Prescription Checking Research Articles

Medication errors: the importance of safe dispensing

1. Although rates of dispensing errors are generally low, further improvements in pharmacy distribution systems are still important because pharmacies dispense such high volumes of medications that even a low error rate can translate into a large number of errors. 2. From the perspective of pharmacy organization and quality assurance, pharmacists should intensify their checking of prescriptions, in order to reduce prescription errors, and should implement strategies to communicate adequately with patients, in order to prevent administration errors. More and better studies are still needed in these areas. 3. More research is also required into: dispensing errors in out-patient health-care settings, such as community pharmacies in the USA and Europe; dispensing errors in hospitals and out-patient health-care settings in middle- and low-income countries; and the underlying causes of dispensing errors.

Technophobia, prescription checking and the future of diabetes management

Is the medical prescription the root cause of the long-term complications of diabetes mellitus? This article presents the argument for introducing prescription checking into diabetes disease management. It discusses an evidence-based need for frequent revisions of the medical prescription as the key to preventing treatment-related complications in diabetes while achieving the now mandated standards in patient care. To do this it will be prudent for diabetes healthcare providers to enrich their clinical services with new information technology-based tools. These are easily acquired by participating in professional workshops focused on advanced diabetes management. In this light, the case presented here challenges leading practitioners to become early participants in the evolution of information technology that will ultimately enhance the management of all patients with diabetes.

がん薬物療法における薬剤師による処方鑑査の有用性

In cancer chemotherapy,it is essential for pharmacists to fully understand dosing regimens and precautions in the use of anticancer agents to ensure rational prescribing.At the Kanto Medical Center NTT EC,pharmacists are involved in regimen management to ensure effective and safe chemotherapy from the pharmaceutical perspective.In this study,we investigated the usefulness of prescription checking by pharmacists in ensuring rational prescribing.The number of prescriptions for anticancer agents checked by pharmacists during the six months from October 2006 to March 2007 was 1,275 and the total time taken for checking prescriptions,including the confirmation of questionable points and prescription corrections,was 83 hours and 35 minutes.The average time taken per prescription was 3.5 minutes.On each day,prescription checks were conducted by 1 or 2 pharmacists.Of 105 prescriptions,11(10.5%) were corrected by pharmacists,with the corrections concerning inappropriate doses,essential medicines that were missing from prescriptions and duplication of medicines.Such errors occurred despite regular regimen management.Our findings show that prescription checking by pharmacists is useful in ensuring that prescribing is rational and achieves effective,safe chemotherapy.The results of this study also showed that pharmacists need to carry out prescription checking based on an understanding of physicians’intentions,an adequate knowledge of the drugs concerned and familiarity with the electronic medical records system.

がん化学療法における処方チェックシステムの確立―１次・２次チェックシステムの導入による処方の安全性向上―

がん化学療法における処方チェックシステムの確立―１次・２次チェックシステムの導入による処方の安全性向上―

レセプトコンピュータ薬剤鑑査システムを用いたお薬手帳鑑査の有用性検討

レセプトコンピュータ薬剤鑑査システムを用いたお薬手帳鑑査の有用性検討

新設計クリーンベンチ・安全キャビネットと注射オーダ情報を利用した注射剤調製鑑査システムの開発

Our pharmacists provide TPN preparations and injectable chemotherapy drugs for inpatients and outpatients.However,since the checking of injectable drug prescriptions is complicated and time consuming,we developed an aseptic preparation support system to raise efficiency in making admixtures of injectable drugs and improve risk management.We redesigned the clean bench and safety cabinet,and incorporated an embedded 15”LCD monitor.It is equipped with a weighing machine that allows us to record weights on a PC in real-time.A three-button footswitch is connected to the PC to allow us to have hands-free control of the system to maintain aseptic conditions.Liquid volumes and weights and number of vials are automatically calculated from the content per vial and the dosage of the drug in the injection order information.All of this information is displayed on the monitor and using it,we mix the injectable drugs.Differences between calculated and measured weights of vials are also recorded on the PC.The new system has raised the efficiency of mixing injections and improved monitoring accuracy.

臨床検査データを利用した処方鑑査支援システムの開発とその有用性

Clinical laboratory data are an important basis for understanding the patient’s condition when pharmacists examine the appropriateness of prescriptions. Since it is difficult for them to check patient clinical laboratory data at the time of dispensing, we developed a prescription checking system under which prescription data and clinical laboratory data are simultaneously transmitted to the pharmacy and any abnormal clinical laboratory data are marked on the prescription sheet and the prescription-checking list. Pharmacists can use these marks to check the patient’s condition.Between December 2004 and November 2005, abnormal clinical laboratory data were marked on 245 prescriptions under our system, and based on this, pharmacists advised doctors of 25 cases in which drugs were contraindicated, and corrections were made. We therefore conclude that our system is useful in promoting the proper use of drugs.

Extending Effects of Salience and Payoffs on Stimulus Discrimination: An Experimental Simulation of Prescription Checking

This study applied specific aspects of signal detection theory (target salience and decision payoffs) to examine the associations among measured attention and accuracy on a stimulus discrimination task patterned after prescription checking. 85 participants completed the d2 Test of Attention and were assigned to either a control condition with general task instructions or a payoff condition with points accumulated or lost based on ultimate performance. Participants checked simulated product order forms for clerical errors for 40 min. The stimulus set included errors that varied with respect to their ease of detection or salience. Analysis indicated that measured attention was related to performance accuracy and speed as expected. Also decision payoffs significantly increased accuracy on the discrimination task regardless of target salience and discrimination accuracy decreased as the salience of the stimulus mismatches decreased. Implications for real-world applications of signal detection theory to tasks such as prescription checking are explored.

Dementia Associates with Undermedication of Cardiovascular Diseases in the Elderly

Objective: To compare medication use in patients suffering from cardiovascular disease with and without dementia. Subjects: All inhabitants aged 75 and older in Lieto, Finland (n = 462, participation rate 82%). Measurements: Direct standardised assessments of dementia and cardiovascular diseases. Quantification of drug use by self-report and by prescription and drug container checks. Results: In multivariate analyses, the odds ratio for demented cardiovascular patients receiving any cardiovascular medication (use vs. non-use) was 0.31 (95% confidence interval 0.12–0.82). Compared to the non-demented, demented stroke patients were treated less often with antithrombotic agents (p = 0.041) and demented hypertensive patients less often with β-blockers (p = 0.045). Conclusion: Demented cardiovascular patients, even mildly to moderately demented, were prescribed fewer evidence-based cardiovascular medications than non-demented patients.

有効かつ安全ながん化学療法の遂行を目指したがん化学療法業務支援システムの開発

We developed a novel support system for more effective and safer cancer chemotherapy, whose major aims were to improve pharmaceutical care by reinforcing prescription checking, providing higher quality medical information and standardizing guidance for cancer patients.Protocols consisting of the dosages, dosing schedules and adverse reactions of anticancer drugs and procedures for their admixture were the key element of our support system. Prescription checking parameters included patient height, weight, body surface area, type of cancer diagnosed, dosage and dosing schedules. For patients who had received the same protocol for the same type of cancer previously, the dosage was checked using past dosage data, laboratory data and adverse effect information. In order to standardize guidance given to patients, we had the system automatically produce adverse effect monitoring and check sheets and used this information together with that obtained from patients to prepare information that would aid consultation. This helped avoid adverse events and ensure that anticancer jobs were used properly, which made cancer chemotherapy more effective and safer.The support system enabled valuable information on cancer chemotherapy to be provided to doctors, nurses and pharmacists. We therefore consider it to be a useful tool in chemotherapy for cancer patients.

Survey on Understanding of and Satisfaction with In-hospital Pharmacist's Work

Since it is necessary to make more physicians and nurses fully understand the in-hospital pharmacist's work, a questionnaire survey was performed for physicians and nurses on their knowledge of and satisfaction with the work. The survey results were analyzed with multiple regression analysis to reflect the results specifically and objectively in the routine activities of the pharmacy. The results showed that physicians with experience of less than 1 year were not well aware of the pharmacists' work related to clinical trials and therapeutic drug monitoring, and that those with an experience of 1 year or longer were not well aware of the work related to clinical trials. Nurses with an experience of less than 5 years or 5 years or longer were not well aware of the work related to in-hospital pharmaceutical preparations. The pharmacists' work that affected the satisfaction of physicians and nurses include the provision of drug information, checking of prescriptions, guidance of patients on drug compliance, and management of nonprescription and poisonous drugs. The present multiple regression analysis was useful for understanding the current status of in-hospital jobs and objectively distinguishing jobs to be improved from those that might be continued in the present manner. Multiple regression analysis may be a useful analytical tool for improving pharmacists' work.

Remote checking of prescriptions in Navy health facilities

Naval Health Care New England (NHCNE), a composite medical command consisting of five military treatment facilities, has instituted a video-assisted procedure that allows a pharmacist at one site to check civilian prescriptions filled at another site. Three NHCNE sites (Naval Branch Health Clinics [NBHCs], located in Brunswick, Maine; Portsmouth, New Hampshire; and Saratoga Springs, New York) are staffed as sole-pharmacist locations. Two larger locations, Naval Ambulatory Care Centers (NACCs), are located in Newport, Rhode Island, and Groton, Connecticut. The NACCs are more complex organizations and are staffed by three or four pharmacists per site. Installation of the necessary equipment started in the summer of 2004. The three NBHCs are equipped with a video monitor and macrocamera and microcamera systems. The macrocamera allows viewing of the site or person, while the microcamera allows for a closeup view of the written prescription, the computer-generated label, and the drug product. The two NACC locations are equipped only with a monitor and macrocamera system; microcameras are unnecessary because NACCs, with multiple pharmacists on staff, have no need to have their prescriptions checked by remote pharmacists.

Trait and state predictors of error detection accuracy in a simulated quality control task

This study examined whether personality traits or mood and workload states are more predictive of detection accuracy in a simulated quality control task mimicking prescription checking in a pharmacy. Ninety-one undergraduate volunteers checked 80 simulated scripts for accuracy in a basic task environment with error rates ranging from 26% to 38%. Four dimensions of perceived workload and three task-related mood factors were assessed multiple times during the task, and several theoretically relevant personality traits were measured before the simulation. Performance was measured using hit rate and false alarm ratios. Results suggested that trait factors were more predictive of hit ratios in this study than were measures of task-related mood and perceived workload. Implications and future research directions are discussed.

病棟担当薬剤師による処方オーダー監査および配薬の実施とその評価

It is important for the clinical pharmacist to maintain the safety and efficacy of drug therapy for individual patients. In order to improve prescribing and help patients to understand their medication better, we began checking prescriptions and providing medicines to patients individually in the oncology surgery ward of our hospital in January 2003. Before preparing medications, we investigated the compliance of each patient through counseling, checked their prescriptions, and pointed out prescription errors to physicians. On the following day, after filling the prescriptions, we handed them to individual patients and explained the medication to each patient. Half a year after introducing this system, we calculated pharmacist prescription intervention rates and analyzed the results. We found a 49% error rate in prescriptions and pointed out the errors to physicians, 93% of which they acknowledged. To evaluate our system, we conducted a questionnaire survey of the doctors and nurses in the oncology surgery ward on the provision of medication by clinical pharmacists. We obtained a 95% response rate and the results were very satisfactory. The checking of prescriptions by clinical pharmacists in this ward reduced inappropriate ordering of medicines, as well as the time taken for us to dispense them and that taken for nurses to distribute the medicines and instruct patients on how to take them. Providing medicines directly to patients enabled us to practice patient counseling more closely and helped ensure that they were taken properly.

オーダリングシステムを利用したリスクマネジメントへの貢献―市販オーダリングパッケージシステムの薬剤関連マスタメンテナンス改良による効率化の検討―

In recent years, computerized prescription order entry systems have played an increasingly important role in medical risk management as such systems have become more sophisticated. Though prescription order entry systems enable us to access huge amounts of information in drug information databases on drug interactions, adverse reactions and so forth, it is very difficult to manage such large amounts of information. Prescription order entry systems have a prescription checking function but the master maintenance must be done properly for it to work well. With this in mind, we developed an improved system using a commercially available program, PC-ORDERING 2000 (NEC Corp.), to make it easier to use the master maintenance screen of the order entry system.In order to investigate the resulting improvements we did the following : 1) measured the improvement in input efficiency, 2) evaluated the improvement in reference functions, 3) evaluated the improvement in file output functions and 4) made a comparison with the existing system.As a result, we found that the required maintenance time with the improved system was reduced to 66% and considered this to be very important to risk management since the prescription checking function in the order entry system had been enhanced.

Signal probability effects on error detection performance in a quality control task.

This study was designed to examine the influence of signal probability on detection accuracy in a quality control task patterned after the checking of prescriptions in a pharmacy. Signal probability was defined as the ratio of erroneous scripts to correct scripts. 91 participants were either exposed to signal probabilities ranging from 26 to 30% ("low probability") or 34 to 38% ("high probability") while checking two sets of 40 simulated scripts for accuracy. Wrong item, wrong number, and wrong label information errors were possible, and performance was measured in terms of sensitivity (percentage of errors detected) and specificity (percentage of correct orders accepted). Analysis indicated that sensitivity was significantly worse for participants in the high signal probability condition, but specificity was not significantly different between signal probability conditions. Connections to existing theory and future directions for research are discussed.

What doctors expect of a pharmacist's work--how a pharmacist is evaluated by doctors

In recent years, a pharmacists' work has changed in terms of therapeutic management and counseling of patients. Generally, a pharmacist has to provide pharmaceutical care in cooperation with a doctor. In the present study, a questionnaire survey on what a doctor expects of a pharmacist was conducted, and directors of hospital were interviewed on what they expect of a pharmacist. Eighty-two doctors participated in the survey. As results, doctors consider that a pharmacist's work is dispensing of drugs (41%), and highly evaluated the works of a pharmacist in advising doctors regarding pharmacotherapy (29%), checking the prescription (28%), providing patient compliance instructions (27%) and providing drug information (26%). Five directors of hospital expect the pharmacists to carry out risk managements and prescription checks, provide drug information, and consultation on drug costs. In addition, doctors want pharmacists to have more knowledge on pharmacotherapy. These results clearly show what doctors expect of a pharmacist's work.

リスクマネジメントにおける処方チェックシステムの有用性の検討

We investigated the usefulness of a prescription checking system in risk management. At Gifu University Hospital, doctors prescribe medications using an order entry system or by writing out a prescription by hand. The ordering of prescriptions is checked by an order entry system when doctors make a prescription, and is checked by a dispensing support system at the time the drugs are dispensed. Regarding prescriptions ordered by this system and handwritten prescriptions prescribed from October, 2000 to April, 2001, the frequency that a prescription was correct was investigated.The total number of prescription during the investigation period was 92, 624 sheets, and 973 prescriptions had to be corrected. The frequency that system ordered and handwritten prescriptions had to be corrected 0.9% and 6.5%, respectively. The frequency of correcting prescriptions ordered through the order entry system was significantly low. Drug duplication, drug interaction, and so on were corrected when ordering with this system, and some of them were checked by the prescription checking system. A mistake in the prescription, the prescription of non-registered medicines at our hospital, all had to be corrected for handwritten prescriptions, and 81% of such mistakes would have been avoided if they had been prescribed by the order entry system. Based on our findings, we consider our order entry system and prescription support system to effectively decrease the number of corrections needed when doctors make prescriptions.

Electronic prescribing for the elderly: will it improve medication usage?

Drug treatment of the elderly is problematic for various reasons. These include the risks of drug interactions, contraindications, incorrect dose and adverse events. Electronic prescribing is a promising tool which should help solve many of the problems associated with the use of medications in the elderly by providing information on drug selection, prescription checks, and information about drugs and prescriptions. Nevertheless, electronic prescribing must be improved by providing a user-friendly interface, structured drug data-bases, and the capacity to generate both criticism and suggestions, if it is to progressively replace pen and paper in the drug prescription process.

Object-Oriented Modeling and Terminologies for Drug Contraindications

There is no available standardized representation of contraindications that can be used in drug knowledge bases. In this paper, an object-oriented representation of contraindications is proposed that would allow computerized checking of drug prescription safety. It distinguishes four types of contraindications: pathological state, physiological state, findings of investigation procedures, and diagnostic or therapeutic procedures. The vocabulary usable for expressing the contraindications appropriate for automated prescription checking was also investigated. ICD10 (International Classification of Diseases, tenth revision), SNOMED III (Systematized Nomenclature of Medicine), ICPC (International Classification of Primary Care), and ATC (Anatomic Therapeutic and Chemical Classification) were studied as potential sources of standardized vocabulary. A system to support entering data on contraindications into a drug knowledge base, compatible with the proposed structure and using the identified vocabulary sources, is also presented.