Indications-based prescribing: A challenge for hospital prescribers.

Abstract

Clinicians, patients, administrators and researchers have become increasingly frustrated by the lack of indication (i.e. problem) information included in prescriptions, despite the obvious benefit this would provide to patients and other healthcare providers [1]. Medication indications are not routinely documented by prescribers, both in inpatient and outpatient settings.[2, 3] Calls have been made to introduce a sixth ‘right’ into the medication management process, whereby the right patient is given the right drug and dose at the right time via the right route for the right indication [4]. Indications-based prescribing has recently gained traction as a potential way forward to facilitate indication documentation [4, 5]. Indications-based prescribing, not currently supported by most electronic prescribing systems (EPSs), describes the scenario where prescribers initially select an indication, not a medication, and the EPS presents the user with suggested medications for addressing the problem. There are clear advantages with this approach, including those associated with guided prescribing (e.g. more appropriate drug selections) and with indication documentation (e.g. improved communication between providers), prompting work to begin on developing EPS functionality in the US to support indications-based prescribing. In a recent usability evaluation of a prototype of this functionality, indications-based prescribing was more efficient to use, resulted in fewer medication errors and in higher usability scores than the traditional EPS functionality [6].