Prescribing decision support

Medicines Management at Keele has long recognised the practical challenges that face healthcare professionals in the implementation of evidence-based, and national guidance-based prescribing. To a degree, NICE and departments such as our own, save the individual practitioner from having to trawl through trial data for evidence of clinical and cost-effectiveness. However, the influences on prescribing are manifold and the amount of information often overwhelming. How easy is it to remember all the NICE guidance and technology appraisals, let alone apply them to individual patients?

Furthermore, this challenge is no longer the exclusive concern of doctors – the traditional medical prescriber. The extended professional role of nurses and pharmacists now means that more healthcare professionals are expected to make individual treatment decisions in both the primary and secondary care settings.

“I read all the relevant papers (some of them twice) and the accompanying editorial, yet came away feeling that I was floundering around in a muddy present rather than striding out into a brave new evidence based future …”

“… I want a simple chart or computer program that will allow me to assess and reduce the risk … I also wish to give patients some idea of the likely benefit they can expect from treatment … So, until someone can clear the waters for me I think I’ll just continue to muddle along.”

Ref: Jeffries D. Having so many different guidelines about risk is so confusing. BMJ. 2000; 321:175.

Against this background, Keele University has developed a series of computerised decision support tools that aim to address the more practical challenges related to the adoption of guidelines and the implementation of evidence-based medicine.

Computerised decision support has been defined as the 'provision of assessments or prompts specific to the patient and selected from a knowledge base on the basis of individual patient data'. In particular, we have sought to develop and deliver easy-to-use software tools that make national guidance more accessible to practitioners and more easily applicable to individual patients.

Specifically, the tools – without being didactic – provide patient-tailored, guidance-based prescribing recommendations at the point of care. Each prescribing recommendation is generated by cross referencing patient specific profiles, created by the healthcare professional user, with multiple treatment algorithms. Each recommendation is referenced. In addition, each tool provides additional functionality that will be of further value to both the healthcare professional user and the patient. For example, personalised patient reports that the patient can take away, visual aids and personalised materials to support patient discussion, and costing tools for medicines.

If you would like further information regarding our work in decision support please feel free to contact us at:

Prescribing Decision Support
The Hornbeam
Keele University
Tel: 01782 715458