By Calandra Feather, Clinical Safety Officer, Dosium
From reading the news to food delivery and home CCTV, digital technology has permeated almost every part of our daily lives. A quick touch of a button makes things easier, more efficient, and safer.
When we interact with the healthcare service it’s easy to assume that technology has permeated it, too. But, as many of us know too well, it hasn’t.
MRI scans done at one trust can’t be seen in another. Hospital discharge letters arrive by post, often after the patient has already been to see their GP (who had no idea they’d even been in hospital).
Whiteboards, clipboards, and spreadsheets are key tools for bed management. And, clinicians making a prescription are still manually calculating the drug dosages for the patient sitting in front of them.
Prescriptions are a cornerstone of our profession, yet working out the right dosage of drugs can be hugely time-consuming, cognitively demanding, and has a high risk of error.
The consequences of errors are potentially severe.
This is a huge problem that is proving intractable, despite efforts to tackle it.
It’s clear that we need a new approach – and a new generation of prescribing tools – to reduce avoidable errors.
The problem with the way we calculate prescriptions now
The systems may have changed from predominantly paper to online, and we may have the best formulary in the world with BNF and BNF for Children (BNFC), but safeguards that prevent prescribing mistakes have improved very little.
Instead of writing dosages on paper pads, we type them into a computer, but the process still relies on manual input and human backstops to check and triple check at every step.
The safety measures are far too fallible.
Manual lookups and calculations
As an example – a clinician wanting to prescribe for a child might need to check the safe dosing requirements.
First, they’d look up the BNFC recommendations in a physical copy of the book, or in the app, then cross-check it with any local guidelines on the hospital intranet.
Based on the BNFC listing and local guidelines, they might need to calculate the child’s body surface area or ideal body weight, based on notes in the patient’s record.
Literal back-of-the-envelope calculations are commonplace, as is hastily plugging the numbers into (usually unregulated) online calculators. Only then can the prescriber calculate the right dose.
Sound familiar?
Copying data across systems
Finally, they type or copy and paste the dosage they just calculated into the order form, and hit “save”. Often, a system alert pops up, which is hurriedly closed without reading.
At every stage of transferring information from one system or resource to another, there is potential for error.
Two numbers written the wrong way around, a zero mistaken for a nine, a decimal out by a point, accidentally copying “g” instead of “mg”.
Every NHS prescriber will be able to identify with this in some form or other. We’ve all been in a scenario where it was easy to make a mistake, and many of us have made mistakes.
This is happening across every hospital and healthcare setting across the whole of the NHS.
It simply should not be that something done so frequently, and of such importance, is so inefficient, and frankly, so unsafe. Every step in the process presents an opportunity for error and avoidable harm.
So what’s the solution?
A new generation of prescribing tools
There are lots of tech and non-tech ways to improve prescribing safety – more training, barcode medication administration, and “tall man” lettering are just three examples.
Dr Calandra Feather
But I want to look to the future – or actually the present – and Touchdose.
Touchdose, created by a team of clinicians and researchers at Dosium, gives prescribers detailed, patient-specific, dosing recommendations.
It draws on patient data from the electronic health record to calculate the dose, frequency, duration of treatment, and a recommended administration route, without the prescriber ever having to pull out their calculator or scribble calculations on a pad of paper.
A view from the front line
The solution has been implemented at West London Children’s Healthcare – a collaboration between Imperial and Chelse and Westminster – and the results highlight a staggering 83 per cent reduction in prescribing errors using the solution in paediatrics.
Every month, I visit clinicians working in paediatric departments and wards using the system, and they tell me how happy they are to have Touchdose as part of their toolkit.
It has built their confidence in prescribing accuracy, particularly given how busy they are and how often they are working in pressurised circumstances, and has quickly become a “vital” part of their toolkit.
Before they started using Touchdose, prescribing could be stressful, with many steps, tools, and calculations involved – and of course, anxious parents and patients standing by.
At Dosium, we wanted to give them a usable, useful tool, that they could learn how to use fast, and see the impact of right away.
With Touchdose, prescribing is a lot simpler for clinicians, and safer for the patients.
The time for change is now.
The NHS has long recognised the need for safer, smarter prescribing, yet too many clinicians still rely on outdated, error-prone methods.
Solutions like Touchdose demonstrate that with the right technology, we can dramatically reduce errors, improve efficiency, and make prescribing safer for both patients and clinicians.
But progress won’t happen in isolation. Healthcare leaders, NHS Trusts, and policymakers must prioritise fit-for-purpose digital prescribing tools as a core part of patient safety initiatives.
The evidence is clear – now we need the commitment to scale these innovations across the system.
