Implementation Of E-prescribing Research Articles

MEDICINES PLANNING AND PROCUREMENT MANAGEMENT AN ACADEMIC HOSPITAL IN YOGYAKARTA, INDONESIA: A QUALITATIVE STUDY

Inventory management remains a critical issue for hospital pharmacies. Thus, there is a need for pharmaceuticals to meet economic resources. Moreover, the decision to make drug requests available should be considered, and the complexity of the problem lies in the random nature of and the various constraints that must be considered in any decision. This study aimed to analyze drug management during the planning and procurement stages of medicine in a teaching hospital in Yogyakarta. The qualitative method was used to his type of research is descriptive-analytical with a case study design of one of the public, academic hospitals in the Yogyakarta area. Data collection was conducted through interviews using a content analysis approach. The analysis technique was carried out by reducing data, analyzing data, identifying themes, and extracting data interpretation with the help of NVIVO 12 software. Overall, interviews were conducted with six participants to obtain information on drug management during the planning and procurement stages in the hospital, following the standards of home pharmacy services. The stages also included budget allocation by volume of services, increasing the competence of human resources, which supports the improvement of drug management performance, implementation of e-prescribing to facilitate monitoring evaluation, and availability of complete standard operating procedures. However, the accuracy of drug planning still needs to be improved so that an integrated management information system can support optimal drug management in a teaching hospital pharmacy installation. Keywords: Drug management, drug planning, drug procurement, public academic hospital

Benefits and challenges of electronic prescribing for general practitioners and pharmacists in regional Australia.

To explore the benefits and challenges of electronic prescribing (e-prescribing) for general practitioners (GPs) and pharmacists in regional New South Wales (NSW). This qualitative study utilised semistructured interviews conducted virtually or in-person between July and September 2021. General practitioners and pharmacists practising in Bathurst NSW. Self-reported perceived and experienced benefits and challenges of e-prescribing. Two GPs and four pharmacists participated in the study. Reported benefits of e-prescribing included improvement in the prescribing and dispensing process, patient adherence, and prescription safety and security. The increased convenience for the patients was appreciated particularly during the COVID-19 pandemic. Challenges discussed were how the system was perceived to be unsafe and insecure, costs of messaging and updating general practice software, utilisation of new systems and patient awareness. Pharmacists reported the need for education to patients and staff to minimise the impact of inexperience with the novel technology on workflow efficacy. This study provided first insight and information on the perspectives of GPs and pharmacists 12 months after the implementation of e-prescribing. Further nationwide studies are required to consolidate these findings; provide comparisons with the system's progress since conception; determine whether metropolitan and rural health care professionals share similar perspectives; and shed light on where additional government support may be required.

Pharmacists' Perspectives on the Implementation of e-Prescribing in Hospitals and Community Pharmacies: A Literature Review

Pharmacists' Perspectives on the Implementation of e-Prescribing in Hospitals and Community Pharmacies: A Literature Review

Transition to ePrescribing for systemic anti-cancer therapy - Perceptions of a multidisciplinary haematology/oncology team in a large teaching hospital.

A National Cancer Information System is planned for phased implementation in Irish cancer centres to enable electronic prescribing (ePrescribing) of systemic anti-cancer therapy. This study aimed to capture the opinions of healthcare professionals in a hospital setting relating to the current paper-based workflow for systemic anti-cancer therapy prescribing and their attitudes and expectations of the new ePrescribing system to develop recommendations, which assist in the planning and implementation of future ePrescribing systems. A mixed methods study of concurrent design was conducted. Interviews with healthcare professionals primarily aimed to evaluate processes and identify areas requiring improvement within the current paper-based workflow for systemic anti-cancer therapy prescribing. An online questionnaire adapted from the Information Systems Expectations and Experiences tool primarily aimed to capture expectations of the new ePrescribing system and attitudes towards the transition. Twelve healthcare professionals were interviewed, and 50 healthcare professionals responded to the online questionnaire (response rate: 33.3%). Eight major themes emerged from interview transcripts relating to opinions on the paper-based workflow. Questionnaire respondents reported positive attitudes towards ePrescribing implementation and had high expectations for workflow improvements and functionalities of the new system. Seven recommendations for ePrescribing implementation were developed: (1) prioritise specific processes; (2) plan for changes in communication; (3) repeat research in the post-implementation setting; (4) ensure good information technology infrastructure and system support; (5) ensure optimum training; (6) outline limitations of clinical decision support; (7) provide clear instructions on local configurability. This study identifies potential challenges in transitioning to ePrescribing and provides recommendations, which assist stakeholders in ensuring safe and effective transitions, thus informing future ePrescribing systems' implementation in haematology/oncology settings.

Electronic prescribing systems in hospitals to improve medication safety: a multimethods research programme

Electronic prescribing systems in hospitals to improve medication safety: a multimethods research programme

Users’ Views Regarding Electronic Prescribing Implementation: A Qualitative Case Study in A Private Hospital of Magelang City, Indonesia

The use of the Internet and digital system in a hospital named the Hospital Information System (HIS) has grown rapidly and remarkably, including in Indonesia. One of the HIS components is electronic prescribing (e-prescribing). Although the Indonesian government has mandated HIS in hospitals since 2011, successful implementation is not without challenges. Therefore, this study aimed to explore users' views regarding e-prescribing implementation through a case study in a private hospital in Magelang City, Indonesia. This study applied a qualitative approach. Participants were e-prescribing users who were selected purposively. Data were gathered using interviews. The Capability, Opportunity, Motivation, and Behavior (COM-B) model was used to structure the interview guideline. Data were transcribed verbatim and analyzed using a thematic approach. Twenty participants were interviewed. Five themes emerged through the interviews: selfreflection, perceived advantages, policy, capacity building, and quality assurance. The themes express optimism in implementing eprescribing. Users are central to e-prescribing system acceptance, as is explained in the self-reflection and perceived advantages themes. Furthermore, top management plays a pivotal role in improving the capacity and ensuring system implementation quality. This study’s findings imply that the user, system, and organization play crucial roles in enhancing health care service quality through e-prescribing.

Implementing computerized physician order entry in a public tertiary care hospital.

It is reported that at least one medication error per day occurs in hospitalized patients. Medication errors are not only harmful but also expensive. Prescription review by pharmacists is the standard to reduce prescribing error; however, due to the manual process, pharmacists lack time to conduct prescription reviews. Computerized physician order entry (CPOE) allows clinicians to directly place medication orders electronically, transmitted directly to the pharmacy. Successfully implemented CPOE systems improve the prescribing process and result in fewer medication errors. However, regardless of its significance, implementation of CPOE is a very difficult task, particularly in a public-sector hospital. Lady Reading Hospital-Medical Teaching Institution has a manual system for indenting medication system; pharmacists could only ensure the current dispensing of medication, but lack time and information to conduct a review to ensure the appropriateness of prescription. The article entails the barriers and the process of implementation of e-prescribing.

Community Pharmacists' Opinions towards Poor Prescription Writing in Jazan, Saudi Arabia.

Avoidance of medication errors is imperative for the safe use of medications, and community pharmacists are uniquely placed to identify and resolve the errors that may arise due to poorly handwritten prescriptions. Purpose: To explore the opinion and attitudes of community pharmacists towards poor prescription writing and their suggestions to overcome this concern. Methods: A cross-sectional, self-administered survey was conducted among the community pharmacists in the Jazan region, Saudi Arabia. Descriptive analysis and chi-square test were used at 5% p-value (p > 0.05) as the significance level. Results: The response rate for the survey was 78.66%, and 140 community pharmacists agreed to participate. Among the study subjects, the majority (73.57%) had a bachelor’s degree. Nearly three-fourths (3/4) of the pharmacists (72.29%) chose to send the patient back to the prescriber when they found difficulty in interpreting the information from an illegible prescription. As many as 80.71% of the pharmacists believed that poorly handwritten prescriptions were the cause of actual errors when dispensing medications. The most commonly encountered problem due to poorly handwritten prescriptions was the commercial name of medicine, which was reported by around two-thirds (67.86%) of the pharmacists. The use of e-prescription was suggested by 72.86% of the pharmacists as a probable solution to encounter this problem. Conclusion: Our findings highlight the belief and attitudes of community pharmacists in the region and their opinions to solve this impending problem of poor prescription writing. Continuous professional development courses can be adopted to tackle the problem. Additionally, health authorities can work on incorporating and facilitating the use of e-prescription in the community sector, which can be a boon to physicians, pharmacists, and patients. Proper and extensive training is however needed before the implementation of e-prescribing.

Optimizing telehealth pain care after COVID-19.

Optimizing telehealth pain care after COVID-19.

Hospital E-prescribing Implementation in Reducing Medication Error

The purpose of this study was to describe and analyze hospital e-prescribing implementation in reducing medication errors. The hospital information system was an information system that was used for hospitals wherein this information system allows data flow from a hospital can be done electronically. The service to patients can be done more quickly, accurately, and transparently which in the end could provide satisfaction to patients. Medication errors often occurred in hospitals. One of the causes was prescription errors or prescribing errors. The wrong medical decision had an impact on the safety and quality of the patient's health. Therefore, the efforts were needed to prevent and reduce errors by e-prescribing. This study used a qualitative approach in which the research conducted was descriptive. That was how the implementation of e-prescribing in RSUP Sanglah Denpasar in reducing medication error. The research results obtained from interviews, observations, and documentation were the implementation of e-prescribing in Sanglah Hospital going well by involving interviews with management, IT, pharmacists, doctors, and nurses. However, the obstacle faced was the internet network was sometimes not strong and the number of devices a computer was lacking. It can interfere with the process of drug service.

A cross-sectional study of the Belgian community pharmacist’s satisfaction with the implementation of the electronic prescription

BackgroundSeveral benefits and problems of electronic prescribing (ePrescribing) are described in scientific literature, though problems remain in the implementation. In this study, we evaluated the pharmacist’s perception of the ePrescription implementation within the community pharmacy software in Belgium, and the frequency and hindrance of encountered problems. Material and methodsA cross-sectional study was conducted among community pharmacists in Belgium to measure satisfaction with the ePrescribing implementation and factors influencing this satisfaction. ResultsIn total 246 pharmacists (3.3 % response rate) rated the implementation in their software with an average score of 6.46 ± 2.16 (SD) on a scale of 10. In Belgium, French-speaking pharmacists gave a significantly higher satisfaction score compared to Dutch-speaking pharmacists (P = 0.032), whereas Dutch-speaking pharmacists perceived to process significantly more ePrescriptions compared to French-speaking pharmacists (P < 0.001). Satisfaction with the implementation of the ePrescription was significantly associated with the software package (P < 0.001), the knowledge of the ePrescribing workflow (P = 0.036), the frequency of slow responses of the software (P < 0.001) and the perception of unavailability of the system (P = 0.003). ConclusionsThe Belgian pharmacist was moderately satisfied with the implementation of the ePrescription. Problems with the availability of Belgian eHealth systems and interoperability issues with national codes used between prescriber and dispenser have to be resolved in the future in order to meet the Belgian community pharmacist’s needs.

Unexpected Increase in Benzodiazepine Prescriptions Related to the Introduction of an Electronic Prescribing Tool: Evidence from Multicenter Hospital Data.

Electronic Prescribing tools (e-prescribing) have shown several benefits in terms of prescribing process adequacy and health care quality in hospital settings. We hypothesize however, that an undesired effect of digitalisation, due to the easier and faster prescribing process allowing patients to skip face-to-face conversations with patients and nurses, is that it could facilitate the prescription of medications at high risk of overuse or abuse, such as benzodiazepines (BZDs). We conducted a panel data study to investigate, the impact of the introduction of an e-prescribing system on new BZD prescriptions in hospitalised patients in a network of five teaching hospitals. During the observation period 1 July 2014–30 April 2019, 43,320 admissions were analysed. A fixed-effects model was adopted to estimate the effect of e-prescribing on new BZD prescriptions. E-prescribing implementation was associated with a significant increase of new BZD prescriptions: absolute +1.5%, and relative +43% (p < 0.001). The effect was similar in males and females (respectively, absolute +2.3%, relative +65% (p < 0.001); absolute +1.8%, relative +58% (p = 0.01)) and in patients ≥70 years old (absolute +1.6%, relative +59% (p < 0.001)). After controlling for time-varying explanatory variables, the implementation of the e-prescribing tool showed similar significant effects. E-prescribing implementation was associated with a significant increase of new in-hospital BZD prescriptions. For classes of drugs at risk of overuse or abuse, e-prescribing should be used cautiously, to minimize the risk of over-prescriptions. Further research in other settings and countries is needed to analyse causal interactions between e-prescribing and BZD prescriptions in the hospital setting, and to promote the ultimate goal of high-value care.

Evaluation of Transition to Electronic Prescriptions in Turkey: Perspective of Family Physicians.

Background: One of the most important steps of the health transformation program involves the application of electronic prescriptions (e-prescriptions) in health services. Information technologies are highly important in generating e-prescriptions, which can be described as a document produced by authorized personnel electronically, containing written information and instructions regarding a patient’s medication and its usage. E-prescribing has become increasingly applied in recent years as a contributing application to prescribers and patients. The aim of this study was to determine the level of satisfaction of family physicians providing primary care in Turkey regarding the application of e-prescriptions, and reveal the related positive effects and problems encountered in the first months of implementation of e-prescribing. Methods: A questionnaire with eight questions was sent to e-mails of all family physicians working in Turkey in May 2013. A total of 1564 family physicians filled in the questionnaire form and sent it back by e-mail. The responses to openended questions were evaluated by content analysis. Results: It was observed that the most frequently indicated advantages of the application of e-prescriptions were speeding up the prescription process and saving time (36.6%). The most commonly reported problems regarding the application of e-prescriptions were found to be system-induced problems (26.5%) and internet problems (19.9%). In addition, the mean score of satisfaction of the family physicians who did not report problems with the application of e-prescriptions was higher than that of those who reported having problems with it. In the study, 77.8% of the family physicians were satisfied with the application of e-prescriptions. Conclusion: Although some problems were reported regarding the application of e-prescriptions in the first months of the application, family physicians participated in the study were found to be satisfied with the application of e-prescriptions, and identified positive effects on their work and processes.

Perceptions of Prescribers towards Electronic Prescription: A Pre-Implementation Evaluation

Objective: Electronic (e) prescribing is computerised prescribing. The Government of Kerala has started the e-health initiative. The objective of this study was to obtain the perceptions of prescribing doctors on e-prescription before its implementation. Method: This was a questionnaire based cross sectional study conducted for a period of six months in a Government tertiary care teaching hospital of Kerala. The prescribing doctors of the institution formed the sample population. The response to the structured questionnaire was measured on Likert scale. Data were analysed using SPSS 16. Domain scores of perceived usefulness, ease of use and fitness to the Institution were calculated by averaging the response. Chi square test was done to find the association of score of each domain with independent variables. Results: Two hundred and fifty seven prescribing doctors of age range 22-60 years participated of which 49% were females and 51% males. Response rate was 73% (257/350). Although 70.5% have heard of e-prescriptions only 14% participants had hands on exposure. The mean perceived usefulness, perceived ease of use and fitness were 3.5±0.47, 3.35± 0.49 and 2.95 ± 0.44. Conclusion: Dislike for paper prescriptions was the single most important factor associated with perceived usefulness, perceived ease of use and perceived fitness of e-prescription in the institution. Information technology training and infrastructure development should go hand in hand with implementation of e-prescribing. Key words: Electronic prescribing, Electronic prescription, Medication error, Health Information Technology

E-Prescribing in the Acute Care Setting: Determining the Educational and Motivational Needs of Healthcare Providers.

The study sought to determine the barriers to e-prescribing particular to the acute care setting, the educational and motivational needs of acute care providers, and the optimal process for incentive, education, and implementation of e-prescribing. A theoretically based survey instrument was adapted from previous work. Four domains were assessed: finesse, intent to use, perceived usefulness, and perceived ease of use. The survey was offered to a group of acute care providers. The educational and motivational needs of acute care providers are different from those in primary care. Perceived barriers centered on uncertain pharmacy hours, unconfirmed transmittal, and accidental transmission to wrong pharmacy. Healthcare providers with more self-assessed knowledge of e-prescribing are more likely to use e-prescribing. Providers with fewer years in practice seem to have greater knowledge of e-prescribing. Providing education and exposure to e-prescribing has the potential to decrease perception of barriers and increase perceived usefulness for acute care providers. Software redesign may be needed to remove barriers associated with uncertain pharmacy hours, controlled substance prescribing, transmittal confirmation, and bidirectional communication needs, thereby improving motivation to e-prescribe.

The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study.

Objectives To explore paediatric nurses' experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice. Methods A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis. Results Two overarching analytical themes were identified: the centrality of risk management in nurses' role in the medication process and the distributed nature of nurses' medication risk management practices. Nurses' contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety. Conclusions Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.

Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions

We conducted a systematic review identifying users groups' perceptions of barriers and facilitators to implementing electronic prescription (e-prescribing) in primary care. We included studies following these criteria: presence of an empirical design, focus on the users' experience of e-prescribing implementation, conducted in primary care, and providing data on barriers and facilitators to e-prescribing implementation. We used the Donabedian logical model of healthcare quality (adapted by Barber et al) to analyze our findings. We found 34 publications (related to 28 individual studies) eligible to be included in this review. These studies identified a total of 594 elements as barriers or facilitators to e-prescribing implementation. Most user groups perceived that e-prescribing was facilitated by design and technical concerns, interoperability, content appropriate for the users, attitude towards e-prescribing, productivity, and available resources. This review highlights the importance of technical and organizational support for the successful implementation of e-prescribing systems. It also shows that the same factor can be seen as a barrier or a facilitator depending on the project's own circumstances. Moreover, a factor can change in nature, from a barrier to a facilitator and vice versa, in the process of e-prescribing implementation. This review summarizes current knowledge on factors related to e-prescribing implementation in primary care that could support decision makers in their design of effective implementation strategies. Finally, future studies should emphasize on the perceptions of other user groups, such as pharmacists, managers, vendors, and patients, who remain neglected in the literature.

PHP56 - Current Status and Evidence of Effects of E-Prescribing Implementation in United Kingdom, Italy, Germany, Denmark, Poland and United States

PHP56 - Current Status and Evidence of Effects of E-Prescribing Implementation in United Kingdom, Italy, Germany, Denmark, Poland and United States

Physicians and pharmacists call for more rapid implementation of e-prescribing in Canada

Canada should aim to have all prescriptions in the country created, signed and transmitted electronically by 2015, according to a joint statement released by the Canadian Medical Association (CMA) and the Canadian Pharmacists Association (CPhA) on May 21, 2013. The statement acknowledges that achieving this vision poses challenges, but says efforts must be made because of the extensive potential benefits to patients, providers and the health care system. These benefits will be realized when e-prescribing is integrated with Drug Information Systems (DIS) currently in place or being developed in various jurisdictions, say the 2 associations. The CMA and CPhA have laid out a 5-point plan for achieving full e-prescribing functionality by 2015. It includes the need for the provinces and Canada Health Infoway to complete electronic connectivity requirements among points of care, and for provinces, territories and regulatory bodies to develop regulatory frameworks to facilitate and govern clinicians’ use of electronic prescribing. The full e-prescribing joint statement is available at www.pharmacists.ca and www.cma.ca.

Experiences and opinions of non-medical prescribers in a paediatric hospital concerning electronic prescribing

AimsTo evaluate resources used by non-medical prescribers (NMPs) whilst making prescribing decisions. Describe any difficulties concerning the availability of paediatric prescribing information to NMPs required for writing prescriptions. Establish views...