Authors (including presenting author) :
Leung KS(1), Chu CS(1), Chiu PL(2), Wong YY(1), Chi CY(1), Ng MY(1), Hau LM(3), Hau KC(1), Ho YY(1)
Affiliation :
(1)Department of Medicine and Geriatrics, Tuen Mun Hospital, (2)Nursing Services Division, Tuen Mun Hospital, (3)Quality & Safety Division, New Territories West Cluster
Keyword 1: :
Medication safety
Keyword 2: :
In-Patient Medication Order Entry (IPMOE)
Keyword 3: :
Local anaesthesia
Keyword 5: :
Bedside procedures
Keyword 6: :
Allergy cross-checking
Introduction :
Local anaesthetic (LA) lignocaine is commonly administered during bedside procedures in medical wards, such as pleural paracentesis and bone marrow examination. Traditionally, LA lignocaine administration in our hospital was documented using paper-based Medication Administration Records (MAR), relying largely on manual checks by clinicians. This workflow carries inherent risks, particularly incomplete cross-checking of drug allergy history, as some allergy records may reside in other electronic platforms such as Electronic Health Record Sharing System (eHRSS) and may be overlooked at the point of care. In the era of digital medication safety, omission of electronic allergy verification and patient identification may predispose to preventable adverse drug events. To address these gaps, our department implemented a structured In-Patient Medication Order Entry (IPMOE) workflow for LA lignocaine administered during bedside procedures.
Objectives :
This project aimed to enhance medication safety by integrating LA lignocaine administration into the IPMOE system. Specific objectives were to:
1. enable automatic cross-checking of documented drug allergies and drug-drug interactions across existing electronic platforms;
2. improve patient identification through barcode wristband scanning; and
3. standardise documentation of LA lignocaine administration for bedside procedures within inpatient wards.
Methodology :
A standardised LA lignocaine order set was developed within IPMOE for bedside procedures. Doctors prescribe LA lignocaine using predefined templates, followed by electronic medication administration using mobile devices (ToughPad). The workflow requires verification of patient identity via wristband scanning prior to administration and system-based allergy and clinical intelligence checking before proceeding. Estimated injection volume is entered at the time of administration and can be amended post-procedure if necessary, ensuring accurate documentation. A pilot was conducted in a medical day ward covering common bedside procedures such as bone marrow examination and renal biopsy. Following workflow refinement based on frontline feedback, phased promulgation was carried out through email circulation and departmental education sessions. Subsequently, the project was extended to all medical inpatient wards within the department, standardising LA lignocaine prescribing and administration practices across medical wards and embedding the IPMOE workflow into routine bedside procedural care.
Result & Outcome :
The IPMOE-based workflow was successfully implemented across medical inpatient wards. Automatic cross-checking of allergy and drug-drug interaction improved clinicians’ awareness of documented allergies and potential adversed outcomes, including those recorded outside the immediate clinical system. Mandatory patient wristband scanning enhanced patient identification safety. Documentation of LA lignocaine administration became standardised, traceable, and auditable. Pilot feedback led to optimisation of lignocaine concentration templates and prescribing practices. Overall, the initiative strengthened medication safety culture, reduced reliance on manual checks, and demonstrated the feasibility of extending IPMOE to traditionally paper-based bedside medications.
