Prescription Order Research Articles

Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country

BackgroundThere is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction.MethodsWe prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants’ pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants’ charts were reviewed for records of analgesics administered.ResultsPain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control.ConclusionAdequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores.

Perfil de erros de dispensação de acordo com o sistema de dispensação adotado em um hospital público

Medication errors are frequent and should be focus in the prevention of medication-related harm under a broad and systemic approach. In this context, the aim of the present study was to characterize the profile of dispensing errors in a public hospital in Belo Horizonte (MG), and to evaluate the association of its occurrence with the the dispensing system. For this purpose, a cross-sectional study was carried out at the pharmacy of the hospitalization unit. The frequency, type of error, and drug involved in the error (type of drug and whether it was a high-alert medication - HAM) were determined by dispensing system (profile I - single pack dispensed every 24 hours; profile II - single pack dispensed every 12 hours, profile III – individual packaging according to the administration time dispensed every 12 hours). The difference in the proportion of errors between the profiles was determined (Pearson’s chi-square test; statistical significance = 5%). A total of 726 prescriptions were analyzed, and in 109 of them (15%) 138 dispensing errors were found; 26 of these errors (n = 19%) involved a HAM. The most common error was ‘dose omission’ (n = 55; 40%). The drugs most involved in errors were metamizole (n = 26; 19%), metoclopramide (n = 14; 10%) and heparin (n = 10; 7%). The dispensing profile III presented a higher proportion of prescriptions with errors (n = 42; 16%). Regarding the dispensed items (n = 9,730), 3% of them presented an error (n = 268). Profile II was highlighted, with the highest proportion of items with errors (n = 114, 4%), which was superior to the other dispensing profiles (p <0.05). A high frequency of dispensing errors was detected among the prescription orders, highlighting the omission errors and the dispensation profile II.

Decreasing medication errors in four intensive care units of a tertiary care teaching hospital in India using a sensitization programme.

Medication errors have an adverse impact on the healthcare system by increasing patient morbidity and mortality. They are preventable, and educational or technology-based interventions are needed to reduce their prevalence and improve medication safety. We aimed to study the impact of a sensitization programme and a blame-free reporting tool for doctors and nurses on the prevalence and reporting of medication errors in the intensive care units (ICUs) of a tertiary care teaching hospital. This prospective interventional study was conducted in the ICUs of cardiology, medicine, paediatrics and neonatology. Baseline medication errors were detected by prescription order review and direct observation of administration of medication for 30 days. A sensitization programme was conducted for doctors and nurses in these ICUs, the results were discussed, and a blame-free medication error reporting tool was introduced. Medication charts were modified to remove the transcription process in the cardiology and paediatrics ICUs. The follow-up study was conducted for 30 days in each ICU to monitor the impact of the sensitization programme. The prevalence of medication errors was found to be 334.1/1000 patient observation days. Prescription errors were the most common types of errors at 129.1/1000 patient observation days. The interventions significantly reduced the error rate in all four ICUs. The overall number of prescriptions with errors was reduced from 9.1% (177/1944) to 3.5% (48/1373) and no medication error was reported using the tool. The sensitization programme on medication errors for doctors and nurses may be effective in improving medication safety. The impact was more pronounced in prescription errors. Reporting of medication errors did not improve in this study despite the introduction of a blame-free reporting tool.

Medication Error in Hospitals and Effective Intervention Strategies: A Systematic Review

Background: Medication error (ME) posing a challenge to health care systems across the world; which is posing a challenge to health care systems across the world which has increased the risk of death of patient also the consumption cost approximately $42 billion annually in healthcare expenditure. Different types of interventions; including manual physician order reviews and electronic prescription order entry have been proposed as potential solutions to help combat this issue. Objective: To analyze clinical studies on medication errors to assess implemented intervention strategies and measured outcomes, to determine the effective intervention practices with reduced medication errors. Methods: Analysis of meditational error achieved through a systematic review. A search of PubMed was conducted to identify research studies on ME published between May 1960 and June 2017 in English. Result: The types of interventions discussed by computerized physician order entry (CPOE), Pharmacist and computerization, Automatic dispensing cabinets, and bar-coded assisted medication. The number of effective interventions used was [85%, 17/20] decreased the proportion of medication error while [15%, 3/20] interventions, recorded an increase in the proportion of medication error. The CPOE was found to intercept the highest of error [96%] followed by computer-assisted prescription [86%] and Clinical Pharmacist intervention [80%]. Conclusion: Most of the interventions used were found effective in reducing the occurrence of medication errors. The most common intervention used was CPOE by Clinical Pharmacist and Computerization; which was the most effective intervention strategy, followed by Clinical pharmacist, computerization, Automatic dispensing cabinets, and bar-code.

Impact of outpatient pharmacy services collaborating with oncologists at an outpatient clinic for outpatient chemotherapy prescription orders

Abstract Objectives: This retrospective study was conducted to evaluate the impact of a service in which clinical pharmacists collaborated with oncologists at an outpatient clinic on chemotherapy order prescriptions and adverse drug reaction management in outpatient cancer chemotherapy. Methods: This was a single-center retrospective cohort study. Subjects were patients who received pharmacist services at an outpatient clinic in 6 treatment divisions at the National Cancer Center Hospital East from June to September 2016. Pharmacist interventions were categorized and assessed for impact by 2 pharmacists according to previously published methods. Results: The 6 pharmacists worked a total of 1396 hours, providing 1645 pharmacy interventions to 3419 patients. Of the 1645 interventions, 459 interventions (27.9%) involved chemotherapy order prescriptions. The 459 interventions for chemotherapy prescriptions were categorized according to the previously reported categories “drug therapy safety” (n = 330, 71.9%), “other” (n = 91, 19.8%), “drug therapy efficacy” (n = 28, 6.1%), and “drug therapy indication” (n = 10, 2.2%). Of the 91 interventions categorized as “other,” the 2 most frequent types of interventions were “confirmation from pharmacists to oncologists about laboratory test order” (n = 54, 11.7%) and “consultation from oncologists to pharmacists about chemotherapy regimen” (n = 23, 5.0%). Most interventions were identified as having “no error” (n = 369, 80.4%), while 8 interventions (1.8%) were identified as being “potentially lethal” or “serious.” Moreover, 92.8% of interventions were identified as being “extremely significant,” “very significant” or “significant.” Conclusions: This study clarified the benefits of outpatient pharmacy services in which pharmacists collaborate with oncologists at an outpatient clinic on outpatient chemotherapy prescription orders.

The effect of a prescription order requirement for pharmacist-administered vaccination on herpes zoster vaccination rates

ObjectiveTo determine the effect of a prescription order requirement for pharmacist-administered zoster vaccination on zoster vaccination in adults aged 60+. MethodsA 50-state law review of statutes and regulations regarding pharmacists’ ability to administer the zoster vaccine with/without a prescription order was performed. States were classified as prescription order required or not required as of January 1, 2014. Data on adults aged 60+ were obtained from the 2014 Behavioral Risk Factor Surveillance System (BRFSS). Chi-square tests and multilevel logistic regression models with and without propensity scores methods were used. ResultsOf the 50 states, 39 and the District of Columbia did not require a prescription order. After propensity score matching, zoster vaccination rates for adults ages 60 and older were significantly higher in states that did not require a prescription order (23.0% vs 21.1%, p = 0.0022). The propensity score-matched multilevel logistic regression model for adults aged 60+ found modestly higher odds of HZ vaccination for states that removed the prescription order requirement (OR 1.17, 95% CI 1.01–1.35). Similar estimates were found across other methodologies employed and age strata, although statistical significance varied. ConclusionsPrescription order requirements are associated with HZ vaccination rates. By removing a prescription order requirement, states may be able to promote increases in HZ vaccination in adults aged 60+.

A Cross-sectional Study on Occurrence of Medication Errors in Outpatient Pediatric Department of Public Sector Hospital, Lahore, Pakistan

<p style="text-align: justify;"><strong>Background:</strong> The knowledge of medication errors is an essential prerequisite for better healthcare delivery. Medication errors are potential errors and impart a significant burden on patient quality of life as well as economic status.<strong> Objectives:</strong> The study was conducted with objective to determine the prevalence and nature of medication errors in pediatric out-patients and also to study their prescribing pattern. <strong>Methods:</strong> A quantitative cross-sectional study was conducted in Outpatient Pediatric Department of Public Sector Hospital, Lahore, Pakistan over a period of one month during which 240 prescriptions were evaluated to identify medication errors and prescribing pattern. Data was collected by using a self-designed data collection tool and analyzed using SPSS version 20. <strong>Results:</strong> Current study evaluated 240 outpatient prescription orders out of which 234 were found to have medication errors. Highest percentage of errors observed in studied population including prescription errors (missed prescriber and patient information) (86.8%), prescribing errors (7.6%) and dispensing errors (3.6%) respectively. Upper Respiratory Tract Infection was the extensive complaint of majority of patients and the drugs of concern were mainly antibiotics, antihistamines, analgesics and anti-inflammatory and expectorants. <strong>Conclusion:</strong> The current detection of medication errors reveals about recurrent basis of prescribing errors in addition to prescription parts errors. These findings emphasizes that prescribers need to work in alliance with pharmacist to improve patient&rsquo;s quality of life in primary care. <p style="text-align: justify;"><strong>Key words:</strong> Medication error, Pediatric, Outpatient, Prescription.

Differences in the characteristics, treatment, and outcomes of patient groups reviewed by intensive care liaison nurses in Australia: A multicentre prospective study

BackgroundThere is a lack of knowledge about tasks intensive care unit liaison nurses (ICU LNs) perform during patient review, despite this role operating in at least 31 acute care hospitals in Australia. ObjectivesTo evaluate the tasks that ICU LNs perform during patient review in the following referral subcategories: review after ICU discharge, rapid response team (RRT) review, and ward referral. MethodsA 2-month prospective observational study using standardised case report forms to collect data on patients reviewed by ICU LNs in 20 Australian hospitals was conducted. ResultsFrom 3799 patients screened, 3542 were included, among whom 1933 (54.6%) were men, and the mean (standard deviation) age was 63 (19.4) years. The admitting units were surgical 1765 (49.8%) and medical 1696 (47.9%), and the breakdown of referral types were routine review after ICU discharge (1732; 47.9%), RRT review (1208; 34.1%), and ward referral (602; 17.0%). Patients subject to ward and RRT reviews were older, more likely to be medical admissions with less favourable vital signs on the initial review, and less likely to have repeat reviews. Of note, ward reviews were more likely to receive palliative care. Intensive care liaison nurse–initiated medication prescription and investigation ordering was uncommon. The most common interventions included consultation with medical staff, bedside education, adjusting oxygen flow and patient position, and directing the change in frequency of vital sign measurement. In-hospital mortality was lower in patients reviewed after ICU discharge (2.3%), compared with those after RRT review (2.8%) and ward referral (4.4%). ConclusionsMost patients were reviewed after ICU discharge or in the context of the RRT. RRT and ward patients were less physiologically stable and more likely to die in hospital. The most common interventions performed by the ICU LN were nontechnical skills including clinical education, consultation with medical staff, and changes to vital sign frequency. Finally, the most common medication therapies administered related to intravenous therapy and electrolyte administration.

GLOSS TO THE VERDICT OF THE SUPREME COURT ON 4 APRIL 2018, V KK 112/18, WHICH STATED THAT IF THE POTENTIAL PERPETRATOR HAS A STRONG ALIBI, HE CANNOT BE CONVICTED

The verdict under consideration relates to the case heard by the Supreme Court as a result of a cassation filed by the Prosecutor-General - the Minister of Justice against a prescriptive order issued by the District Court in S. on December 3, 2015. The district court, in the issued order warrant, found the accused person guilty of theft of cosmetics worth about PLN 25 (Article 119 § 1 of the Code of Offences (CO)). The court adjudicated a one-month limitation of liberty with the obligation to provide unpaid, controlled work for social purposes of 40 hours. Due to the fact that the ruling was not appealed against, there was no appeal proceedings - the judgment thus became legally valid.

PACE Forward-Making Pharmacogenomics Testing Available for Real-Life Clinical Utility.

Although pharmacogenomics (PGx) offers the promise of ensuring the right patient receives the right medication at the right dose the first time, gene-drug interaction data have yet to be seamlessly integrated into patients' health records. PGx testing that is preemptive, adaptable, current, and executable (PACE) overcomes the human and technological barriers to successful implementation, thus capitalizing on the affordable cost of such testing and clinical practice guidelines at the point of prescription ordering.

Potential drug incompatibilities in the neonatal intensive care unit: a network analysis approach

BackgroundThere is little information on the frequency of drug incompatibilities in neonatal intensive care units (NICU) and the agents most commonly involved in them. The objective of the study was to characterize potential Drug Incompatibilities (DI) in the NICU by frequency, type and combination of drugs.MethodsBetween August 2015 and December 2016, all neonates admitted for more than 24 h and who received any drug treatment were included in this cohort study conducted in the NICU of a teaching maternity hospital in Brazil. Patient data were collected from patient records and prescription orders, and the compatibilities of all drug pairs were classified using the Trissel’s™ 2 IV Compatibility tool. Network analysis was performed in order to visualize the drug pairs commonly involved in potential DI.ResultsThe study population consisted of 281 neonates with a median NICU length of stay of 11 days (range 2–184) and received 1343 intravenous medications. A total of 1114 potential DI were identified, 469 (42.1%) were restricted compatibilities, 348 (31.2%) unknown compatibilities and 297 (26.7%) documented incompatibilities. The incidence of documented incompatibilities in the NICU was 25.0% patient-days (95% confidence interval (CI) 19.4–30.7% patient-days). Incompatible potential DI affected 46.3% (95%CI 40.3–52.3%) of the neonates. Ampicillin (408 of 1114 pairs), gentamicin (216 of 1114 pairs) and aminophylline (197 of 1114 pairs) were the main medicines involved in potential DI.ConclusionPotential DI are extremely common in NICU, with half of the population susceptible to simultaneous administration of incompatible medications. More research is needed to understand the actual drug incompatibilities and their clinical outcomes.

Reducing Medication Administration Frequency in Veteran Community Living Centers

Background: A quality improvement initiative of the Veterans Health Administration (VHA) aims to reduce frequency of medication administration to Veterans per day. Medication administration practices in our community living center (CLC) units are similar to an acute care medical unit versus a home environment. The objective of this project was to reduce medication administration frequency in order to minimize the number of interruptions to both Veterans and nurses. Methods: A retrospective chart review was conducted for Veterans residing in a pilot CLC from January through March 2018. Electronic medical records and barcode medication administration (BCMA) logs were assessed. Data collected included demographic information and medication details (eg, drug name, frequency, administration time). Data were analyzed and pharmacist recommendations were documented into an Excel document, and then discussed with the pilot CLC unit medical provider in March 2018. The primary outcomes measured were the number and type of pharmacist recommendations, percent reduction in the average number of Veteran interruptions per day, and percent reduction in the average number of medication passes by nurse per day. Results: Thirty-one Veterans were identified with a range of 4 to 31 active prescription orders. Fifty-five pharmacist recommendations were made and 31 were implemented. The average number of Veteran interruptions per day was reduced by 13.9%. The average daily number of medication passes was reduced by 16.3%. Conclusion: Both Veteran interruptions and nurse workload decreased due to the implemented pharmacist recommendations. Pharmacists will continue medication consolidation on a monthly basis and spread this project to other CLC units.

193. Duration of Antimicrobial Therapy: The Impact of Defaults

BackgroundDefault durations imbedded in the electronic prescription (e-script) order entry process may be interpreted by providers as duration recommendations. This process could lead to inappropriately long durations of therapy for antibiotics, especially at hospital discharge when patients have received inpatient antibiotics.MethodsDefault durations of 7 or 10 days for fluoroquinolones (FQ) were removed from inpatient and outpatient e-scripts from Duke University Health System (DUHS) hospitals (one academic, two community) and clinics (N = 86) on December 19, 2017. We evaluated the impact on FQ duration by comparing mean duration and percent of 10 day durations in the 12 months pre-default duration removal (DDR) and 3 months post-DDR. All inpatient or outpatient encounters with an FQ e-script with days duration less than 31 days were included. FQ durations were captured in days duration fields or calculated from sig and quantity fields. We used descriptive statistics to compare FQ duration pre- and post-DDR using a chi-squared test.ResultsA total of 35,765 FQ e-scripts and 276,056 FQ e-script days of therapy were included pre-DDR. The post-DDR included 9,526 FQ e-scripts and 71,028 FQ e-script days of therapy. Mean (standard deviation) durations in the pre- and post-periods were 7.78 (4.35) and 7.55 (3.99), respectively (P < 0.001). Common discharge durations in both time periods across all settings were 5, 7, and 10 days. The 10-day default duration was the most common in the pre-DDR with 11,000 e-scripts (31%), and declined by 16% (2,475 e-scripts, 26%) in the post-DDR period. The academic center realized the greatest shift away from 10-day default duration (Table 1).ConclusionRemoval of default e-script durations, a novel and minimally resource intensive strategy, reduced prescribed duration of FQ therapy.Table 1: Ten-day Durations for Fluoroquinolone E-scripts Pre- and Post-DDRPractice SettingPre-DDRN (%) 10 day E-scriptsPost-DDRN (%) 10 day E-scripts% Change Pre–PostAcademic Medical Center771 (20)125 (11)-42Community hospital452 (20)90 (15)-23Community hospital514 (24)126 (21)-16Outpatient9,263 (34)2,134 (30)-12Total11,000 (31)2,475 (26)-16Disclosures All authors: No reported disclosures.

EOSINOPHIL LEVELS, EXACERBATIONS, RESOURCE UTILIZATION AND COSTS AMONG MODERATE-TO-SEVERE ASTHMA PATIENTS

Introduction In the US, ∼900,000 patients (≥12 years) have uncontrolled moderate-to-severe asthma despite using available treatments. Elevated eosinophils (EOS) are a marker of Type-2 asthma; however, their association with asthma exacerbations, healthcare resource utilization (HCRU) and costs has not been well described in a real-world setting. Methods Patients with diagnosis codes for asthma (ICD-9 493, 493.9, 493.92, or ICD-10 J45.40, J45.41, J45.50, J45.51, J45.998) were identified from the Geisinger Health System electronic health records (EHR). Patients with ≥1 EOS measurement within 90 days of an inhaled corticosteroid and long-acting beta-2 agonist (ICS/LABA) prescription from 01/01/2010–11/01/2016 were identified. Date of EOS result was the index date (ID); patients had continuous EHR enrollment for 12 months before and after ID. Patients were stratified by baseline EOS. Baseline demographics, comorbidities, HCRU and costs during 12 months before ID were compared across baseline EOS levels using ANOVA or chi-square tests. Results 491 patients were categorized into four EOS levels: –299 (n=168), 300–499 (n=87), and ≥500 (n=64) cells/uL. Overall, top three diagnosed Type-2 comorbidities were allergic rhinitis, chronic sinusitis, and eczema. Over 75% of patients experienced ≥1 exacerbation in the past year across all baseline EOS levels. HCRU, cost, and asthma exacerbations were not significantly different across baseline EOS levels (Table 1). Conclusions A large proportion of moderate-to-severe asthma patients experienced exacerbations, while HCRU and costs were high irrespective of baseline EOS level. The results demonstrate a high unmet need among patients across all EOS levels. Table 1. Baseline characteristics (during 12 months prior to index date). *P-values represent results of chi-square tests or ANOVA. †Asthma exacerbations were defined as either an asthma-related hospital admission or emergency department visit, or a prescription order for an oral or injectable corticosteroid.

Improved Medication Management With Introduction of a Perioperative and Prescribing Pharmacist Service

Background: The medication lists in pre-admission clinic (PAC) questionnaires completed by patients prior to surgery are often inaccurate, potentially leading to medication errors during hospitalization. Studies have shown pharmacists are more accurate when obtaining a medication history and transcribing prescription orders, thereby reducing errors. Objective: To evaluate the impact of a PeRiopErative and Prescribing (PREP) pharmacist on postoperative medication management. Methods: A randomized prospective interventional study enrolled elective surgery patients at high risk for medication misadventure to receive PREP pharmacy service or usual care (control group). A best possible medication history (BPMH) was obtained by the PREP pharmacist and was available to surgical staff on admission. The PREP pharmacist also prepared discharge prescriptions for their patients. The primary outcomes for the study were accuracy of BPMH and discharge prescriptions compared to usual care. The study was powered to 80% with 2-tailed significance α of .05. Results: The medication history in the PREP pharmacist group had fewer errors than the control group: 9% (5/53) versus 96% (49/51; P < .001). Discharge prescriptions prepared by the PREP pharmacist had fewer errors than control group: 25% versus 78% (P < .001). Significantly, more PREP pharmacist patients received a discharge summary with a complete medication list: 75% versus 33% (P = .001). Inpatient prescribing was more accurate in the PREP pharmacist patients: 0.64 versus 1.31 errors per patient (P = .047). Conclusion: Inclusion of the PREP pharmacist role in the elective surgery multidisciplinary team improved the accuracy of medication histories, inpatient prescribing, and discharge prescriptions for patients at high risk of medication misadventure.

Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

Overprescribing of opioids has generated and sustains the opioid overdose epidemic. Health systems have a responsibility to lead the effort to reduce overprescribing. To measure the effects of multilevel interventions on opioid prescribing within a health system. Quality improvement study comparing a 6-month preintervention baseline with a 16-month postintervention period ending in April 2018. Inpatient and outpatient clinical activity within a regional health system including an acute care hospital, same-day surgery, and outpatient clinics. Opioid prescribing activity by hundreds of clinicians involving over a million clinical encounters was measured using a health system's electronic medical record. Multiple parallel interventions in different domains, including prescriber education and accountability, enhanced oversight via measurement of individual prescribers, tools to right-size postoperative discharge prescriptions, reduction of default amounts on standard opioid prescription orders, and professionally written patient and public education about opioid risks and alternatives. Morphine milligram equivalents (MME) per encounter per month, MME per opioid prescription, and rate of opioid prescriptions (opioid prescriptions per encounter per month). More than 44 000 clinical encounters per month were recorded. All baseline trends were not significantly different from 0. Total health system MME per encounter decreased 1.0 MME per encounter per month. At the end of the postintervention observation period, the monthly MME per encounter was 58% lower than the average of the 6-month baseline, the MME per opioid prescription per month was 34% less than the average of the baseline, and the opioid prescription rate was 38% lower than the average of the baseline. Opioid overprescribing was reduced with multifocal interventions targeting patient and public demand, creating prescriber awareness and accountability, and creating tools for clinical leadership accountability. The interventions described are adoptable by most organized health systems. Reducing total opioid supply within communities should be given high priority by those with a mission to protect and improve public health.

Impact of specialty pharmacist involvement on patient access to PCSK9 inhibitors

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are novel antilipemic agents commonly associated with barriers to access for patients. They are indicated as adjunctive therapy for the treatment of heterozygous familial hypercholesterolemia, homozygous familial hypercholesterolemia, and atherosclerotic cardiovascular disease needing additional low-density lipoprotein cholesterol (LDL-C) lowering. On average, annual therapy costs total approximately $14,000 per year. Due to high cost and specific indications, rates of prescription coverage denial are high for patients prescribed these medications with approximately 50% of prescriptions ultimately being rejected.Objectives: The purpose of this study is to demonstrate the impact of specialty pharmacist involvement on patient access to PCSK9 inhibitors.Methods: This was a retrospective study of patients over the age of 18 who were prescribed a PCSK9 inhibitor by a Medical University of South Carolina (MUSC) provider, with additional training in lipid management or cardiology, from 1 January to 30 June 2017. Patients were excluded if they were actively enrolled in a clinical trial at the time of PCSK9 inhibitor prescribing, or they were pregnant or lactating.Results: A total of 76 prescription orders were included in the analysis. The results were divided into three categories and compared to industry standards via chi-squared goodness of fit tests. Overall, 34/38 (89.5%) prescriptions were eligible to be filled at MUSC, statistically significantly higher than the expected 30.9% overall fill rate (p < .001). Additionally, 50/57 (87.7%) of prescriptions requiring a prior authorization (PA) and sent to MUSC received approval, statistically significantly higher than the expected 47.29% approval rate (p < .001). Lastly, 28/31 (90.3%) of patients received medication and a PA, statistically significant compared to 65.3% expected (p = .003). Regarding clinical outcomes, 35/38 patients (92.1%) in the MUSC eligible fill group did not have an unplanned cardiovascular-related emergency department visit or admission.Conclusions: As specialty pharmacy continues to grow and diversify, costly medications, like PCSK9 inhibitors, will continue to require added steps to obtain them. In this study, dedicated specialty pharmacists increased patient access to PCSK9 inhibitors by 58.6% compared to expected. This not only demonstrated improved quality of care, but also positive impacts on clinical outcomes, especially in patients who maintain the continuum of care through the health system.

A robotic system to prepare IV solutions

Drugs need to be used regularly and correctly in order to be effective. When medicines are used correctly, negativities that threaten human health and life can be avoided, but they can cause unwanted situations that can occur until the end of life when they are used incorrectly. The most common drug administration errors in hospitals are: The wrong dosage of the drug given to the patient, the timing and / or the method of administration, the wrong drug given to the patient, the drug given to the wrong patient, or even not given. Furthermore, the information about the drug that is administered to the patient may not be registered at all. In this research, a robotic drug preparation system and a communication server accepting prescription orders have been developed. Component engineering methodology is further utilized in the design of the Drug Preparation System to maximize reuse, increase product reliability, reduce design, code and test efforts. The IV Robotic Drug Preparation Robot is composed of a robotic work station and a Cartesian carrier to carry the work station to the desired location. The robotic work station has several grippers to handle syringes, to pull the piston of the syringe and to lock the closed system connector to the vial. The IV Robotic Drug Preparation System and communication server are developed and being used in the hospitals. Due to this system, medicines left unused in vials can be used and a great amount of savings is obtained from the drug purchases.

Time to Filling of New Prescriptions for Chronic Disease Medications Among a Cohort of Elderly Patients in the USA.

Data on primary nonadherence remains sparse, due to a lack of data resources that combine information on medication prescribing and dispensing. In addition, previous work on primary nonadherence has used follow-up periods ranging from 30days up to 18months, making results difficult to compare. To evaluate the prevalence and predictors of primary nonadherence by measuring time until filling in a cohort of elderly patients. Retrospective cohort study of new prescription episodes. Data comes from a linked database of electronic health records and claims for patients aged ≥65years enrolled in Medicare Parts A, B, and D during 2007-2014. We identified patients receiving a new prescription for a chronic disease medication with continuous Medicare enrollment for 180days prior to the index prescription order and no fills or orders for the medication during this period. Time until filling of the index prescription for up to 1year. In 32,586 new medication orders, the majority (75%; 95% confidence interval [CI] 74-75%) of new prescriptions were filled within 7days, 81% (81-82%) were filled within 30days, and 91% (91-92%) were filled within 1year. The rate and timing of dispensing were similar across therapeutic areas. Timing of initial filling within 7days or within 30days could be predicted with moderate accuracy (C-statistics = 0.70-0.74). Patients with > 5 current medications on hand at the time of the index prescription and average out-of-pocket medication costs < $5 filled 89% of prescriptions within 7days. Patients with no current medications and out-of-pocket costs > $50 filled only 25% of prescriptions within 7days. Nearly 20% of patients do not fill a new chronic disease prescription within 30days. Patients with fewer recent fills and higher out-of-pocket costs are at higher risk of primary nonadherence.

Effect of an Automated Patient Dashboard Using Active Choice and Peer Comparison Performance Feedback to Physicians on Statin Prescribing

Statins are not prescribed to approximately 50% of patients who could benefit from them. To evaluate the effectiveness of an automated patient dashboard using active choice framing with and without peer comparison feedback on performance to nudge primary care physicians (PCPs) to increase guideline-concordant statin prescribing. This 3-arm cluster randomized clinical trial was conducted from February 21, 2017, to April 21, 2017, at 32 practice sites in Pennsylvania and New Jersey. Participants included 96 PCPs and 4774 patients not previously receiving statin therapy. Data were analyzed from April 25, 2017, to June 16, 2017. Primary care physicians in the 2 intervention arms were emailed a link to an automated online dashboard listing their patients who met national guidelines for statin therapy but had not been prescribed this medication. The dashboard included relevant patient information, and for each patient, PCPs were asked to make an active choice to prescribe atorvastatin, 20 mg, once daily, atorvastatin at another dose, or another statin or not prescribe a statin and select a reason. The dashboard was available for 2 months. In 1 intervention arm, the email to PCPs also included feedback on their statin prescribing rate compared with their peers. Primary care physicians in the usual care group received no interventions. Statin prescription rates. Patients had a mean (SD) age of 62.4 (8.3) years and a mean (SD) 10-year atherosclerotic cardiovascular disease risk score of 13.6 (8.2); 2625 (55.0%) were male, 3040 (63.7%) were white, and 1318 (27.6%) were black. In the active choice arm, 16 of 32 PCPs (50.0%) accessed the patient dashboard, but only 2 of 32 (6.3%) signed statin prescription orders. In the active choice with peer comparison arm, 12 of 32 PCPs (37.5%) accessed the patient dashboard and 8 of 32 (25.0%) signed statin prescription orders. Statins were prescribed in 40 of 1566 patients (2.6%) in the usual care arm, 116 of 1743 (6.7%) in the active choice arm, and 117 of 1465 (8.0%) in the active choice with peer comparison arm. In the main adjusted model, compared with usual care, there was a significant increase in statin prescribing in the active choice with peer comparison arm (adjusted difference in percentage points, 5.8; 95% CI, 0.9-13.5; P = .008), but not in the active choice arm (adjusted difference in percentage points, 4.1; 95% CI, -0.8 to 13.1; P = .11). An automated patient dashboard using both active choice framing and peer comparison feedback led to a modest but significant increase in guideline-concordant statin prescribing rates. ClinicalTrials.gov Identifier: NCT03021759.