Electronic Prescribing System Research Articles

Electronic prescription systems in Greece: a large-scale survey of healthcare professionals’ perceptions

BackgroundThe national e-prescription system in Greece is one of the most important achievements in the e-health sector. Healthcare professionals’ feedback is essential to ensure the introduced system tends to their needs and reduces their everyday workload. The number of surveys collecting the users’ views is limited, while the existing studies include only a small number of participants.MethodsIn this study, healthcare professionals’ perceptions on e-prescription are explored. For this, a questionnaire was distributed online, containing closed- and open-ended questions aiming to address strengths and identify drawbacks in e-prescription. Answers were collected from primary health care physicians, specialized medical doctors and pharmacists.ResultsIn total, 430 answers were collected (129 from primary health care physicians, 164 responses from specialized medical doctors and 137 pharmacists). Analysis of the collected answers reveals that the views of the three groups of healthcare professionals mostly converge. The positive impact e-prescribing systems have on the overall prescribing procedure in preventing errors and providing automation is commented. Among gaps identified and proposed improvements, health care professionals note the need for access to information on adverse drug reactions, side effects, drug-to-drug interactions and allergies. Flexible interaction with Therapeutic Prescription Protocols is desired to ameliorate monitoring and decision-making, while drug dosing features, and simplified procedures for copying, repeating, canceling a prescription, are perceived as useful to incorporate.ConclusionsCollecting healthcare professionals’ feedback is important, as their views can be transcribed to system requirements, to further promote e-prescribing and improve the provided health care services by facilitating decision making through safer and more efficient e-prescription. Introduction of the identified improvements can simplify the everyday workflow of healthcare professionals. To the best of our knowledge, a survey with more than 400 answered questionnaires on the use of e-prescription systems by healthcare professionals has never been conducted in Greece before.

Information Technology, Improved Access, and Use of Prescription Drugs

Abstract We estimate the effects of health information technology designed to improve access to medication while limiting overuse through easier prescription renewal and improved information provision. We focus on benzodiazepines, a commonly prescribed class of mental health and insomnia medications, which are highly effective but potentially addictive. We study the staggered rollout of a nationwide electronic prescribing system over four years in Finland and use population-wide, individual-level administrative data sets. We find that e-prescribing increases average benzodiazepine use due to increased prescription renewals. The increase is most pronounced for younger patients. E-prescribing can improve the health of elderly patients and may help to balance the access-overuse trade-off. Without additional monitoring for addiction in place, it may, however, also have unintended health consequences for younger patients, who are more likely to develop mental and behavioral health disorders.

Patient Satisfaction with Private Community Pharmacies versus Pharmacies in Primary Health Care Centers in Saudi Arabia

IntroductionSaudi Arabia has begun reforming its government-run health care system to increase efficiency and reduce costs. One effort is the adoption of an electronic prescribing system (Wasfaty) and outsourcing pharmaceutical services from government-run clinics to community pharmacies (CP). This study aims to compare satisfaction with pharmaceutical services offered in the two systems. Materials and methodsThis cross-sectional observational study used existing survey data collected from patients (≥15 years of age) visiting government primary health care centers from January 2022 to June 2022. Satisfaction with three pharmaceutical services (availability of medications, pharmacist’s explanation of the prescription, and waiting time to get medications) were the main outcomes. ResultsThe study comprised 91,317 participants, 74.06 % of them were CP/Wasfaty users. CP/Wasfaty patients had lower odds of satisfaction with the three pharmaceutical services: availability of medications (OR = 0.49, 95 % CI = 0.47–0.51), pharmacists’ explanation of prescription (OR = 0.55, 95 % CI = 0.53–0.58), and waiting time to get medications (OR = 0.81, 95 % CI = 0.75–0.88). Additional findings showed variations in satisfaction levels based on demographic factors and clinic types. ConclusionsThe significant differences observed in satisfaction levels based on demographic characteristics and type of clinics visited emphasize the importance of tailoring pharmaceutical services to meet the specific needs and expectations of different patient populations.

The impact of electronic prescribing systems on clinical pharmacy practice

The impact of electronic prescribing systems on clinical pharmacy practice

Discrepancies in Electronic Medical Prescriptions Found in a Hospital Emergency Department: A Prospective Observational Study.

The medication in an electronic prescribing system (EPS) does not always match the patient's actual medication. This prospective study analyzes the discrepancies (any inconsistency) between medication prescribed using an EPS and the medication revised by the clinical pharmacist upon admission to the observation area of the emergency department (ED). Adult patients with multimorbidity and/or polypharmacy were included. The pharmacist used multiple sources to obtain the revised medication list, including patient/carer interviews. A total of 1654 discrepancies were identified among 1131 patients. Of these patients, 64.5% had ≥1 discrepancy. The most common types of discrepancy were differences in posology (43.6%), commission (34.7%), and omission (20.9%). Analgesics (11.1%), psycholeptics (10.0%), and diuretics (8.9%) were the most affected. Furthermore, 52.5% of discrepancies affected medication that was high-alert for patients with chronic illnesses and 42.0% of medication involved withdrawal syndromes. Discrepancies increased with the number of drugs (ρ = 0.44, p < 0.01) and there was a difference between non-polypharmacy patients, polypharmacy ones and those with extreme polypharmacy (p < 0.01). Those aged over 75 years had a higher number of prescribed medications and discrepancies occurred more frequently compared with younger patients. The number of discrepancies was larger in women than in men. The EPS medication record requires verification from additional sources, including patient and/or carer interviews.

Evaluation of an electronic prescription platform: Clinicians’ feedback on three distinct services aiming to facilitate clinical decision and safer e-prescription

BackgroundHealth Care Professionals (HCPs) are the main end-users of digital clinical tools such as electronic prescription systems. For this reason, it is of high importance to include HCPs throughout the design, development and evaluation of a newly introduced system to ensure its usefulness, as well as confirm that it tends to their needs and can be integrated in their everyday clinical practice. MethodsIn the context of the PrescIT project, an electronic prescription platform with three services was developed (i.e., Prescription Check, Prescription Suggestion, Therapeutic Prescription Monitoring). To allow an iterative process of discovery through user feedback, design and implementation, a two-phase evaluation was carried out, with the participation of HCPs from three hospitals in Northern Greece. The two-phase evaluation included presentations of the platform, followed by think-aloud sessions, individual platform testing and the collection of qualitative as well as quantitative feedback, through standard questionnaires (e.g., SUS, PSSUQ). ResultsTwenty one HCPs (8 in the first, 18 in the second phase, and five present in both) participated in the two-phase evaluation. HCPs comprised clinicians varying in their specialty and one pharmacist. Clinicians' feedback during the first evaluation phase already deemed usability as “excellent” (with SUS scores ranging from 75 to 95/100, showing a mean value of 86.6 and SD of 9.2) but also provided additional user requirements, which further shaped and improved the services. In the second evaluation phase, clinicians explored the system's usability, and identified the services' strengths and weaknesses. Clinicians perceived the platform as useful, as it provides information on potential adverse drug reactions, drug-to-drug interactions and suggests medications that are compatible with patients' comorbidities and current medication. ConclusionsThe developed PrescIT platform aims to increase overall safety and effectiveness of healthcare services. Therefore, including clinicians in a two-phase evaluation confirmed that the introduced system is useful, tends to the users’ needs, does not create fatigue and can be integrated in their everyday clinical practice to support clinical decision and e-prescribing.

ПРЕИМУЩЕСТВА И НЕДОСТАТКИ СИСТЕМЫ ЭЛЕКТРОННЫХ РЕЦЕПТОВ С ТОЧКИ ЗРЕНИЯ ФАРМАЦЕВТИЧЕСКИХ РАБОТНИКОВ

Various electronic prescription systems are being developed both in Russia and around the world. For their effective implementation, it is necessary not only to bring regulatory and legal acts in line with modern technological innovations, but also to take into account the point of view of the users of such systems - patients, pharmacists and doctors. In order to identify the opinion of pharmacists about the current state of the system and their satisfaction, a survey was conducted. For this purpose, we used a questionnaire, tested for reliability (Cronbach's alpha measurement) and validity (Pearson correlation coefficient estimation). The results of the questionnaire, literature review, regulatory and legal documents allowed us to conduct a PEST-analysis with the establishment of political, economic, socio-cultural and technological factors that influence the system, as well as a SWOT-analysis with the identification of strengths, weaknesses, opportunities and threats of the system. Its advantages, with which most of the interviewed specialists agree, include reduction of medical errors in prescribing, increased protection of users' personal data, contribution to the fight against fake prescriptions. Strengths include simplified pharmaceutical review of prescriptions, no need to analyze doctors' handwriting and simplified dispensing of medicines. Weaknesses include various technical failures, lack of or insufficient training. It is important to note that more than half (54%) of the surveyed pharmacists encounter difficulties when working with the system. In addition, recommendations for the improvement of this system were proposed, taking into account the data of sociological research, PEST-analysis and SWOT-analysis.

Analysis of the use of antibiotics by AWaRe categories during the COVID-19 pandemic in hospitals across Scotland: a national population-based study

ObjectiveThe Access, Watch and Reserve (AWaRe) list of antibiotics was developed by the WHO to support antibiotic stewardship programmes (ASP). The Access group incorporates first-line options, while Watch antibiotics have...

Healthcare professionals’ understanding and perception of drug-related issues linked to off-label pharmacological medications used for COVID-19

ABSTRACT Background To evaluate the opinions of healthcare workers regarding drug therapy problems linked to anti-infective medicines used for the treatment of COVID-19 infection in Pakistan. Research methodology This cross-sectional study was conducted from January to October 2022 using a self-administered questionnaire developed by the authors, having three sections: demographics, knowledge, and perception. The study was validated by research experts and pilot-tested on 30 subjects. The study included medical doctors, nurses, pharmacists from Punjab’s government and private medical institutes. Results In this study, 382 of 400 participants replied. The mean knowledge score was 9.52 (SD 2.97), showing that participants had adequate knowledge of COVID-19 pharmacological interventions. The knowledge scores were significantly higher of those who treated COVID-19 patients and were from Lahore. Many doctors considered that elderly patients and those with blood disorders were at greater risk of experiencing drug-related problems. Most pharmacists support electronic prescription systems. Many doctors thought the lack of unified treatment guidelines, multiple prescribers, and self-medication were key obstacles in managing COVID-19 patients. Conclusion Most respondents had adequate knowledge. Older patients with comorbidities are at risk of adverse effects. Self-medication, polypharmacy, and multiple prescriptions can lead to misdiagnosis and complications. Electric prescriptions, team effort, and training programs can decrease these issues.

The Relationship of Implementation of The Electronic Prescription System on User Satisfaction in General Hospital Royal Prima Medan

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;The use of ICT is also utilized in the health sector to increase the effectiveness of services to the community. Electronic prescriptions have been widely used in hospitals to replace manual prescriptions. In several studies, electronic prescriptions are said to have many advantages, including reducing the incidence of prescribing errors. The location of study is General Hospital Prima Medan. The aim of this research is to determine the relationship between the implementation of an electronic prescription system and user satisfaction at General Hospital Royal Prima Medan. The type of research used in this research is descriptive correlational using a quantitative approach at General Hospital Royal Prima Medan and this study was 137, divided into 124 doctors and 40 pharmacy officers. The data analysis used in this research is univariate analysis and bivariate analysis. Data analysis in this study used univariate, bivariate, multivariate analysis using the SPSS Version 25 statistical application. The research results showed that a significant relationship between the implementation of the electronic prescription system and user satisfaction at General Hospital Royal Prima Medan with a very strong level of relationship, and this correlation is significant because p &amp;lt; 0.05 (0.000 &amp;lt; 0.05), So it can be concluded that there is a relationship between the implementation of the electronic prescription system and user satisfaction at General Hospital Royal Prima Medan. The results of research regarding the relationship between the implementation of the electronic prescription system and user satisfaction at General Hospital Royal Prima Medan which has been carried out show that 110 respondents said the implementation of electronic prescriptions at General Hospital oyal Prima Medan was good with a percentage of 80.3%, 27 respondents were not doing well with a percentage of 19.7% of the total respondents in this study of 137 respondents.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords: Electronic, Hospital, Implementation, Prescriptions, Satisfaction&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

P23 Benchmarking voriconazole therapeutic drug monitoring in adults and paediatrics

Abstract Background Voriconazole is the first-line agent for invasive aspergillosis and microbiology approved fungal infections. Voriconazole acts as both a substrate/inhibitor of several hepatic cytochrome P450 enzymes and demonstrates non-linear kinetics due to metabolism saturation. Inter-individual variability of voriconazole pharmacokinetics is high.1 Therapeutic drug monitoring (TDM) of trough plasma levels can mitigate treatment failure/toxicity. A therapeutic index between 1 and 5.5 mg/L is aimed for.1 An online protocol directs IV/oral dosing in line with British National Formulary guidance. An audit was conducted to benchmark protocol compliance. Standards Total compliance to the following standards was investigated for all voriconazole prescriptions: (i) suitable indication; (ii) documented stop or review date; (iii) protocol prescribed loading and maintenance dose; (iv) dose adjustment for non-therapeutic voriconazole trough level; and (v) trough sampling between 4 and 7 days since initiation. Methods Retrospective voriconazole dispensing data (April 2020–April 2022) was used to identify treated adult and paediatric patients. Correlating electronic prescribing and medicines administration (ePMA) system data was examined in line with standards. Patients receiving voriconazole prophylaxis or under 7 days total treatment were excluded from data collection. Descriptive statistics were used to describe patient characteristics and compliance with standards. Results In total, 47 patients (31 adults and 16 children) were identified. The IQR of age was 48 years. Total compliance was obtained to standard (ii) only. Overall, 94% of patients’ prescriptions possessed an appropriate indication and 6% were clinically appropriate with unclear documented indications. A total of 66% received protocol directed loading and maintenance doses, 6% were prescribed appropriate loading doses, without maintenance doses, and 28% received an inappropriate loading/maintenance dose. Within 4 to 7 days since treatment initiation, 55% had therapeutic trough levels; 27% had supratherapeutic levels, but only 33% of doses were reduced, whereas when subtherapeutic trough levels were encountered in 18% of cases, 75% of doses were increased. Overall, 47% had plasma trough levels taken within the recommended period; 30% did not have a trough level ordered, whilst the remaining 23% had sampling taken before 4 days or after 7 days. Conclusions Person and system interventions are required to improve pre-/post-prescription standards. Prescriber education focusing on indication documentation and recent patient body weight for dosing is required. Whereas an ePMA prescribing package incorporating protocol guidance, consecutive loading and maintenance doses, plus trough sampling orders should be trialled. Protocol integrated instructions on dosing adjustment as done for other TDM drugs should be explored. Occasional nursing omissions of both 12-hourly loading doses on Day 1 of treatment should be addressed with practice educators. Reliance on an external laboratory and third party to communicate trough sample results was associated with delays. This should be investigated further as a cause of dose adjustment issues. ePMA availability of samples, direct laboratory communication with prescribers/pharmacists and investigations into cost-effectiveness of internal laboratory assays should be considered. Interventions should be agreed with stakeholders and reaudit occur. Earlier sampling and dosing practices better representing local the patient population could be investigated further as part of an antimicrobial stewardship improvement project.

PRESCRIPTION PERILS: SAFEGUARDING PATIENT WELFARE THROUGH ENHANCED ELECTRONIC PRESCRIBING PROTOCOLS IN PRIMARY HEALTH CARE

As electronic prescribing becomes ubiquitous in primary health care settings, the imperative to ensure patient safety is paramount. This paper delves into the potential hazards associated with electronic prescribing systems and proposes enhanced protocols to mitigate medication errors. The discussion encompasses the intricate landscape of electronic prescription processes, identifying vulnerabilities that may compromise patient welfare. Through an analysis of current practices, this paper outlines proactive measures and improved guidelines aimed at fortifying the electronic prescribing framework. By emphasizing the importance of a comprehensive approach to medication safety, this research contributes to the ongoing dialogue surrounding electronic prescribing in primary health care.

Usability evaluation of electronic prescribing systems from physicians' perspective: A case study from southern Iran

IntroductionThe evaluation of e-prescribing systems' usability is crucial as they are integral to the quality of healthcare services. This study evaluates the usability of three e-prescribing systems and examines the impact of individual factors on system usability. MethodThe objective of this descriptive study was to assess the usability of e-prescribing systems (EP, Dinad, and Shafa) as perceived by 105 physicians from three clinics at Hormozgan University of Medical Sciences in Bandar Abbas, Iran. The data was collected using the 2020 edition of the Isometric Questionnaire 9241/110, which comprises of seven axes and 66 questions. The participants were asked to rate their opinions on a 5-point Likert scale, with options ranging from completely disagree [1] to completely agree [5]. ResultsEP, Dinad, and Shafa received average scores of 3.45, 3.32, and 3.24, respectively. Self-descriptiveness and User Error Tolerance axes were rated the highest ratings, with average scores of 3.60 and 3.48. Conversely, conformity and suitability axes received the lowest ratings, with average scores of 3.19 and 3.22, respectively. Upon evaluating the usability axes, the EP significantly improved controllability and user engagement compared to other systems. The usability of Dinad and Shafa in the Gynecology clinic was significantly higher than the two other clinics. Also, older physicians with more work experience rated the Shafa significantly higher than two other systems. ConclusionThe evaluated systems had average usability. although there was no statistically significant difference in the usability of these systems, the evaluation of dimensions revealed unique strengths in each system.

Electronic prescribing system for pharmacy pathfinder programme should be ready from spring 2024, says IT provider

Electronic prescribing system for pharmacy pathfinder programme should be ready from spring 2024, says IT provider

რეცეპტის ინსტიტუტის დანერგვის გამოწვევები საქართველოს ჯანდაცვის ინსტიტუციურ განვითარებაში

Ministry of Labour, Health and Social Affairs realized reform from 1th february till 1th september in 2014 for prescription system implementation. According to these changes pharmaceutical products of second group becamethe prescription medicines. In Georgia, access to and supply Rx medicines is governed by a regulatory framework. Second group drugs are only available to the public when prescribed by doctors on new prescription form N 3. The aim of research is to reveal and evaluate positive and negative sides of new prescription system; to study it, sinfluence on achievement process to drugs. As part of the quantitative research, doctors and pharmacists of the medical institution were interviewed. As part of the qualitative research, in-depth interviews with healthcare experts were conducted. The special questionnaire was designed for each aimed group. The questionnaires consist of open and closed questions. The results of the study revealed the positive aspects of the Prescription Institute: with this reform, the system returned to the logic of normal clinical medicine; The role of the doctor in relation to the patient's pharmacotherapy has been strengthened; The competence of the pharmacist was included in the appropriate framework and the specific skills of selling medicinal products by prescription were developed; The culture of purchasing medicines with prescriptions has been established among the population; At the same time, the results of the research revealed such actual problems that are an obstacle to the introduction of the prescription institute: prescription drugs are sold without a prescription; In the doctor's offices opened next to the pharmacies, the doctor is limited to prescribing only prescriptions; In case of chronic or long-term diseases, patients' access to prescription drugs is complicated; Doctors do not have complete information about the dispensing mode of this or that pharmaceutical product from the pharmacy. Pharmacists talk about the lack of specific skills in prescribing prescriptions: in the case of more than one medicine prescribed on one prescription form, the prescription is cancelled; Prescriptions not certified with a seal are invalid; Incorrectly indicated generic name, inconsistency between generic and trade names, prescription of a combined pharmaceutical product with a generic name prolongs the service of the user; Incorrectly indicated course of treatment, drug release forms, medicinal dose are the cause of misunderstanding; e.g. A pharmacist is prohibited from selling a 10 mg tablet of the same name medicine instead of a specified 5 mg tablet. One of the goals of the reform planned by the Ministry of Health is the correct treatment, the reduction of the share of expenses on medicine and the harm caused by self-medication. It is too early to talk about these achievements within the framework of the conducted research, however, one of the details was revealed that will contribute to the reduction of expenses on medicines, namely: it is necessary to indicate the diagnosis in the prescription according to ACD-10; The doctor's prescription should always be consistent with the diagnosis; The institute of prescriptions should reveal the rationality of the prescription issued by the doctor, compliance with the guidelines, which will partially reduce the costs of medicines. The reform implemented in connection with the restoration and establishment of the Institute of Recipes in Georgia is a step forward. The medical community unequivocally welcomes this change. The competence and authority of the doctor increased; the specific rules for prescribing by a doctor and issuing prescription medication by a pharmacist are gradually being established. Along with the highlighted positive aspects, significant systemic errors and technical flaws are visible. The sale of drugs of the second group without a prescription is an obstacle to the introduction of the Institute of Prescriptions. At this stage, fining the pharmacy cannot solve the problem. The Ministry of Health considers the establishment of an electronic prescription system to eliminate this problem. The current activity of the "pharmacy" doctor also hinders the reform. Access to medicines for patients with chronic diseases is complicated. The existing classification of medicines has flaws. Recommendations Based on the conducted research, the following recommendations were developed: • Improving the administration of the prescription institute implementation process; • Study of the activities of "pharmacy" doctors by the Agency for the Regulation of Medical Activities; • Refinement of regulatory normative base, administration tools; • Revision of the classification of pharmaceutical products and periodically making rational changes taking into account the data of AMEA, WHO, PSUR; • In order to use medicines rationally, it is advisable to introduce a system of electronic prescriptions.

The impact of the implementation of computerized insulin order sets for the control of hyperglycemia in hospitalized cardiac patients.

Glycemic control is crucial in managing hospitalized patients with type II diabetes (T2DM), and it presents as a clinical challenge in the cardiac population. Therefore, we aimed to evaluate the impact of computerized insulin order sets in T2DM hospitalized cardiac patients. A quasi-experimental, pre- and post-study design. We included T2DM patients who were hospitalized for at least 3 days. Patients undergoing cardiac surgery were excluded. The primary endpoint was the mean difference in random blood glucose level (BGL) before and after the implementation of insulin order sets. While the secondary endpoints were to compare the median differences in fasting BGLs and the number of hyperglycemic and hypoglycemic episodes during the first 7 days. The study consisted of three phases: pre-implementation, intervention and post-phase. In the intervention phase, insulin order sets were integrated into the electronic prescribing system, and education was provided to the cardiology department. The post-phase included the patient's post-implementations. A total of 194 patients were enrolled during the study period. The mean random BGL was 11.17 mmol/L, 95% CI, 10.6-11.7 in the pre-phase and 9.5 mmol/L, 95% CI, 9-1 -9.9 mmol/L in the post-phase (P < 0.001). The median fasting BGL was 9.2 mmol/L (7.4-11.8, IQR) in the pre-phase and 8.5 mmol/L (6.6-10.3, IQR) in the post-phase (P = 0.027). The number of hypoglycemic episodes was 24 in pre-phase and 33 in post-phase (P = 0.13). The use of computerized insulin order sets was associated with potential improvements in random and fasting glycemic control without increasing the risk of hyperglycemia or hypoglycemia.

The Impact of Health Informatics on Radiologist, Laboratory Technician, Pharmacist-Physician Collaboration, and Patient Outcomes

Health informatics has revolutionized the way healthcare professionals collaborate and deliver care, with significant implications for patient outcomes. This abstract explores the impact of health informatics on the collaboration between radiologists, laboratory technicians, pharmacists, and physicians, and its influence on patient outcomes. The abstract provides an overview of the role of health informatics in facilitating communication, information sharing, and decision-making among these healthcare professionals. It also discusses the potential benefits and challenges associated with integration of health informatics in collaborative care, and highlight the importance of leveraging technology to improve patient safety, treatment efficacy, and overall healthcare quality. The review concludes that, the professions of radiologists, laboratory technicians, chemists, doctors, and patient outcomes have all been significantly impacted by health informatics. Healthcare practitioners are now able to make better decisions thanks to the increased efficiency and accuracy of diagnostic imaging and laboratory tests brought about by the integration of technology and data management systems. Electronic prescribing and medication management systems have improved collaboration between chemists and doctors, guaranteeing safe and efficient pharmaceutical use. The application of health informatics has also helped patients receive more individualized care, better communication, and access to health information. All things considered, the use of health informatics has changed the way that healthcare is delivered and may continue to enhance patient outcomes in the future.

Evaluation of simvastatin and CYP3A4-inhibitor interactions in an inpatient population

Abstract Introduction The maximum recommended dose for simvastatin in conjunction with the CYP3A4 inhibitors amiodarone, amlodipine, diltiazem, or verapamil is 20 mg/day.1 Studies have reported on the extent of potentially harmful simvastatin interactions which can increase the risk of myopathy.2 A project in a local primary care setting had identified that 42 (14%) of 305 patients prescribed simvastatin and one of these CYP3A4 inhibitors were receiving the unlicensed dose of simvastatin 40mg. We wanted to investigate if there were similar concerns for hospital inpatients. Aim The aim of this evaluation was to ascertain whether patients were prescribed simvastatin 40mg with one of the named interacting drugs during their hospital admission and whether any action was taken for patients on such a combination. Methods A search was undertaken of patients prescribed simvastatin 40mg with amiodarone, amlodipine, diltiazem, or verapamil using the electronic prescribing system (EPS) (Careflow Medicines Management) between January to October 2022. Relevant data were extracted from the EPS and discharge summaries were searched for any additional information, in particular for any notes made by the prescriber or pharmacy team that they had recognised and acted on this combination. Data were collated and analysed using Microsoft Excel. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required. This project was registered on the hospital’s clinical audit database. Results Fifty-six patients (mean age 78, range 59-94, 50% female) were prescribed a combination of interest during their admission. A further 13 who died in hospital were excluded. Thirty (54%) patients were admitted on this combination. Simvastatin 40mg appeared with amlodipine in 77% (n=43) of instances, diltiazem in 11% (n=6), amiodarone in 11% (n=6), and verapamil in 1% (n=1). Thirty-one (55%) of 56 patients were discharged on this combination, and 6 had no discharge information. Of the 19 (34%) not discharged on the combination, six were due to proactive pharmacy intervention, whilst remaining instances were due to other clinical reasons. Discussion/Conclusion We observed a possible lack of knowledge of these potentially hazardous interactions with some inpatients commenced on the combination, and just over half of the cohort discharged on such a combination. Such in-hospital prescribing of interacting drugs and lack of pharmacy team clinical check could be due to unawareness of the MHRA alert. Though our EPS has the functionality of triggering alerts to notify prescribers of interactions, only level 4 warnings are flagged and the interactions we examined, as a level 3 warning, remain suppressed and not easily visible to the prescriber. Our results will be shared with hospital and primary care pharmacy teams, as this is an area of prescribing that the Care Quality Commission may review when inspecting general practices.3 This evaluation will be repeated. Recognised limitations of this single centre, retrospective study include: we did not look at interactions between simvastatin and other medicines, nor interactions with other statins; we did not investigate whether these patients were suffering from muscle-related adverse events.

Hospital pharmacists', doctors' and nurses' perceptions of intra- and inter- professional communication in the context of electronic prescribing and medication administration systems: A qualitative study.

Effective, integrated and coordinated communication is essential in providing high quality patient care. Little prior research has detailed the impact of electronic prescribing and medication administration (ePMA) systems on healthcare professionals' (HCPs') communication. We investigated hospital pharmacists', doctors' and nurses' perceptions of how ePMA systems have affected, or are expected to affect, the way they communicate with each other in an inpatient setting. A qualitative study in three English NHS hospitals: two used different inpatient ePMA systems, and one used paper-based prescribing. We conducted focus groups with pharmacists, and semi-structured individual interviews with doctors and nurses. Transcribed data were analysed inductively using thematic analysis. Nine focus groups, three at each hospital, were conducted with pharmacists with different levels of seniority (58 pharmacists in total). Fourteen doctors and twelve nurses took part in individual interviews. Four themes were generated: modes of communication, reduced pharmacist visibility, system limitations, and future aspirations for ePMA. Whether working with ePMA or paper-based systems, all participants preferred to communicate face-to-face to facilitate collaborative discussions regarding patient care. Participants perceived that ePMA reduced contact time with patients. Pharmacists perceived that both their physical ward presence and their written communication on medication charts had reduced since introduction of ePMA. Doctors felt they were now less likely to ask pharmacists questions due to pharmacists' reduced physical presence on the ward. Hardware and software limitations were identified by all HCPs, with suggestions made for future developments to better support communication. ePMA does not necessarily support communication among HCPs. Pharmacists and doctors were also concerned that ePMA reduces communication between themselves and their patients. Hospital managers should ensure sufficient hardware for HCPs, including pharmacists, to conduct their work in clinical areas, and work with ePMA system suppliers to develop ways of enhancing, rather than inhibiting, communication.

A Service Evaluation of the Implementation of E-sign for Homecare Prescriptions in Secondary Care

Abstract Introduction Homecare Medicine Services allow patients with chronic conditions, reliant on specialist medicines prescribed by secondary care, to manage their symptoms at home rather than requiring regular attendance to a hospital for treatment1. The Royal Cornwall Hospital NHS Trust (RCHT) manages over 3000 patients on homecare services across a range of specialties. Traditional homecare processes required prescriptions to be printed on paper at the hospital, signed by hand by a prescriber and then securely couriered to the homecare provider for processing. The secondary care Electronic Prescription Service (EPS) is coming but in the interim a solution was commissioned by the National Homecare Medicines Committee to improve processes, reduce administrative burden, and improve the timeliness of prescriptions for direct patient benefit. The product selected was E-sign (E-Sign (UK) Ltd) which allows prescriptions, as PDF files, to be signed with an advanced electronic signature and tracked through a managed workflow compliant with applicable legislation2. Working collaboratively with Sciensus we introduced E-sign in March 2022. In the last year we have processed approximately 3500 prescriptions via this process. We sought to evaluate E-sign prior to wider adoption within the Trust. Aim To evaluate the acceptability, benefits or drawbacks of the new E-sign process for prescribers and patients. Methods In January 2022 (pre- implementation) we audited 100 homecare prescriptions recording the time between prescribing on our electronic prescribing system (ePMA) and collection by the Sciensus courier. Post-implementation data was gathered by comparing the time of prescribing on ePMA and time of release to Sciensus on the E-sign workflow for 142 prescriptions in May 2023. Data was analysed in Microsoft Excel and a T-test was used to test significance. A short survey was sent to all prescriber and pharmacist users of the E-sign system (12) to evaluate the speed, flexibility and ease of use of the system. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required, it was registered with the Trust’s clinical audit database. Results There was a statistically significant (p &amp;lt; 0.05) decrease in the average time taken for prescription transmission, from 200 hours pre-implementation to 25 hours post-implementation. All respondents to the survey (N=8) agreed it was easier to use than the manual system and would recommend it to colleagues. Most (75%) felt the system was faster and more flexible than the paper system. 50% believed it improved the service to patients. All respondents would recommend the system to their colleagues. Discussion/Conclusion The E-sign system has brought benefits to prescribers and ultimately patients. Prescriptions are now transferred significantly more quickly to homecare providers, and the risk of lost prescriptions is removed. E-sign has allowed for service transformation; we now have prescribers who work entirely remotely using E-sign. Future developments will include collaborating with additional homecare providers, including a new patient workflow, and migrating to EPS when available. Study limitations were due to the sample size of prescribers available for survey.