Electronic Prescribing Research Articles

Pharmacist review of discharge antibiotics for urinary tract infections in the emergency department

AbstractEmergency medicine (EM) pharmacists provide high‐quality patient care in a fast‐paced environment by optimizing pharmacotherapy regimens and reducing medication errors. Current literature demonstrates higher rates of medication errors with antibiotics compared with other medication classes. The aim of this quality improvement (QI) project was to reduce medication errors by 25% from baseline for antibiotic discharge prescriptions for urinary tract infections (UTIs). This QI initiative utilized the Institute for Healthcare Improvement Model for Improvement to implement a UTI stewardship intervention and prospective pharmacist review of discharge prescriptions. Patients discharged from the adult ED with an electronic prescription for UTI treatment with select antibiotics were included. The primary outcome metric was the percent of medication errors, defined as a composite of appropriate antibiotic agent, dose, frequency, and treatment duration based on our local treatment algorithm. The balancing metric was time spent per order reviewed. Data over time were assessed using statistical process control charts. A total of 534 antibiotic prescriptions were reviewed from January 9, 2022 to May 31, 2023. The most common indication was cystitis (70%), followed by pyelonephritis (17.4%) and asymptomatic bacteriuria (12.5%). Composite error rate decreased from 64.2% to 5%. Duration of therapy was the most common baseline error and was reduced from 45.3% to 11.6%. Errors in agent, dose and frequency decreased from 19.7% to 3.5%, 10.3% to 0.8% and from 5.7% to 0%, respectively. The aim of this QI initiative was achieved through a series of interventions, including prospective review of discharge antibiotics for UTIs by EM pharmacists, which reduced medication errors. This project demonstrates EM pharmacists have a positive impact in optimization of antimicrobial therapy for the treatment of UTIs.

Legislative mechanisms of personal data protection in the health care system

Human rights and freedoms, guarantees of their observance and protection should be the basis of the activities of any democratic country in the world. The issue of information security becomes particularly relevant in modern conditions, because medical institutions collect and store personal data of persons who contact them, the results of laboratory and instrumental research, diagnoses, medical histories, etc. Endless reforms, changes in legislation, introduction of an electronic system in the field of health care cause a lot of discussions about individual mechanisms of its functioning and ensuring the protection of personal data. The collection of personal data must be lawful, subject to strict requirements and for a legitimate purpose. In addition, persons or organizations engaged in the collection and processing of personal information must protect it from abuse and respect the rights of data owners guaranteed by law. The reform of legislation in the field of data protection should take place in parallel with the dynamic process of development of Internet technologies, including the creation of a formalized system of legislation in the field of privacy. In addition, considerable attention should be paid to the level of awareness of citizens about how their personal data may be collected and used. In particular, the request for consent to the processing of personal data must be clear; access to own data should be simplified and their mobility should be increased for easier transfer of data from one service to another; companies and organizations must report serious security breaches in a timely manner. And of course, ensuring the appropriate level of responsibility and reporting of all those involved in personal data processing. Health care is increasingly reliant on information technology. More and more hospitals and healthcare institutions are using information and communication technologies to support and improve their work. Digital technologies are widely used in the public health care sector, including electronic prescriptions, appointments with a family doctor, records of services rendered, hospitalization, hospital discharge, etc. In this context, a wide range of eHealth tools and services have emerged. Electronic medical records are created in such a way that it is possible to transfer patient data between different medical professionals. Although digital health technologies have so many important functions, their high dependence on sensitive patient health information can cause information security issues. At the same time, a significant part of personal health data is often collected without informing patients about it.

A Preliminary Scoping Review of the Impact of e-Prescribing on Pharmacists in Community Pharmacies.

This scoping review aims to map the available literature and provide an overview of the published articles discussing the impact of electronic prescribing on medication errors and pharmacy workflow. The literature search was conducted using PubMed®, Web of Science®, and the Cochrane Database of Systematic Reviews®, as well as grey literature reports, using the search terms and related components of "pharmacists", "electronic prescribing", "medication errors", and "efficiency". The search included all articles that were published from January 2011 to September 2023. Twenty-two relevant articles were identified and fully reviewed, ten of which were included in this review. Electronic prescribing (e-prescribing) provides a solution for some of the challenges that are associated with handwritten and paper prescriptions. However, the implementation of e-prescribing systems has been recognized as a source of new unforeseen medication errors in all the reviewed articles. Productivity in community pharmacies has been affected with receiving electronic prescriptions (e-prescriptions) and having to deal with the issues that arise from them. The pharmacists' interventions were not eliminated with e-prescriptions compared to other prescription formats. The most frequently reported reason for intervention was related to incomplete instructions in the field of directions of use. Other common challenges with e-prescriptions were related to missing information, quantity, inappropriate dose, dosage form, and drug. This review demonstrates the scarcity of research about the impact of electronic prescribing on medication error and efficiency in community pharmacies. In the literature, most of the studies had mainly focused on hospital pharmacies. The literature search demonstrated that there are still some barriers to overcome with e-prescribing systems and that medication errors were not fully eliminated with e-prescriptions. New errors have been identified with e-prescriptions, all of which caused delays in processing, which affected the productivity of the pharmacy staff, and could have negatively impacted patients' safety if not properly resolved. e-Prescribing solved some of the challenges associated with illegibility of handwritten prescriptions. However, more time is required to allow e-prescribing systems to mature. Further training for prescribers and pharmacists is also recommended before and after the implementation.

Seeking systems-based facilitators of safety and healthcare resilience: a thematic review of incident reports.

Patient safety incident reports are a key source of safety intelligence. This study aimed to explore whether information contained in such reports can elicit facilitators of safety, including responding, anticipating, monitoring, learning, and other mechanisms by which safety is maintained. The review further explored whether, if found, this information could be used to inform safety interventions. Anonymized incident reports submitted between August and October 2020 were obtained from two large teaching hospitals. The Systems Engineering Initiative for Patient Safety (SEIPS) tool and the resilience potentials (responding, anticipating, monitoring, and learning) frameworks guided thematic analysis. SEIPS was used to explore the components of people, tools, tasks, and environments, as well as the interactions between them, which contribute to safety. The resilience potentials provided insight into healthcare resilience at individual, team, and organizational levels. Sixty incident reports were analysed. These included descriptions of all the SEIPS framework components. People used tools such as electronic prescribing systems to perform tasks within different healthcare environments that facilitated safety. All four resilient capacities were identified, with mostly individuals and teams responding to events; however, monitoring, anticipation, and learning were described for individuals, teams, and organizations. Incident reports contain information about safety practices, much of which is not identified by traditional approaches such as root cause analysis. This information can be used to enhance safety enablers and encourage greater proactive anticipation and system-level learning.

Postoperative opioids administered to inpatients with major or orthopaedic surgery: A retrospective cohort study using data from hospital electronic prescribing systems.

Opioids administered in hospital during the immediate postoperative period are likely to influence post-surgical outcomes, but inpatient prescribing during the admission is challenging to access. Modified-release(MR) preparations have been especially associated with harm, whilst certain populations such as the elderly or those with renal impairment may be vulnerable to complications. This study aimed to assess postoperative opioid utilisation patterns during hospital stay for people admitted for major/orthopaedic surgery. Patients admitted to a teaching hospital in the North-West of England between 2010-2021 for major/orthopaedic surgery with an admission for ≥1 day were included. We examined opioid administrations in the first seven days post-surgery in hospital, and "first 48 hours" were defined as the initial period. Proportions of MR opioids, initial immediate-release(IR) oxycodone and initial morphine milligram equivalents (MME)/day were calculated and summarised by calendar year. We also assessed the proportion of patients prescribed an opioid at discharge. Among patients admitted for major/orthopaedic surgery, 71.1% of patients administered opioids during their hospitalisation. In total 50,496 patients with 60,167 hospital admissions were evaluated. Between 2010-2017 MR opioids increased from 8.7% to 16.1% and dropped to 11.6% in 2021. Initial use of oxycodone IR among younger patients (≤70 years) rose from 8.3% to 25.5% (2010-2017) and dropped to 17.2% in 2021. The proportion of patients on ≥50MME/day ranged from 13% (2021) to 22.9% (2010). Of the patients administered an opioid in hospital, 26,920 (53.3%) patients were discharged on an opioid. In patients hospitalised with major/orthopaedic surgery, 4 in 6 patients were administered an opioid. We observed a high frequency of administered MR opioids in adult patients and initial oxycodone IR in the ≤70 age group. Patients prescribed with ≥50MME/day ranged between 13-22.9%. This is the first published study evaluating UK inpatient opioid use, which highlights opportunities for improving safer prescribing in line with latest recommendations.

Medication errors involving intravenous paracetamol in children: experience from enquiries to the National Poisons Information Service

IntroductionChildren are at higher risk of medication errors due to the complexity of drug prescribing and administration in this patient group. Intravenous (IV) paracetamol overdose differs from overdose by ingestion...

Spermatogenesis induction audit over a 5-year period at a UK male fertility centre

Background: This audit aimed to evaluate and measure the outcomes of spermatogenesis induction over a 5-year period. Men with primary, as well as central hypogonadism, received gonadotrophin therapy to stimulate sperm production and fertility outcomes, including live birth rates. Predictors associated with live births, were measured retrospectively. Methods: Men with severe oligospermia (sperm concentration <5million/ml), having gonadotrophin prescriptions for a minimum of 6 months, were identified via the electronic prescription system. They were asked to complete a service evaluation questionnaire. Results: Men with persistent azoospermia were more likely to have a diagnosis of PH (Odds ratio 22.5, p<0.001) and smaller testicular size (Odds ratio 8.8, p<0.001), compared to men with successful spermatogenesis. Twenty-eight per cent (13/47) had partners, who conceived spontaneously and delivered healthy babies. Nine per cent (4/47) had a live birth after ART. Live birth rate was higher in men with CH compared to PH, with 17 of 45 (38%) men with CH having a partner that successfully delivered a baby. Conclusion: Men with mainly central hypogonadism and female partners with no known subfertility are most likely to achieve conception and live birth. Patient education on the results of semen analysis or female factors affecting fertility could improve overall outcomes.

Patient satisfaction with Saudi community pharmacy services (Wasfaty System)

IntroductionThe healthcare system in KSA has been substantially transformed as part of Vision 2030, including implementation of an electronic prescribing system, called Wasfaty, to enable patients to receive their prescriptions from community pharmacies (CPs). This study assessed patient satisfaction with CPs and the Wasfaty system. MethodsThis cross-sectional observational study used existing data from the Saudi Ministry of Health's patient experience program. Data were collected from patients (≥15 years of age) visiting governmental primary care clinics in 2022. Summary statistics were determined and multivariable logistic regression analyses were conducted. ResultsThe sample included 66,541 patients. More than 70% of patients were satisfied with the services of the CPs and the Wasfaty system. Being older and being female consistently showed a positive association with satisfaction across several services. Whereas patients in preventive clinics had higher odds of satisfaction with medication availability (OR: 1.19, 95% CI: 1.03–1.37) and waiting time (OR: 1.23; 95% CI: 1.03–1.47), patients in chronic disease clinics had lower satisfaction with medication availability (OR: 0.92, 95% CI: 0.85–0.99). Saudi patients had lower odds of being satisfied with multiple services. ConclusionsThe overall high satisfaction among patients suggested the success of the Wasfaty system in meeting patient needs and expectations. However, areas for improvement exist to increase patient satisfaction, such as addressing medication shortages and ensuring clear patient–pharmacist communication. The results highlight the importance of continued monitoring and evaluation to support the patient experience with pharmacy services, and to improve patients' journeys, medication adherence, and overall healthcare outcomes.

Manajemen Rumah Sakit dalam Pencegahan Medication Error melalui Patient Safety

Medication errors are preventable events which include errors in prescribing, reading a prescription (transcribing), preparing and administering drugs (dispensing), and the process of using drugs (administering). Medication errors can result in direct harm to the patient or indirectly to the hospital. The aim of this scoping review is to answer questions that have been determined from the research topic using a variety of similar research articles, then group them and draw conclusions. This research uses a scoping review approach to identify steps for developing a research protocol. Factors that cause medication errors can be prevented through good hospital management, namely patient safety, including treatment planning, electronic prescriptions, electronic medical records and medication review

Medication safety strategies in European adult, paediatric, and neonatal intensive care units: a cross-sectional survey

ObjectivesPatients in intensive care units (ICUs) are potentially more vulnerable to medication errors than patients admitted to general wards. However, little is known about medication safety strategies used in European...

Prevalence and Incidence of Medication-Treated Diabetes and Pattern of Glucose-Lowering Treatment During the COVID-19 Pandemic: Real-World Data from the Electronic Greek Prescription Database.

This study aimed to investigate the prevalence and incidence of medication-treated diabetes mellitus and the evolving patterns of glucose-lowering treatments the year before and during the first two years of the coronavirus disease 2019 (COVID-19) pandemic. Data from the Greek electronic prescription database were analyzed for 2019, 2020, and 2021. The study population included individuals with active social security numbers. Prevalence and incidence rates were calculated based on the dispensing of glucose-lowering medications according to their unique anatomical therapeutic chemical (ATC) code. The study population comprised 10,289,140 individuals in 2019, 10,630,726 in 2020, and 11,246,136 in 2021. Diabetes prevalence rates were 8.06%, 6.89%, and 7.91%, and incidence rates were 16.8/1000, 8.6/1000, and 13.4/1000 individuals, respectively. Metformin was the most prescribed medication, and newer classes, like sodium-glucose cotransporter-2 inhibitors 2 (SGLT-2) inhibitors and glucagon like peptide-1 (GLP-1) receptor agonists exhibited increasing trends. The study identified a decrease in medication-prescribed diabetes prevalence and incidence during the initial year of the COVID-19 pandemic, attributed to healthcare access restrictions. Subsequently, figures returned close to baseline levels. Glucose-lowering medication trends reflected adherence to local and international guidelines, with metformin as the cornerstone, and increasing preference for newer classes such as GLP-1 receptor agonists and SGLT-2 inhibitors.

Secondary uses of electronic prescribing and pharmacy data in UK hospital care: a national survey

Electronic hospital pharmacy (EHP) systems are ubiquitous in today’s hospitals, with many also implementing electronic prescribing (EP) systems; both contain a potential wealth of medication-related data to support quality improvement....

Hoarding medication and suicide attempts with 1180 tablets of mirtazapine overdose: A case report

AbstractBackgroundConfirming a patient's consistent adherence to prescribed medication remains a persistent challenge for healthcare professionals. One reason for nonadherence is that patients accumulate their prescribed medicines with the intent of taking large quantities as a suicidal attempt. We present a case involving hoarding and overdosing on the highest quantity of mirtazapine ever reported.Case PresentationOur patient, a 44‐year‐old man suffering from depression, was admitted to our emergency department due to an overdose of 1180 mirtazapine tablets, equivalent to 17,700 mg. He exhibited a prolonged disturbance of consciousness, liver enzyme abnormalities, and serotonin syndrome. After 7 weeks in the intensive care unit, he was transferred to a psychiatric ward. Over time, his depressive symptoms improved, as did his suicidal ideation. On the 73rd day of his illness, he was discharged without any lasting effects, although he experienced retrograde amnesia.ConclusionsIn this case, ensuring the patient's medication adherence is paramount. Implementing electronic prescription technologies may offer the potential to enhance healthcare by avoiding medication duplication, preventing stockpiling of duplicated medicine, and preventing overdosing.

Real-world Treatment Sequencing and Outcomes With Cabozantinib After First-line Immune Checkpoint Inhibitor-based Combination Therapy For Patients With Advanced Renal Cell Carcinoma: CARINA Study Results

IntroductionReal-world data are limited on treatment sequencing and outcomes after first-line (1L) immune checkpoint inhibitor (CPI)-based combination treatment of advanced renal cell carcinoma (aRCC). Patients and MethodsIn this real-world, UK-based, retrospective study (CARINA; NCT04957160), data were obtained from hospital and electronic prescribing records. Patients were aged ≥ 18 years at aRCC diagnosis and had received 1L CPI–CPI or tyrosine kinase inhibitor (TKI)–CPI combination therapy before second-line (2L) therapy including cabozantinib. We describe treatment outcomes including 1L and 2L durations of treatment (DoT) and overall survival (OS). ResultsData from April 2015 to June 2022 were collected on 281 patients from nine UK centres. Median 1L DoT was 2.3 months for CPI–CPI therapy (n = 171) and 5.0 months for TKI–CPI therapy (n = 58). After 1L CPI–CPI or TKI–CPI therapy, median 2L DoT was 5.8 versus 4.2 months, respectively, for cabozantinib (n = 163), and 3.8 versus 2.4 months for other therapies (n = 118); median 2L OS was 15.2 and 15.3 months, respectively, for cabozantinib, and 14.6 and 24.2 months for other therapies. ConclusionDoT for 2L treatment was numerically better for cabozantinib than for other therapies, and after 1L CPI–CPI therapy than after 1L TKI–CPI therapy. Median OS was similar for 2L cabozantinib and other 2L therapies, and median OS for 2L cabozantinib was similar after both 1L therapy types. These results demonstrate the antitumour effect of 2L therapies, including cabozantinib, after 1L CPI-based combination treatment, regardless of whether 1L CPI–CPI or TKI–CPI therapy is used.

Evaluation of Lead Time for Non Concoacted Patiens Electric Electronic Prescription at The Pharmaceutical Installation Medica Citratama Tasikmalaya Hospital

Evaluation of Lead Time for Non Concoacted Patiens Electric Electronic Prescription at The Pharmaceutical Installation Medica Citratama Tasikmalaya Hospital

Challenges and advantages of electronic prescribing system: a survey study and thematic analysis

IntroductionElectronic prescribing (e-prescribing) systems can bring many advantages and challenges. This system has been launched in Iran for more than two years. This study aimed to investigate the challenges and advantages of the e-prescribing system from the point of view of physicians.MethodsIn this survey study and thematic analysis, which was conducted in 2023, a researcher-made questionnaire was created based on the literature review and opinions of the research team members and provided to the physician. Quantitative data were analyzed using SPSS software, and qualitative data were analyzed using ATLAS.ti software. Rank and point biserial, Kendall’s tau b, and Phi were used to investigate the correlation between variables.ResultsEighty-four physicians participated in this study, and 71.4% preferred to use paper-based prescribing. According to the results, 53.6%, 38.1%, and 8.3% of physicians had low, medium, and high overall satisfaction with this system, respectively. There was a statistically significant correlation between the sex and overall satisfaction with the e-prescribing system (p-value = 0.009) and the computer skill level and the prescribing methods (P-value = 0.042). Physicians face many challenges with this system, which can be divided into five main categories: technical, patient-related, healthcare providers-related, human resources, and architectural and design issues. Also, the main advantages of the e-prescribing system were process improvement, economic efficiency, and enhanced prescribing accuracy.ConclusionThe custodian and service provider organizations should upgrade the necessary information technology infrastructures, including hardware, software, and network infrastructures. Furthermore, it would be beneficial to incorporate the perspectives of end users in the system design process.

Development and Implementation of an Integrated Standard e-Prescription Model in Alignment with Iranian National EHR.

The implementation of an Electronic Prescribing (EP) system offers numerous advantages in enhancing the efficiency of prescribing practices. To ensure successful implementation, a comprehensive understanding of the workflow in paper-based prescribing is crucial. In Iran, the Ministry of Health, and Medical Education (MOHME) has been actively involved in developing an EP system since 2011. The pilot results within MOHME have garnered significant support from all basic insurance organizations, primarily due to the importance of addressing financial considerations. As a result, these insurance organizations have taken the lead in the national development of the EP system, as responsibilities have shifted. The development of an Integrated Care Electronic Health Record (ICEHR or EHR) and the approach adopted by MOHME have paved the way for the creation of a standardized set of Application Programming Interfaces (APIs) based on openEHR and ISO13606 standards. These APIs facilitate the secure transfer of consolidated data from the EP systems, stored in the data warehouses of basic insurance organizations, to the Iranian EHR. This model follows an ICEHR architecture that emphasizes the transmission of this information to the Iranian EHR. This paper provides a detailed discussion of the various aspects and accomplishments related to these developments.

Innovation and Practice of "yae920.com" One-stop Service Mode from the Perspective of Digital Transformation

With the deepening of digital transformation, the medical service industry is facing huge innovation opportunities and challenges. This paper studies the "yae920.com" one-stop service model and discusses the impact of digital transformation on its service innovation and practice. The study first analyzed the overall impact of the digital transformation on the medical service industry, including the optimization of the service process, the improvement of the patient experience, and the improvement of the operational efficiency. Then, through the method of case study, it expounds how "yae920.com" innovates the one-stop service mode in the process of digital transformation, including the integration and optimization of functions such as online appointment registration, online consultation and consultation, electronic prescription circulation, online drug purchase and distribution and so on. The research also deeply explores the challenges and coping strategies encountered by "yae920.com" in the process of service model innovation, as well as the practical results achieved. The research results show that the digital transformation provides strong support for the innovation of the "yae920.com" one-stop service mode, and effectively improves the service efficiency and patient satisfaction. The research in this paper has certain reference value for promoting the digital transformation and service mode innovation of the medical service industry.

Three cases of Cutibacterium avidum prosthetic valve infective endocarditis at a single heart center

ObjectiveTo resolve an exceptional clustering of Cutibacterium avidum prosthetic valve infective endocarditis (IE) at a single heart center. MethodsDuring a period of 21 months, three patients experienced C. avidum bacteremia 24-128 days after aortic valve replacement. Operative procedures and electronic prescriptions of antimicrobials were surveyed, and bacterial isolates were genome sequenced. ResultsThe prosthetic valves were inserted by separate surgical teams. In one case, echocardiographic confirmation of IE was not achieved until 4 months after the first positive blood culture, but the causative agents were irrefutably documented in all cases by culture, or amplification of bacterial deoxyribonucleic acid, from removed prosthetic material. Whole-genome sequencing clustered isolates to a distinctive subgroup of the species but did not suggest inter-patient transmission of isolates. ConclusionsDespite vigorous sampling of blood and tissue, detection of C. avidum was not unconditional, neither by culture nor polymerase chain reaction test. The causative agent is likely underreported and should be meticulously searched for in culture-negative prosthetic valve endocarditis.

Handing Off Electronic Prescription Data From Prescribers to Community Pharmacies: A Qualitative Analysis of Pharmacy Staff Perspectives.

The aims of the study are to understand the process of how community pharmacies handle electronic prescriptions (e-prescriptions) and learn about different errors or potential errors encountered. Fifteen remote, semistructured interviews were conducted with community pharmacy staff. Interview analysis was done with two adapted Systems Engineering Initiative for Patient Safety methods to understand the workflow and an affinity wall, which led to key words that were tallied to understand the frequency of different issues. Data entry in community pharmacies is a process that varies based on the different software platforms receiving e-prescriptions. Data entry of a medication product is typically a human-reliant process matching an e-prescription with an equivalent medication product. Current automated safety supports focus on matching the dispensed medication to the medication chosen at data entry. Substitutions may be required for a variety of reasons, however, pharmacists' comfort and permissions in doing so without provider involvement fluctuates. Prescription errors remain that could be prevented with additional support at the data entry step of e-prescriptions. Few studies demonstrate where these errors originate and what role current technology plays in contributing to or preventing these errors. Future work must consider how these matches between prescribed medications and pharmacy fulfilled medications occur. There is a need to identify potential tools to support data entry and prevent medication errors.