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Alipour J, Payandeh A, Hashemi A, Aliabadi A, Karimi A. Physicians' Perspectives with the E-prescribing System in Five Teaching Hospitals. Appl Clin Inform 2024; 15:428-436. [PMID: 38810656 PMCID: PMC11136528 DOI: 10.1055/s-0044-1786872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/24/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVES Despite the evidence suggesting the potential of electronic prescribing (e-prescribing), this system also faces challenges that can lead to inefficiency and even failure. This study aimed to evaluate physicians' perspectives on the efficiency, effectiveness, opportunities, and challenges associated with the e-prescribing system. METHODS In 2023, a descriptive analytics cross-sectional study was carried out. Due to the finite population size, all the physicians from five studied hospitals who agreed to participate in the study were included through the census method (n = 195). Data collection was conducted using a validated questionnaire. Data were analyzed using descriptive (mean, standard deviation, and frequency) and analytical (Pearson's correlation coefficient, two-sample t-test, one-way analysis of variance (ANOVA), and linear multiple regression model) statistics. RESULTS The mean scores of efficiency and effectiveness were 47.47 ± 14.46 and 36.09 ± 10.67 out of 95 and 65, respectively. Removing the illegibility of the prescriptions (n = 22) was the most frequent opportunity and internet connectivity problem (n = 37) was the most frequent challenge associated with the e-prescribing system. There was a strong positive significant correlation between efficiency and effectiveness (r = 0.850, p < 0.01). Moreover, age was found to have a significant negative correlation with efficiency (B = -7.261, p = 0.004) and effectiveness (B = - 5.784, p = 0.002). CONCLUSION Physicians believe that e-prescribing enhances the efficiency and effectiveness of their work. There are many opportunity and challenges to the use of e-prescription. Assessing the needs of physicians, actively participating and training them in the stages of design and implementation, and conducting regular evaluations of the e-prescribing system are crucial to overcome the challenges. Our finding offers insightful information about how doctors see the e-prescribing system at teaching hospitals and provide a basis for managers and policy makers at the local and national levels to support the implementation of this system and plan for improvement of its shortcomings.
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Affiliation(s)
- Jahanpour Alipour
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolfazl Payandeh
- Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Aida Hashemi
- Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Aliabadi
- Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Afsaneh Karimi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Cassidy CE, Boulos L, McConnell E, Barber B, Delahunty-Pike A, Bishop A, Fatima N, Higgins A, Churchill M, Lively A, MacPhee SP, Misener RM, Sarty R, Wells R, Curran JA. E-prescribing and medication safety in community settings: A rapid scoping review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100365. [PMID: 38023632 PMCID: PMC10679534 DOI: 10.1016/j.rcsop.2023.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Medication prescribing is essential for the treatment, curing, maintenance, and/or prevention of an illness and disease, however, medication errors remain common. Common errors including prescribing and administration, pose significant risk to patients. Electronic prescribing (e-prescribing) is one intervention used to enhance the safety and quality of prescribing by decreasing medication errors and reducing harm. E-prescribing in community-based settings has not been extensively examined. Objective To map and characterize the current evidence on e-prescribing and medication safety in community pharmacy settings. Methods We conducted a rapid scoping review of quantitative, qualitative, and mixed methods studies reporting on e-prescribing and medication safety. MEDLINE All (OVID), Embase (Elsevier), CINAHL Full Text (EBSCOHost), and Scopus (Elsevier) databases were searched December 2022 using keywords and MeSH terms related to e-prescribing, medication safety, efficiency, and uptake. Articles were imported to Covidence and screened by two reviewers. Data were extracted by a single reviewer and verified by a second reviewer using a standardized data extraction form. Findings are reported in accordance with JBI Manual for Evidence Synthesis following thematic analysis to narratively describe results. Results Thirty-five studies were included in this review. Most studies were quantitative (n = 22), non-experimental study designs (n = 16) and were conducted in the United States (n = 18). Half of included studies reported physicians as the prescriber (n = 18), while the remaining reported a mix of nurse practitioners, pharmacists, and physician assistants (n = 6). Studies reported on types of errors, including prescription errors (n = 20), medication safety errors (n = 9), dispensing errors (n = 2), and administration errors (n = 1). Few studies examined patient health outcomes, such as adverse drug events (n = 5). Conclusions Findings indicate that most research is descriptive in nature and focused primarily on rates of prescription errors. Further research, such as experimental, implementation, and evaluation mixed-methods research, is needed to investigate the effects of e-prescribing on reducing error rates and improving patient and health system outcomes.
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Affiliation(s)
- Christine E. Cassidy
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | | | - Andrea Bishop
- Nova Scotia College of Pharmacists, Halifax, Nova Scotia, Canada
| | - Nawal Fatima
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Rowan Sarty
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | - Janet A. Curran
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
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Gleeson LL, Clyne B, Barlow JW, Ryan B, Murphy P, Wallace E, De Brún A, Mellon L, Hanratty M, Ennis M, Holton A, Pate M, Kirke C, Flood M, Moriarty F. Medication safety incidents associated with the remote delivery of primary care: a rapid review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:495-506. [PMID: 36595375 DOI: 10.1093/ijpp/riac087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/18/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The COVID-19 pandemic triggered rapid, fundamental changes, notably increased remote delivery of primary care. While the impact of these changes on medication safety is not yet fully understood, research conducted before the pandemic may provide evidence for possible consequences. To examine the published literature on medication safety incidents associated with the remote delivery of primary care, with a focus on telemedicine and electronic prescribing. METHODS A rapid review was conducted according to the Cochrane Rapid Reviews Methods Group guidance. An electronic search was carried out on Embase and Medline (via PubMed) using key search terms 'medication error', 'electronic prescribing', 'telemedicine' and 'primary care'. Identified studies were synthesised narratively; reported medication safety incidents were categorised according to the WHO Conceptual Framework for the International Classification for Patient Safety. KEY FINDINGS Fifteen studies were deemed eligible for inclusion. All 15 studies reported medication incidents associated with electronic prescribing; no studies were identified that reported medication safety incidents associated with telemedicine. The most commonly reported medication safety incidents were 'wrong label/instruction' and 'wrong dose/strength/frequency'. The frequency of medication safety incidents ranged from 0.89 to 81.98 incidents per 100 electronic prescriptions analysed. SUMMARY This review of medication safety incidents associated with the remote delivery of primary care identified common incident types associated with electronic prescriptions. There was a wide variation in reported frequencies of medication safety incidents associated with electronic prescriptions. Further research is required to determine the impact of the COVID-19 pandemic on medication safety in primary care, particularly the increased use of telemedicine.
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Affiliation(s)
- Laura L Gleeson
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - James W Barlow
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Benedict Ryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Lisa Mellon
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Marcus Hanratty
- Department of Product Design, National College of Art and Design, Dublin, Ireland
| | - Mark Ennis
- TU Dublin School of Creative Arts, Technological University Dublin City Campus, Dublin, Ireland
| | - Alice Holton
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Muriel Pate
- Quality and Safety Directorate, Health Service Executive, Ireland
| | - Ciara Kirke
- Quality and Safety Directorate, Health Service Executive, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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White A, Fulda KG, Blythe R, Chui MA, Reeve E, Young R, Espinoza A, Hendrix N, Xiao Y. Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety. Expert Opin Drug Saf 2022; 21:1357-1364. [PMID: 36377503 PMCID: PMC9850835 DOI: 10.1080/14740338.2022.2147923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Over 4 billion prescriptions are dispensed each year to patients in the United States, with the number of prescriptions continuing to increase. There is a growing recognition of pharmacists' potential in improving medication safety in community settings, in collaboration with primary care providers (PCPs). However, the nature of collaboration has not been well defined, and barriers and strategies are not articulated. AREA COVERED For this narrative review, published studies were retrieved from PubMed between January 2000 and December 2020. Search terms included "patient safety," "medication safety," "collaboration," "primary care physician," and "community pharmacy." Resulting articles were categorized as follows: defining collaboration, types of collaboration, and barriers and solutions to collaboration. EXPERT OPINION It is important to understand the factors within a community pharmacy setting that limit or facilitate community pharmacists' participation in medication safety activities. Strategies such as medication review are a common form of collaboration. Barriers to collaboration include misconceptions regarding roles and differences in access to clinical information and community pharmacy practice variability. Future recommendations include increasing training and utilization of pharmacists/PCP teams, increasing community pharmacists' practice in emerging roles, and expanding the community pharmacist role in transitions of care from the hospital to the community.
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Affiliation(s)
- Annesha White
- Department of Pharmacotherapy, University of North Texas Health Science Center College of Pharmacy, Fort Worth, TX, USA
| | - Kimberly G. Fulda
- University of North Texas Health Science Center, Department of Family Medicine and Osteopathic Manipulative Medicine, North Texas Primary Care Practice-Based Research Network (NorTex), Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Rachel Blythe
- Department of Pharmacotherapy, University of North Texas Health Science Center College of Pharmacy, Fort Worth, TX, USA
| | - Michelle A. Chui
- Social and Administrative Sciences Division, University of Wisconsin – Madison School of Pharmacy, Madison, WI, USA
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Richard Young
- JPS Hospital, Department of Family Medicine, Residency Program, Fort Worth, TX, USA
| | - Anna Espinoza
- University of North Texas Health Science Center, Department of Family Medicine and Osteopathic Manipulative Medicine, North Texas Primary Care Practice-Based Research Network (NorTex), Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Noah Hendrix
- University of Texas at Arlington, Arlington, TX, USA
| | - Yan Xiao
- University of Texas at Arlington, Arlington, TX, USA
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Schreier DJ, Lovely JK. Optimizing Clinical Monitoring Tools to Enhance Patient Review by Pharmacists. Appl Clin Inform 2021; 12:621-628. [PMID: 34161988 DOI: 10.1055/s-0041-1731341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The Clinical Monitoring List (CML) is a real-time scoring system and intervention tool used by Mayo Clinic pharmacists caring for hospitalized patients. OBJECTIVE The study aimed to describe the iterative development and implementation of pharmacist clinical monitoring tools within the electronic health record at a multicampus health system enterprise. METHODS Between October 2018 and January 2019, pharmacists across the enterprise were surveyed to determine opportunities and gaps in CML functionality. Responses were received from 39% (n = 162) of actively staffing inpatient pharmacists. Survey responses identified three main gaps in CML functionality: (1) the desire for automated checklists of tasks, (2) additional rule logic closely aligning with clinical practice guidelines, and (3) the ability to dismiss and defer rules. The failure mode and effect analysis were used to assess risk areas within the CML. To address identified gaps, two A/B testing pilots were undertaken. The first pilot analyzed the effect of updated CML rule logic on pharmacist satisfaction in the domains of automated checklists and guideline alignment. The second pilot assessed the utility of a Clinical Monitoring Navigator (CMN) functioning in conjunction with the CML to display rules with selections to dismiss or defer rules until a user-specified date. The CMN is a workspace to guide clinical end user workflows; permitting the review and actions to be completed within one screen using EHR functionality. RESULTS A total of 27 pharmacists across a broad range of practice specialties were selected for two separate two-week pilot tests. Upon pilot completion, participants were surveyed to assess the effect of updates on performance gaps. CONCLUSION Findings from the enterprise-wide survey and A/B pilot tests were used to inform final build decisions and planned enterprise-wide updated CML and CMN launch. This project serves as an example of the utility of end-user feedback and pilot testing to inform project decisions, optimize usability, and streamline build activities.
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Affiliation(s)
- Diana J Schreier
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, United States
| | - Jenna K Lovely
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, United States
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