A view from the top-NHS project

张琨

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<br>The NHS is a key element of the current government’s modernisation programme and has been under constant scrutiny in the UK national media recently.
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<br>We have seen the latest report produced by the National Audit Office (NAO), A Safer Place for Patients: Learning to improve patient safety, stating that up to 34,000 people could have died as a result of hospital errors and accidents in 2004-05.
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<br>Also, it has recently been announced by the government that nurses and pharmacists are likely to be given greater powers to prescribe the majority of drugs and GP surgeries are being urged to stay open longer.
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<br>Coverage of these issues has been rather negative, often focusing on the problems rather than the benefits or solutions. However, some interesting questions have been raised.
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<br>atient safety
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<br>With these additional challenges, how can we ensure patient safety? How can errors at the point of prescribing and dispensing be reduced in order to bring down the alarming statistics highlighted by the NAO? How can we ensure consistent treatments from a growing range of clinicians who are able to prescribe?
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<br>First DataBank Europe (FDBE) believes the solution is simply a more joined up healthcare system and increasingly extensive use of the clinical decision support systems that are currently available. NHS Connecting for Health (NHS CfH) will support these new prescribers through the roll out of the National Programme for IT (NPfIT) to reduce errors and ensure consistency in the area of medicines management.
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<br>Clinical IT systems are available here and now and, if used effectively and in line with the NPfIT, can support clinicians in making informed decisions about which medication to prescribe safely, and prevent medication errors. In fact, these systems have been in use in GP practices and pharmacies for many years and are demonstrating real benefits, as well as in those hospitals where they have been introduced. Drug knowledge bases for clinical decision support systems are continually being researched and developed to ensure an up-to-date picture for the clinician.
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<br>NHS CfH, supported by substantial new investment from the government, is working hard to ensure that all hospitals will benefit from new IT systems at the earliest possible date. This is a significant step in helping to reduce the tragic loss of lives through medication errors and should be welcomed by both clinicians and patients alike.
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<br>The future of clinical decision support
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<br>The potential for the development of clinical decision support over the next decade in terms of both scope and capability is an exciting prospect. The standardisation of clinical and drug terminology through the adoption of the Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) and the NHS Dictionary of Medicines and Devices (dm+d) will offer clinicians a picture of the nation’s health.
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<br>The consistent terms for medication will reduce the potential for misinterpretation of prescriptions, dramatically reducing the chance of errors. Through population of the NHS National Care Records Service (NCRS), clinicians working on site and on the move, will have real-time access to patient care records therefore maximising the benefits of clinical decision support.
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<br>Imagine, in 20 years' time, the prospect of a child being hit by a car on a busy street. The paramedics are called and a mobile response unit arrives. The child is unconscious so the medic takes her name from her identity card. By entering her name and NHS Number into a handheld PDA the medic has instant, real-time access to her NHS Care Record, which shows she is local, aged 11 and an asthmatic.
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<br>The medic makes an informed decision regarding the child’s treatment within minutes. He knows which medication he can prescribe safely, how much he should give her and how it should be administered. This is enough to save her life.
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<br>It is these technology-based clinical decision support systems which will underpin the expanding role of clinicians in the NHS and aid them in making the right decision for each patient at the point of prescribing. The result is a better service, with reduced errors and appropriate treatments, ensuring the path to patient safety.
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