrescribing.

ePrescribing hazard framework (October 2008)

The ePrescribing programme has worked with the National Patient Safety Agency to develop and publish a set of guidelines (PDF, 274Kb) outlining a core set of design-related safety features that ePrescribing system suppliers should incorporate in their systems. The guidelines identify hazards that should be mitigated in order to ensure that previous lessons learned are not forgotten. The long term aim is to develop the guidelines into information standards for use throughout the whole of the NHS in England.

ePrescribing reporting guidelines (November 2007)

The ability to generate appropriate clinical, management and financial reports can add real value to the introduction of ePrescribing. Clinicians and other stakeholders have helped the ePrescribing programme to develop further guidance on the reporting requirements (PDF, 198Kb) associated with ePrescribing systems, which supplements the information included in the ePrescribing functional specification.

ePrescribing functional specification (January 2007)

The functional specification (PDF, 498Kb) was published after an extensive clinical engagement process. The document contains a set of functional requirements for ePrescribing systems to be used primarily within acute care settings in the NHS in England. The document was developed as an aid to software development but may also be of interest to doctors, nurses, midwives and pharmacists – indeed all healthcare professionals with a role in the prescribing, administration and supply of medicines, and who may therefore have an interest in the benefits ePrescribing can bring.