Medication Ordering System Research Articles

Beyond the end of exceptionalism: integrating HIV testing into routine medical care and HIV prevention

In September 2006, the US CDC issued new guidelines for HIV testing. These guidelines were designed not only to simplify and expand HIV testing but also to integrate testing into routine medical care in the USA. The nationwide implementation of these guidelines is currently facing several political and legal barriers. In this article, we examine the origins of current patient-driven and risk-based HIV testing in the USA and highlight shortcomings of this strategy. We then demonstrate how the changing HIV epidemic in the USA requires routine HIV screening at all points of contact in the medical system in order to control the HIV epidemic and how novel testing strategies could increase the yield of testing in these settings.

Quality of Medication Ordering at a Large Teaching Hospital

Objectives: To identify and quantify deficiencies in the prescribing/ordering of inpatient and discharge medications and determine strategies to address them.Design and setting: A descriptive study in medical and surgical wards at a tertiary referral teaching hospital.Patients: All available inpatients in 12 medical and 2 surgical wards on two consecutive days and all discharges on a single day.Results: Medication orders for 230 inpatients and 68 discharge patients were audited. A total of 2978 inpatient orders were reviewed including 634 ‘once only’ doses, 1840 regular and 504 ‘as required’ medications. Errors in physician prescribing occurred at a frequency of 25/1000 prescriptions and included 48 (1.6%) incorrect, ambiguous or unspecified doses and four prescriptions where the specific oral form was not stated. In 14 (0.5%) cases, the dosing frequency specified was wrong, unclear or absent and there were three cases of duplication. Two patients were prescribed drugs to which they had a documented allergy. Details of previous adverse drug reactions were complete in only 14 of 62 (23%) patients. Of the 68 discharge prescriptions audited, orders for 49 of 329 regular medications (15%) had been unintentionally omitted (range 1‐8 medications per patient).Conclusions: The audit identified limitations in the quality of prescribing/ordering which were in part due to deficiencies in the current medication chart and discharge summary. To address these limitations, the medication ordering system has been revised and a multidisciplinary educational program implemented to promote safe and explicit prescribing.