1
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Farghali AA, Borycki EM. A Preliminary Scoping Review of the Impact of e-Prescribing on Pharmacists in Community Pharmacies. Healthcare (Basel) 2024; 12:1280. [PMID: 38998815 PMCID: PMC11241554 DOI: 10.3390/healthcare12131280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVE This scoping review aims to map the available literature and provide an overview of the published articles discussing the impact of electronic prescribing on medication errors and pharmacy workflow. METHODS The literature search was conducted using PubMed®, Web of Science®, and the Cochrane Database of Systematic Reviews®, as well as grey literature reports, using the search terms and related components of "pharmacists", "electronic prescribing", "medication errors", and "efficiency". The search included all articles that were published from January 2011 to September 2023. Twenty-two relevant articles were identified and fully reviewed, ten of which were included in this review. RESULTS Electronic prescribing (e-prescribing) provides a solution for some of the challenges that are associated with handwritten and paper prescriptions. However, the implementation of e-prescribing systems has been recognized as a source of new unforeseen medication errors in all the reviewed articles. Productivity in community pharmacies has been affected with receiving electronic prescriptions (e-prescriptions) and having to deal with the issues that arise from them. The pharmacists' interventions were not eliminated with e-prescriptions compared to other prescription formats. The most frequently reported reason for intervention was related to incomplete instructions in the field of directions of use. Other common challenges with e-prescriptions were related to missing information, quantity, inappropriate dose, dosage form, and drug. DISCUSSION This review demonstrates the scarcity of research about the impact of electronic prescribing on medication error and efficiency in community pharmacies. In the literature, most of the studies had mainly focused on hospital pharmacies. The literature search demonstrated that there are still some barriers to overcome with e-prescribing systems and that medication errors were not fully eliminated with e-prescriptions. New errors have been identified with e-prescriptions, all of which caused delays in processing, which affected the productivity of the pharmacy staff, and could have negatively impacted patients' safety if not properly resolved. CONCLUSION e-Prescribing solved some of the challenges associated with illegibility of handwritten prescriptions. However, more time is required to allow e-prescribing systems to mature. Further training for prescribers and pharmacists is also recommended before and after the implementation.
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Affiliation(s)
- Amr A Farghali
- School of Health Information Science, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Victoria, BC V8P 5C2, Canada
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2
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Rupp MT, Warholak T, Murcko AC, Axon DR. Stakeholder views on requiring diagnosis or clinical indication on e-prescriptions. J Manag Care Spec Pharm 2024; 30:305-312. [PMID: 38555625 PMCID: PMC10982572 DOI: 10.18553/jmcp.2024.30.4.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Medication safety organizations have been recommending the inclusion of diagnosis or clinical indication on prescription orders for decades. However, this information is typically not provided by prescribers and shared with pharmacists, despite the availability of data fields in the most commonly used standard for electronic prescriptions. OBJECTIVE To elucidate the views of selected industry stakeholders relative to perceived barriers to including diagnosis or indication on all electronic prescriptions. METHODS Semistructured concept elicitation interviews identified key issues. Survey items were refined iteratively by the research team. The final instrument consisted of 34 questions intended to elicit the importance and relative priority of perceived barriers and potential solutions. A link to the Internet survey was emailed to members of the National Council for Prescription Drug Programs in February 2023, with biweekly follow-up reminders. RESULTS A total of 139 surveys were analyzed for a response rate of 9.6%. On the importance of resolving issues related to the inclusion of diagnosis or indication on e-prescriptions, a majority of respondents indicated "extremely important" or "very important" for all items except one. On level of agreement with statements about how to implement such a requirement, a majority indicated "strongly agree" or "agree" for 10 of 17 items. CONCLUSIONS Although clearly exploratory, the results of our survey suggest industry stakeholder agreement that uniform inclusion of diagnosis or clinical indication on all e-prescriptions would improve patient safety and health outcomes. A number of important questions and potential barriers must be resolved for implementation to be successful.
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Affiliation(s)
| | - Terri Warholak
- St. Louis College of Pharmacy, University of Health Sciences & Pharmacy, MO
| | - Anita C. Murcko
- College of Health Solutions, Arizona State University, Phoenix
| | - David R. Axon
- R. Ken Coit College of Pharmacy, University of Arizona, Tucson
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3
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Schiff GD, Lambert BL, Wright A. Prescribing medications with indications: time to flip the script. BMJ Qual Saf 2023; 32:315-318. [PMID: 36948544 DOI: 10.1136/bmjqs-2023-015923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Gordon D Schiff
- Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bruce L Lambert
- Communication Studies, Northwestern University, Chicago, Illinois, USA
| | - Adam Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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4
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Feather C, Appelbaum N, Darzi A, Franklin BD. Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis. BMJ Qual Saf 2023; 32:357-368. [PMID: 36788034 DOI: 10.1136/bmjqs-2022-015452] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Despite recommendations, documentation of indication on prescriptions and inpatient medication orders is not routinely practised. There has been a recent systematic review of indication documentation for antimicrobials, but not for interventions relating to indication documentation for medication more broadly. Our aims were to 1) identify, describe and synthesise the literature relating to effectiveness of interventions aimed at improving indication documentation and/or indication-based prescribing in both primary and secondary healthcare; 2) synthesise participant perspectives to identify barriers and facilitators to these interventions; and 3) make recommendations for both practice and research. METHODS A systematic literature search was conducted using Medline, Embase and CINAHL using two search concepts: electronic prescribing systems, and indication documentation and/or indication-based prescribing. Qualitative, quantitative and mixed-methods studies were included; outcome measures and results were extracted to produce a narrative synthesis. Quality appraisal by two independent reviewers was undertaken using the Mixed Methods Appraisal Tool. RESULTS We identified 21 studies evaluating interventions to aid indication documentation. Indication documentation was either via free-text, selection from a list, or by use of pre-defined indication-based order sentences for individual medications. For a number of outcomes, there was a mostly positive impact, including appropriateness of the medication order (6 of 8 studies), rates of prescribing error (2/2) and some less commonly reported clinical (2/4) and workflow-related outcomes (2/3). There was a less favourable impact on accuracy of indication documentation and rates of medication use, highlighting some unintended consequences that may occur when implementing new interventions. Participant insights from prescribers and other healthcare professionals complemented quantitative study results, highlighting both facilitators and barriers to indication documentation and the associated interventions. For example, barriers included long drop-down lists and the need to use workarounds to navigate approval systems due to time or knowledge constraints. Facilitating factors included the perceived benefits of indication documentation on communication among the healthcare team and with the patient. CONCLUSION Indication documentation has the potential to improve appropriate prescribing and reduce prescribing errors. However, further benefits to the prescriber, multidisciplinary team and patient may only be realised by developing methods of indication documentation that integrate more efficiently with prescriber workflows. PROSPERO REGISTRATION NUMBER CRD42021278495.
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Affiliation(s)
- Calandra Feather
- Department of Surgery and Cancer, Imperial College London, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ara Darzi
- Institute of Global Health Innovation at Imperial College London, London, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- Department of Practice and Policy, UCL School of Pharmacy, London, UK
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5
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Peeters M, Iturrospe E, Jans D, van Nuijs ALN, De Loof H. Incorporating 'reason for use' into the prescribing process of medication: a survey on the opinion of patients in Flanders, Belgium. BMC Health Serv Res 2022; 22:1216. [PMID: 36180847 PMCID: PMC9523178 DOI: 10.1186/s12913-022-08596-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background A longstanding debate exists about including a ‘reason for use’ on prescriptions for medication. Little is known, however, about patients’ opinions on this subject. Methods An internet-based questionnaire, consisting mainly of Likert scale questions, was distributed online to the general public in Belgium. Results from 1034 responses were analyzed using descriptive statistics. Results Opinions from patients toward including a ‘reason for use’ on medication prescriptions were generally positive. A clear majority of 62% increased to 74% after providing information about the possible link between indication and medication dose. A majority of the participants expressed a positive attitude regardless of the pathology involved, although sexually transmitted diseases were of greatest concern. Other important aspects differentiating the opinion positively was the transmission of this information in an electronic-only form and limiting it to the regular pharmacist excluding further use by third parties such as other pharmacies or insurance companies. Patients using multiple medicines and those frequenting the same pharmacy also had a more favorable opinion about including the reason for use. In addition, analysis of physician and pharmacist questionnaire responses, explicitly excluded from the main analysis, confirmed the known contrasting opinions in these subgroups. Conclusions Patients have strong support for transferring information on the ‘reason for use’ of their prescriptions to their regular pharmacy if this is done in a secure and privacy-conscious way enabling increased patient safety and improved pharmaceutical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08596-w.
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Affiliation(s)
- Marijke Peeters
- University of Antwerp, Toxicological Centre, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Elias Iturrospe
- University of Antwerp, Toxicological Centre, Universiteitsplein 1, 2610, Antwerp, Belgium.,Department of In Vitro Toxicology and Dermato-cosmetology, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
| | - Dominique Jans
- University of Antwerp, Laboratory of Physiopharmacology, Universiteitsplein 1, 2610, Antwerp, Belgium
| | | | - Hans De Loof
- University of Antwerp, Laboratory of Physiopharmacology, Universiteitsplein 1, 2610, Antwerp, Belgium.
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6
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Mercer K, Carter C, Burns C, Tennant R, Guirguis L, Grindrod K. Including the Reason for Use on Prescriptions Sent to Pharmacists: Scoping Review. JMIR Hum Factors 2021; 8:e22325. [PMID: 34842545 PMCID: PMC8663503 DOI: 10.2196/22325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/17/2020] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In North America, although pharmacists are obligated to ensure prescribed medications are appropriate, information about a patient's reason for use is not a required component of a legal prescription. The benefits of prescribers including the reason for use on prescriptions is evident in the current literature. However, it is not standard practice to share this information with pharmacists. OBJECTIVE Our aim was to characterize the research on how including the reason for use on a prescription impacts pharmacists. METHODS We performed an interdisciplinary scoping review, searching literature in the fields of health care, informatics, and engineering. The following databases were searched between December 2018 and January 2019: PubMed, Institute of Electrical and Electronics Engineers (IEEE), Association for Computing Machinery (ACM), International Pharmaceutical Abstracts (IPA), and EMBASE. RESULTS A total of 3912 potentially relevant articles were identified, with 9 papers meeting the inclusion criteria. The studies used different terminology (eg, indication, reason for use) and a wide variety of study methodologies, including prospective and retrospective observational studies, randomized controlled trials, and qualitative interviews and focus groups. The results suggest that including the reason for use on a prescription can help the pharmacist catch more errors, reduce the need to contact prescribers, support patient counseling, impact communication, and improve patient safety. Reasons that may prevent prescribers from adding the reason for use information are concerns about workflow and patient privacy. CONCLUSIONS More research is needed to understand how the reason for use information should be provided to pharmacists. In the limited literature to date, there is a consensus that the addition of this information to prescriptions benefits patient safety and enables pharmacists to be more effective. Future research should use an implementation science or theory-based approach to improve prescriber buy-in and, consequently, adoption.
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Affiliation(s)
- Kathryn Mercer
- Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Library, University of Waterloo, Waterloo, ON, Canada
| | - Caitlin Carter
- Library, University of Waterloo, Waterloo, ON, Canada.,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Catherine Burns
- Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Advanced Interface Design Lab, Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Ryan Tennant
- Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Advanced Interface Design Lab, Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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Kennelty KA, Coffey CS, Ardery G, Uribe L, Yankey J, Ecklund D, James PA, Vander Weg MW, Chrischilles EA, Christensen AJ, Polgreen LA, Gryzlak B, Carter BL. A cluster randomized trial to evaluate a centralized remote clinical pharmacy service in large, health system primary care clinics. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Korey A. Kennelty
- Department of Pharmacy Practice and Science College of Pharmacy, University of Iowa Iowa City Iowa USA
- Department of Family Medicine Roy J. and Lucille A. Carver College of Medicine, University of Iowa Iowa City Iowa USA
| | - Christopher S. Coffey
- Department of Biostatistics College of Public Health, University of Iowa Iowa City Iowa USA
| | - Gail Ardery
- Department of Pharmacy Practice and Science College of Pharmacy, University of Iowa Iowa City Iowa USA
| | - Liz Uribe
- Department of Biostatistics College of Public Health, University of Iowa Iowa City Iowa USA
| | - Jon Yankey
- Department of Biostatistics College of Public Health, University of Iowa Iowa City Iowa USA
| | - Dixie Ecklund
- Department of Biostatistics College of Public Health, University of Iowa Iowa City Iowa USA
| | - Paul A. James
- Department of Family Medicine University of Washington Seattle USA
| | - Mark W. Vander Weg
- Department of Psychology College of Liberal Arts, University of Iowa Iowa City Iowa USA
- Department of Internal Medicine Roy J. and Lucille A. Carver College of Medicine, University of Iowa Iowa City Iowa USA
- Iowa City Veterans Administration Iowa City Iowa USA
| | | | - Alan J. Christensen
- Department of Psychology College of Liberal Arts, University of Iowa Iowa City Iowa USA
- Department of Internal Medicine Roy J. and Lucille A. Carver College of Medicine, University of Iowa Iowa City Iowa USA
| | - Linnea A. Polgreen
- Department of Pharmacy Practice and Science College of Pharmacy, University of Iowa Iowa City Iowa USA
| | - Brian Gryzlak
- Department of Epidemiology College of Public Health, University of Iowa Iowa City Iowa USA
| | - Barry L. Carter
- Department of Pharmacy Practice and Science College of Pharmacy, University of Iowa Iowa City Iowa USA
- Department of Family Medicine Roy J. and Lucille A. Carver College of Medicine, University of Iowa Iowa City Iowa USA
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8
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Peltoniemi T, Suomi R, Peura S, Lähteenoja MNY. Electronic prescription as a driver for digitalization in Finnish pharmacies. BMC Health Serv Res 2021; 21:1017. [PMID: 34565354 PMCID: PMC8474735 DOI: 10.1186/s12913-021-07003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Finnish community pharmacies have undergone digitalization during the past decade. The introduction of the electronic prescription has had a significant impact on pharmacy workflows, such as the dispensing process. This inevitably has significant sociotechnical implications. We examine the impact of digitalization on the dispensing process and the sociotechnical orientation of a pharmacy. Methods We utilize data collected in customer service situations in Finnish community pharmacies at two points in time: in the traditional workflow, when electronic prescriptions were not in use, and in the new direct dispensing workflow, which is the usual delivery model in the case of electronic prescriptions. We analyze this data in terms of changes in workflow efficiency. We also draw on existing literature to build a conceptual model for digitalization in the pharmacy sector from a sociotechnical standpoint. Results In the Finnish environment, the results, based on our study sample, show that with electronic prescriptions and the direct dispensing model, the delivery time for a single medication over the counter was reduced by 13%. The results also indicate that the process has become more predictable, as the variation in terms of the workflow lead time has decreased. Conclusions The results indicate that the dispensing process has become more efficient in terms of time and throughput as well as more technically oriented and predictable. From a sociotechnical perspective, the results indicate that the technical subsystem has strengthened, and pharmacies have adapted to the new technology in the dispensing process.
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Affiliation(s)
| | - Reima Suomi
- University of Turku, 20014 Turun Yliopisto, Turku, Finland
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9
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Rupp MT, Warholak TL, Murcko AC. Indication or diagnosis should be required on prescriptions. J Manag Care Spec Pharm 2021; 27:1136-1139. [PMID: 34337989 PMCID: PMC10391024 DOI: 10.18553/jmcp.2021.27.8.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although prospective drug utilization review and patient counseling have long been recognized as professional and ethical responsibilities of pharmacists, the implementation of the Omnibus Budget Reconciliation Act of 1990 made them legal responsibilities. Ensuring the safety and effectiveness of prescription pharmaceutical care requires that all members of the prescriber-patient-pharmacist triad are equally informed about the therapeutic plan for which the pharmacist is professionally, ethically, and legally responsible for properly implementing. Providing pharmacists with the clinical indication or diagnosis is an important and long overdue first step. DISCLOSURES: No funding was received for the writing of this article. Warholak has received grant funding through the University of Arizona from Sinfonia Rx, Pharmacy Quality Alliance, and the Arizona Department of Health Services, unrelated to this work. The other authors have nothing to disclose.
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Affiliation(s)
- Michael T Rupp
- Midwestern University College of Pharmacy-Glendale Campus, Glendale, AZ
| | | | - Anita C Murcko
- College of Health Solutions, Arizona State University, Tempe
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10
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Loera C, Olsen J, So A, Murata J, Murcko A, Rupp MT, Warholak T. Prescriber and pharmacist attitudes toward inclusion of diagnosis or clinical indication on prescription orders. J Am Pharm Assoc (2003) 2021; 61:e284-e288. [PMID: 33558187 DOI: 10.1016/j.japh.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pharmacy and medication safety organizations have long recommended that diagnosis or clinical indication be required on medication orders to improve the safety and effectiveness of care. OBJECTIVE To assess attitudes of Arizona prescribers and pharmacists toward the inclusion of the clinical indication or the diagnosis on prescription orders and perceived barriers to its implementation in Arizona. METHODS Data were obtained by questionnaires from pharmacists and primary care prescribers after a continuing pharmacy education presentation on the value of including a clinical indication or a diagnosis on prescription orders. The survey was distributed to licensed pharmacists who attended the Arizona Pharmacy Association's Southwest Clinical Pharmacy Seminar. The survey was distributed to primary care providers with active Arizona licenses who attended the Arizona Osteopathic Medical Association Annual Convention and to nurse practitioners after an Arizona Nurse Practitioner Council educational webinar. Prescriber and pharmacist responses were compared using the Mann-Whitney U test. An a priori alpha of 0.05 was used, and in the cases of multiple comparisons, a Bonferroni correction was employed. RESULTS A total of 74 complete questionnaires were submitted by prescribers and 54 by pharmacists. Approximately 71% of the prescribers and 66% of the pharmacists agreed that they would support voluntary inclusion of a diagnosis or a clinical indication on prescription orders (P = 0.81). However, the 2 groups disagreed on whether the inclusion of the diagnosis or clinical indication should be a requirement (44% of prescribers agreed vs. 96% of pharmacists, P < 0.001). Two perceived barriers revealed statistically significant differences, with the prescribers being more concerned about possible insurance rejections than pharmacists (P = 0.005, whereas the pharmacists were more concerned about potential software transmission accuracy than prescribers (P < 0.001). CONCLUSION Arizona prescribers and pharmacists in our convenience sample supported the voluntary inclusion of a diagnosis or a clinical indication on prescriptions orders but disagreed as to whether it should be required. Prescribers especially indicated they have a variety of concerns that need to be overcome before they could support a statewide mandate.
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11
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Whaley C, Bancsi A, Ho JMW, Burns CM, Grindrod K. Prescribers' perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis. BMC Health Serv Res 2021; 21:89. [PMID: 33499869 PMCID: PMC7836591 DOI: 10.1186/s12913-021-06103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The indication for prescribing a particular medication, or its reason for use (RFU) is a crucial piece of information for all those involved in the circle of care. Research has shown that sharing RFU information with physicians, pharmacists and patients improves patient safety and patient adherence, however RFU is rarely added on prescriptions by prescribers or on medication labels for patients to reference. METHODS Qualitative interviews were conducted with 20 prescribers in Southern Ontario, Canada, to learn prescribers' current attitudes on the addition of RFU on prescriptions and medication labels. A trained interviewer used a semi-structured interview guide for each interview. The interviews explored how the sharing of RFU information would impact prescribers' workflows and practices. Interviews were recorded, transcribed and thematically coded. RESULTS The analysis yielded four main themes: Current Practice, Future Practice, Changing Culture, and Collaboration. Most of the prescribers interviewed do not currently add RFU to prescriptions. Prescribers were open to sharing RFU with colleagues via a regional database but wanted the ability to provide context for the prescribed medication within the system. Many prescribers were wary of the impact of adding RFU on their workflow but felt it could save time by avoiding clarifying questions from pharmacists. Increased interprofessional collaboration, increased patient understanding of prescribed medications, avoiding guesswork when determining indications and decreased misinterpretation regarding RFU were cited by most prescribers as benefits to including RFU information. CONCLUSIONS Prescribers were generally open to sharing RFU and clearly identified the benefits to pharmacists and patients if added. Critically, they also identified benefits to their own practices. These results can be used to guide the implementation of future initiatives to promote the sharing of RFU in healthcare teams.
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Affiliation(s)
- Colin Whaley
- University of Waterloo School of Pharmacy, Health Sciences Campus, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Ashley Bancsi
- University of Waterloo School of Pharmacy, Health Sciences Campus, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
| | - Joanne Man-Wai Ho
- Divisions of Geriatric Medicine & Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Drive, Waterloo, N2J 0E2 ON Canada
- GeriMedRisk, 250 Laurelwood Drive, Waterloo, N2J 0E2 ON Canada
| | - Catherine M. Burns
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
| | - Kelly Grindrod
- University of Waterloo School of Pharmacy, Health Sciences Campus, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
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12
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Hambrook M, Peterson S, Gorman S, Becotte G, Burrows A. Medication management surrounding transitions of care: A qualitative assessment of community pharmacists' preferences (MEMO TOC). Can Pharm J (Ott) 2020; 153:301-307. [PMID: 33110471 DOI: 10.1177/1715163520947444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Multiple medication changes during hospitalization increase the risk of errors upon discharge. Community pharmacists may face barriers to providing pharmaceutical care because of the lack of clinical information and communication from hospitals. Studies implementing handover to community pharmacists upon hospital discharge reported improved patient outcomes, but interventions were time-consuming. Methods One-on-one interviews and a focus group were conducted to identify community pharmacists' barriers to providing care to patients recently discharged from hospital and to determine their preferences for hospital discharge prescriptions. Transcripts were qualitatively analyzed using an inductive semantic approach. Results Four one-on-one interviews and an 8-participant focus group were conducted. Participants described barriers to providing care to discharged patients, including lack of communication, incomplete prescriptions, and limited clinical information. Participants identified that the most valuable information to include comprised laboratory values, hospital contact information and annotation of medication changes. These items would improve their abilities to provide timely and high-quality pharmaceutical care. Interpretation Our results were similar to prior literature identifying a lack of communication and clinical information as barriers to providing care to recently discharged patients. Unexpectedly, study participants did not rate medication indication as a strongly preferred information item. Conclusions Hospital discharge prescriptions lack information, which makes it challenging for community pharmacists to provide pharmaceutical care. Discharge prescriptions should include additional clinical information. Can Pharm J (Ott) 2020;153:xx-xx.
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Affiliation(s)
- Miranda Hambrook
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
| | - Shaylee Peterson
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
| | - Sean Gorman
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
| | - Greg Becotte
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
| | - Andrea Burrows
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
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13
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Whaley C, Bancsi A, Burns C, Grindrod K. Pharmacists' perspectives on the value of reason for use information. Can Pharm J (Ott) 2020; 153:294-300. [PMID: 33110470 DOI: 10.1177/1715163520946052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The indication for a particular medication, or its reason for use (RFU), is important information for prescribers, pharmacists and patients but is not often communicated in writing from prescribers to pharmacists. Adding RFU to a prescription and a medication label would ensure that pharmacists are confident that they are providing high-quality, accurate patient care. This study aims to describe the perspectives of pharmacists on how receiving RFU from prescribers would affect their practice and how pharmacists putting this information on prescriptions would affect patients. Methods Semi-structured qualitative interviews were conducted with 20 pharmacists in Southwestern Ontario. Thematic analysis was used to analyze the interview transcripts, leading to 4 major themes. Results Pharmacists expressed that RFU should be formatted to ensure that it is of clinical utility via the use of written text and noted that either medical or lay (also known as plain) language would be appropriate for use. Pharmacists indicated that patient privacy should be considered when writing RFU on labels and that patient preference with respect to the addition of RFU should dictate its inclusion on a medication label. Pharmacist access to RFU was universally acknowledged to improve patient safety by providing pharmacists with more information to determine whether the given medication was indicated. Conclusions This study provides further information about the impact that having access to RFU would have on pharmacy practice and can be used to advocate for the inclusion of RFU information with prescriptions to improve patient outcomes. Can Pharm J (Ott) 2020;153:xx-xx.
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Affiliation(s)
- Colin Whaley
- School of Pharmacy (Whaley, Bancsi, Grindrod), Faculty of Engineering, Waterloo, Ontario.,Faculty of Science and the Department of Systems Design Engineering (Burns), Faculty of Engineering, Waterloo, Ontario
| | - Ashley Bancsi
- School of Pharmacy (Whaley, Bancsi, Grindrod), Faculty of Engineering, Waterloo, Ontario.,Faculty of Science and the Department of Systems Design Engineering (Burns), Faculty of Engineering, Waterloo, Ontario
| | - Catherine Burns
- School of Pharmacy (Whaley, Bancsi, Grindrod), Faculty of Engineering, Waterloo, Ontario.,Faculty of Science and the Department of Systems Design Engineering (Burns), Faculty of Engineering, Waterloo, Ontario
| | - Kelly Grindrod
- School of Pharmacy (Whaley, Bancsi, Grindrod), Faculty of Engineering, Waterloo, Ontario.,Faculty of Science and the Department of Systems Design Engineering (Burns), Faculty of Engineering, Waterloo, Ontario
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14
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Ho J, Wrzesniewski CE, Hasson NK. Integrating patient-centric indications into the prescribing process: Experience at a tertiary academic medical center. Am J Health Syst Pharm 2020; 77:S26-S33. [PMID: 32426831 DOI: 10.1093/ajhp/zxaa065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe the development of and implementation of a patient-centric clinical indications library (CIL) into the prescribing process and determine the operational and humanistic outcomes (from prescriber, pharmacist, and patient perspectives) of including indications on outpatient prescription labels. METHODS A descriptive retrospective data analysis was conducted. Multiple stakeholder groups were engaged to develop and integrate the CIL into the prescription package. After CIL integration, prescribers, pharmacists, and patients were surveyed. A focus group discussion consisting of Veterans and caregivers was held. RESULTS Following implementation of the CIL, the proportion of prescriptions associated with an indication increased from 88% to 96%. Surveyed clinicians responded that indications helped them better understand a patient's profile (61.1% of prescribers and 100% of pharmacists). Among surveyed pharmacists, 61.5% and 53.8%, respectively, believed that indications helped them catch instances of wrong medications and wrong doses ordered. Veterans surveyed found that indications on their prescription labels helped them know what their medications were for (91.0% of respondents) and why it is important to take their medications (70.7%). In focus group discussions, Veterans and family members and/or caregivers expressed a preference to see indications that describe how a medication works (eg, "to lower blood sugar" vs "for diabetes") because they felt that type of phrasing is measurable, action oriented (which was appealing due to Veterans' military background), provides surreptitious education, and tells the users what to expect. CONCLUSION Engaging multidisciplinary stakeholder groups, optimizing the electronic health record system, and authorizing pharmacists to add known indications to prescriptions increased the number of prescriptions with indications, decreased the perceived time spent on order entry and verification, and enabled better understanding of each medication's purpose by providers and patients.
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Affiliation(s)
- Jackie Ho
- Department of Pharmacy, Alameda Health System - San Leandro Hospital, San Leandro, CA
| | | | - Noelle K Hasson
- Department of Pharmacy, VA Palo Alto Health Care System, Palo Alto, CA
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15
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Salazar A, Karmiy SJ, Forsythe KJ, Amato MG, Wright A, Lai KH, Lambert BL, Liebovitz DM, Eguale T, Volk LA, Schiff GD. How often do prescribers include indications in drug orders? Analysis of 4 million outpatient prescriptions. Am J Health Syst Pharm 2020; 76:970-979. [PMID: 31361884 DOI: 10.1093/ajhp/zxz082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To examine the extent to which outpatient clinicians currently document drug indications in prescription instructions. METHODS Free-text sigs were extracted from all outpatient prescriptions generated by the computerized prescriber order entry system of a major academic institution during a 5-year period. Natural language processing was used to identify drug indications. The data set was analyzed to determine the rates at which prescribers included indications. It was stratified by provider specialty, drug class, and specific medications, to determine how often these indications were in prescriptions for as-needed (PRN) versus non-PRN medications. RESULTS During the study period, 4,356,086 prescriptions were ordered. Indications were included in 322,961 orders (7.41%). From these orders, 249,262 indications (77.18%) were written for PRN orders. Although internal medicine prescribers generated the highest number of medication orders, they included indications in only 6.26% of their prescriptions, whereas orthopedic surgery providers had the highest rate of documenting indications (33.41%). Pain was the most common indication, accounting for 30.35% of all documented indications. The drug class with the highest number of sigs-containing indications was narcotic analgesics. Non-PRN chronic medication prescriptions rarely included the indication. CONCLUSION Prescribers rarely included drug indications in electronic free-text prescription instructions, and, when they did, it was mostly for PRN uses such as pain.
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Affiliation(s)
- Alejandra Salazar
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston Medical Center, Boston, MA
| | | | | | - Mary G Amato
- Division of General Internal Medicine, Brigham and Women's Hospital, MCPHS University, Boston, MA
| | - Adam Wright
- Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kenneth H Lai
- Partners HealthCare, Somerville, MA, and Brandeis University, Waltham, MA
| | | | | | - Tewodros Eguale
- Division of General Internal Medicine, Brigham and Women's Hospital, MCPHS University, Boston, MA
| | | | - Gordon D Schiff
- Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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16
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Rupp MT. 10 ways to improve medication safety in community pharmacies. J Am Pharm Assoc (2003) 2019; 59:474-478. [PMID: 31109811 DOI: 10.1016/j.japh.2019.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
Abstract
DATA SOURCES Not applicable. SUMMARY Since at least the time of Hippocrates, health care providers have recognized their responsibility to protect patients from potential harm resulting from the care they provide. In pharmacy, such harm typically results from a violation of any of the "5 rights" of safe medication use. However, a memorable adage stops short of providing operational guidance to improve medication safety. Specific actionable recommendations are needed to identify changes that, if implemented, would significantly improve the safety of medication delivery and use. CONCLUSION Most threats to medication safety result from weaknesses or failures in one or more of the key system elements identified by the Institute for Safe Medication Practices. Pharmacists should be advocates for implementing targeted recommendations to strengthen their practice systems and improve medication safety.
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17
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Campbell PJ, Patel M, Martin JR, Hincapie AL, Axon DR, Warholak TL, Slack M. Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993-2015. BMJ Open Qual 2018; 7:e000193. [PMID: 30306141 PMCID: PMC6173242 DOI: 10.1136/bmjoq-2017-000193] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 07/19/2018] [Accepted: 08/21/2018] [Indexed: 11/04/2022] Open
Abstract
Importance While much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates. Objective The aim of this study was to determine the rate of community pharmacy dispensing errors in the USA. Methods English language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature. Studies with a denominator reflecting the total number of prescriptions in the sample were necessary for inclusion in the meta-analysis. A random effects meta-analysis was conducted to estimate an aggregate community pharmacy dispensing error rate. Heterogeneity was assessed using the I2 statistic prior to analysis. Results The search yielded a total of 8490 records, of which 11 articles were included in the systematic review. Two articles did not have adequate data components to be included in the meta-analysis. Dispensing error rates ranged from 0.00003% (43/1 420 091) to 55% (55/100). The meta-analysis included 1 461 128 prescriptions. The overall community pharmacy dispensing error rate was estimated to be 0.015 (95% CI 0.014 to 0.018); however, significant heterogeneity was observed across studies (I2=99.6). Stratification by study error identification methodology was found to have a significant impact on dispensing error rate (p<0.001). Conclusion and relevance There are few published articles that describe community pharmacy dispensing error rates in the USA. Thus, there is limited information about the current rate of community pharmacy dispensing errors. A robust investigation is needed to assess dispensing error rates in the USA to assess the nature and magnitude of the problem and establish prevention strategies.
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Affiliation(s)
- Patrick J Campbell
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Mira Patel
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Jennifer R Martin
- University of Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Ana L Hincapie
- Division of Pharmacy Practice and Administrative Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - David Rhys Axon
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Terri L Warholak
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Marion Slack
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
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18
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Napier P, Norris P, Green J, Braund R. Experiences of pharmacy staff during the introduction of the checking technician role in New Zealand. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:149-156. [DOI: 10.1111/ijpp.12483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 07/25/2018] [Indexed: 11/27/2022]
Abstract
Abstract
Objectives
To investigate the experiences of the participants in a study introducing a Pharmacy Accuracy Checking Technician (PACT) role, and specifically their perceptions of any advantages and disadvantages.
Methods
Self-administered surveys were distributed during the introduction of a checking technician role in eight community and four hospital pharmacy sites. Surveys were conducted at three time points; at baseline, at mid-point and a final data collection. Questions covered staff perceptions on; technicians’ ability to take on this role, impact on workflow, impact on pharmacists’ time spent with patients and any perceived advantages or disadvantages.
Key findings
Three hundred and fifty-five responses were received from participants. There was significant support for the introduction of this new role, and the greatest advantage identified was an increase in time available to pharmacists to increase potential clinical activities. Many staff felt that this role could easily fit into their current workplace and workflow with minor adjustments. There was a perception that this new role would increase safety and decrease errors as a result of the separation of clinical and checking tasks. Respondents identified a need for more technicians; however, conversely concern was expressed of a negative impact on the number of pharmacists’ jobs.
Conclusions
Despite the disruption caused by the training process, the respondents believed this new role to be beneficial to both staff and patients, and that the new model would allow for increased error identification and enhanced safety.
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Affiliation(s)
- Patti Napier
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - James Green
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Rhiannon Braund
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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19
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Nelson SD, Woodroof T, Liu W, Lehmann CU. Link between prescriptions and the electronic health record. Am J Health Syst Pharm 2018; 75:S29-S34. [DOI: 10.2146/ajhp170455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Scott D. Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Wing Liu
- HealthIT, Vanderbilt University Medical Center, Nashville, TN
| | - Christoph U. Lehmann
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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20
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Kron K, Myers S, Volk L, Nathan A, Neri P, Salazar A, Amato MG, Wright A, Karmiy S, McCord S, Seoane-Vazquez E, Eguale T, Rodriguez-Monguio R, Bates DW, Schiff G. Incorporating medication indications into the prescribing process. Am J Health Syst Pharm 2018; 75:774-783. [DOI: 10.2146/ajhp170346] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Sara Myers
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Aaron Nathan
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Pamela Neri
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, and Partners Healthcare, Somerville, MA
| | - Alejandra Salazar
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Mary G. Amato
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, and MCPHS University, Boston, MA
| | - Adam Wright
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | | | - Tewodros Eguale
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA
- MCPHS University, Boston, MA
| | | | - David W. Bates
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Gordon Schiff
- Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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21
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Garada M, McLachlan AJ, Schiff GD, Lehnbom EC. What do Australian consumers, pharmacists and prescribers think about documenting indications on prescriptions and dispensed medicines labels?: A qualitative study. BMC Health Serv Res 2017; 17:734. [PMID: 29141618 PMCID: PMC5688705 DOI: 10.1186/s12913-017-2704-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Documenting the indication on prescriptions and dispensed medicines labels is not standard practice in Australia. However, previous studies that have focused on the content and design of dispensed medicines labels, have suggested including the indication as a safety measure. The aim of this study was to investigate the perspectives of Australian consumers, pharmacists and prescribers on documenting the indication on prescriptions and dispensed medicines labels. METHODS Semi-structured interviews were conducted and mock-up of dispensed medicines labels were designed for participants. Consumers (n = 19) and pharmacists (n = 7) were recruited by convenience sample at community pharmacies in Sydney (Australia) and prescribers (n = 8), including two medical students, were recruited through snowballing. RESULTS Thirty-four participants were interviewed. Most participants agreed that documenting the indication would be beneficial especially for patients who are forgetful or take multiple medications. Participants also believed it would improve consumers' medication understanding and adherence. Prescribers and pharmacists believed it could help reduce prescribing and dispensing errors by matching the drug/dosage to the correct indication. Prescribers refrained from documenting the indication to protect patients' privacy; however, most patients did not consider documenting the indication as a breach of privacy. Prescribers raised concerns about the extra time to include indications on prescriptions and best language to document indications, using plain language as opposed to medical terminology. CONCLUSIONS All interviewed stakeholders identified numerous benefits of documenting the indication on prescriptions and dispensed medicines labels. Whether these potential benefits can be realized remains unknown and addressing prescribers' concern regarding the time involved in documenting the indication on prescriptions remains a challenge for vendors of electronic medication management systems.
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Affiliation(s)
- Mona Garada
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, Australia.,Centre for Education and Research on Ageing, Concord Hospital, Sydney, Australia
| | - Gordon D Schiff
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elin C Lehnbom
- Faculty of Pharmacy, University of Sydney, Sydney, Australia. .,Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. .,Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
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22
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Li W, Zhou Q. Patient diagnosis on electronic prescription orders: a key element for appropriateness review by pharmacists. Res Social Adm Pharm 2013; 9:493-4. [PMID: 23890197 DOI: 10.1016/j.sapharm.2013.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 06/10/2013] [Indexed: 11/16/2022]
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