Prescription Process Research Articles

A Process Model for Cooperative Risk Management in Seaports

Seaports are critical links within supply chains that are often located near residential areas. These seaports can be directly affected by the consequences of operational risk sources and natural disasters such as undeclared dangerous goods and flood, respectively. The diversity and large number of stakeholders at seaports add another level of complexity for risk management that requires a standard approach and clear guidelines. This paper aims to develop a prescriptive process model for cooperative risk management (CoRiMaS) in seaports to enable the stakeholder to manage different sources of risk during risk prevention and response. The prescriptive process model builds on two previous published papers which focused on developing a conceptual framework and a descriptive model based on an ontology for CoRiMaS, respectively. A detailed requirement analysis based on focus groups and a survey study in the Baltic Sea Region (BSR) provide important inputs to integrate the required elements into the CoRiMaS prescriptive process model. The model requires an overall input represented by the type of seaport and structure. The prescriptive process model presents all steps and aspects related to stakeholder analysis, risk governance, risk management, and knowledge management. Implications for theory and practice, as well as an agenda for future research, are presented.

Artificial Intelligence in Primary Care: An Overview.

With the increase in computing power and the development of numerous technological devices that facilitate remote work, the involvement of artificial intelligence in medicine has seen a significant increase to help the doctor make decisions and intervene in the medical process and telemedicine. In this paper, we gave an overview of the practical involvement of artificial intelligence through different support systems used in primary medicine or telemedicine and also identified the possibilities and opportunities for the development of new support systems for family medicine. Thus, we identified systems used for primary diagnosis, diagnosis of hypertension, early detection of heart abnormalities, detection of diabetes, support in the prescription process, helping clinicians in the daily workflow by providing certain answers to questions, treatment guidance, determining patient priority for treatment for SARS-CoV-2 infection or early detection of disease, support of artificial ventilation in medical emergency centers, remote support for treatments and medication.

UPAYA PENERAPAN METODE LEAN THINKING PADA PROSES PELAYANAN FARMASI RAWAT JALAN


 Pharmacy services in a hospital are an inaccessible part of the hospital services as a whole. The accumulation of prescriptions in the pharmacy will cause the prescription process to be long and long, which has an impact on customer waiting times, which of course will have a major impact on customer satisfaction. From the standard time set as Quality Indicators at Bali Jimbaran Hospital, namely: drug processing at the outpatient pharmacy of Bali Jimbaran Hospital is 60 minutes of concocted drugs, 30 minutes of non-concocted drugs. The purpose of this research is to identify activities starting from the input, process and results generated through the Lean approach. The method used is an observational action process research, using lean methods to photograph the outpatient pharmacy service process flow through document review, direct interviews, interviews. The result of the research is an improvement in waiting time, it can be seen that the NVA activities can be eliminated by 66% and VA activities show an increase of 44%. With the many activities that are VA and the elimination of NVA activities, it will accelerate the process of outpatient pharmacy services at the Bali Jimbaran Hospital and improve customer satisfaction, which can be seen from the decrease in customer complaints against outpatient pharmacy services by up to 50%, which was previously 80%.
 Keywords: Lean, Pharmacist, Waiting time, Value Added, Non-Value Added

Significant Reduction in Energy Consumption and Carbon Emission While Improving Productivity in Laser Drilling of CFRP Sheets with a Novel Stepped Process Parameter Parallel Ring Method

Although laser drilling of carbon fibre-reinforced polymer (CFRP) composites offers the advantages of zero tool-wear and avoidance of fibre delamination compared with mechanical drilling, it consumes considerably more energy during the drilling process. This research shows that by using a new, stepped parameter parallel ring laser hole drilling method, an energy saving of 78.10% and an 18.37 gCO2 reduction for each hole, while improving productivity by more than 300%, can be achieved in laser drilling of 6 mm diameter holes in CFRP sheets of 2 mm in thickness, compared with previous laser drilling methods under the same drilling quality. The key reason for this is an increase in energy input to the inner rings enabling more rapid removal of the material, while the lower energy input for the outer ring provides a shielding trench to reduce the heat loss into the parent material. The results are compared with single-ring laser drilling and multiple-ring laser drilling with constant processing parameters, and a discussion is given on comparing with mechanical drilling and future prospects, including a combined mechanical drilling and laser pre-scribing process.

Development of a Three-Dimensional (3D) Virtual Reality Apprenticeship Program (VRx) for Training of Medication Safety Practices

ABSTRACT Background: Medication errors is a top concern for patient safety globally. Healthcare staff need to be competent in skillsets in medication safety practices. COVID-19 has negatively impacted programs with on-the-job training. Virtual reality (VR) provides an attractive way to conduct such training. We developed a virtual apprenticeship program (called VRx) for the training of medication safety practices. Methods: VRx was developed in a three-dimensional virtual environment whereby trainees had to complete a series of key competency tasks in prescription processing, pharmaceutical calculations, and preparing, picking, packing and dispensing medications. Pilot testing involved two phases – an alpha-test (Ph1) with 30 pharmacy staff/trainees and a roll-out (Ph2) to 43 new hires at our institution. Participants rated their awareness of VR and perceptions of their training experience through an online self-administered questionnaire. Descriptive statistics and Chi-squared/Fisher’s Exact tests were used for analysis. Results: Over half of participants were slightly aware of VR (Ph1 = 63.3%, Ph2 = 67.4%). One-quarter was aware of and had used VR (Ph1 = 26.7%, Ph2 = 25.6%). Majority agreed that VRx was easy to use (Ph1 = 83.3%, Ph2 = 72.1%), interactive and fun (Ph1 = 90.0%, Ph2 = 79.1%), and helped them develop prescription processing skills (Ph1 = 90.0%, Ph2 = 86.0%). More participants who were slightly aware of VR indicated that VRx was easy to use (94.7% versus 33.3% not aware of VR, p = 0.038, Ph1). Over half felt that the time spent on VRx training was acceptable, and that VRx should be part of their training (Ph1 = 80.0%, Ph2 = 67.4% each). More participants who were aware of and had used VR indicated that VRx should be part of their training (100% versus 55.2% slightly aware, p = 0.007, Ph2). Conclusion: Overall, pharmacy staff/trainees found VRx to provide a realistic, engaging and interactive experience to acquire proficiencies in medication safety practices. VRx can complement the training and assessment needs of pharmacy staff/trainees at our institution.

Safe and Effective Prescribing with Dyslexia: A Collaborative Autoethnography

Prescribing medicines is the most common patient-level intervention made by doctors in the United Kingdom. However, this is associated with a potential for harm. Whilst dyslexia can bring many strengths, it also impacts reading and writing abilities and therefore has the potential to contribute to errors in the prescribing process if dyslexic doctors are unsupported. This paper explores the experiences of Seb – regarding prescribing and prescribing education – as a dyslexic medical student and doctor. We hope that this might spark more research on this overlooked issue. This is a collaborative, analytic, autoethnographic study within an interpretivist paradigm. Firstly, Seb wrote an autobiographical account; he was then interviewed by Mike. The interview audio-recording was transcribed verbatim and both data sources were thematically analysed. Emerging themes included: learning to prescribe, coping, struggling and support, errors, near misses and handwritten charts, and moving forward. Specific issues included a deficiency in active learning/assessment at an undergraduate level, a lack of support, and potential safety concerns regarding handwritten charts. Electronic prescribing was felt to be a positive step forwards for both safety and accessibility. Our findings suggest that further consideration of specific supports is needed to assist dyslexic trainee doctors in the prescribing of medicines, so as to prevent the clinical environment acting to disadvantage them. They also suggest that we may need to review the ways in which we teach and assess this vital skill at an undergraduate level.

A proposal of prescriptive design process towards highly creative engineering design

A proposal of prescriptive design process towards highly creative engineering design

There's an app for that, but nobody's using it: Insights on improving patient access and adherence to digital therapeutics in Germany.

BackgroundMobile health applications and their subset digital therapeutics—defined as evidence-based software interventions to prevent, manage, or treat a medical condition—offer great potential to improve patient care. However, such solutions often struggle to reach widespread adoption.ObjectiveThis study seeks to explore healthcare stakeholders’ roles and potential for fostering patient access and adherence to evidence-based digital therapeutics and thereby improve health outcomes from the perspective of digital therapeutics developers and distributors.MethodsSemi-structured qualitative and semiquantitative interviews were conducted with 19 experts from developers and distributors of digital therapeutics in Germany to discuss their perceived relevance of different healthcare stakeholders and strategies in promoting patient access and adherence to digital therapeutics.ResultsHealthcare professionals were found to have the greatest potential to promote both access and patient adherence to digital therapeutics, followed by health insurers, pharmaceutical companies, and patients themselves. In terms of patient access, healthcare professionals have potential due to their ability to prescribe digital therapeutics. Other stakeholders’ potential stems from their capacity to influence healthcare professionals prescription decision. In terms of patient adherence, only healthcare professionals are of high relevance by onboarding patients and monitoring digital therapeutics use. Most healthcare stakeholders currently do not fully leverage their potential. Further educating healthcare professionals and simplifying processes for them, empowering patients to seek treatment with digital therapeutics, and designing digital therapeutics’ product features for better adherence can help improve patient access and adherence.ConclusionsEstablished healthcare stakeholders and digital therapeutics developers both need to take action to improve patient access and adherence to digital therapeutics. Several macro-level changes can support these efforts, including broader information dissemination, improved financial incentives, simplified prescription and activation processes, and a wider adoption of blended care and pay-for-performance payment models.

Current Status and Prospect of Qualitative Assessment of Antibiotics Prescriptions.

Identifying inappropriately prescribed antibiotics for infectious diseases by monitoring the quality of antibiotics use is essential for effective implementation of antibiotic stewardship. Qualitative assessment of the use of antibiotics has been conducted in some countries, including Korea, since the 2000s. The qualitative assessment generally involves an assessment of each component of the antibiotics prescription process, based on specific criteria. However, there is no standardized assessment method or cycle, and infectious diseases or antibiotics included in the assessments vary from country-to-country. According to the results reported in the United States, Europe, Australia, and Korea so far, approximately 20 - 55% of all antibiotics prescriptions are inappropriate. In this review, we describe the current progress in the quality assessment of the use of antibiotics on a global scale. Further, we highlight the future directions to improve antibiotic stewardship activities and the quality assessment of the use of antibiotics in Korea.

Design and Development of We-CDSS Using Django Framework: Conducing Predictive and Prescriptive Analytics for Coronary Artery Disease

Clinical Decision Support System (CDSS) has become the ultimate point of care for healthcare sectors to assist the public in terms of Medical care. Through this research work, we propose the design and development of a Web-based Clinical Decision Support System (We-CDSS) using the Django framework with an aim to make CDSS accessible for both common people and clinicians on computers and mobile devices that integrates Predictive Analytics involving the LWGMK-NN algorithm for predicting Coronary Artery Disease, and Prescriptive Analytics involving prescription rules. The proposed research work consists of three phases. The first phase presents the design and development of a web-based CDSS outlook using the Django framework. The second and final phase embeds Predictive Analytics and Prescriptive Analytics into the We-CDSS to manage the functionalities of predictive decisions, and the functionalities of prescriptive processes that evaluates the predictive results and recommends personalized lifestyle suggestions to reduce the risk of coronary artery disease.

Study on Central Composite Design Method to Optimize the Preparation Process of Chrysophanol‐Pluronic F127 Nanomicelles and Pharmacokinetics

Objective. In order to find the best process for the preparation of Chrysophanol‐Pluronic F127 nanomicelles in the laboratory, the preparation of Chrysophanol‐Pluronic F127 nanomicelles was optimized using the central composite design method. In order to investigate the properties of the prepared Chrysophanol‐Pluronic F127 nanomicelles, physicochemical properties were examined and in vitro dissolution experiments were performed, and the pharmacokinetics of Chrysophanol and Chrysophanol‐Pluronic F127 nanomicelles were investigated in rabbits. Methods. In the preexperimental study, the best physical solubilization method and organic solvent for Chrysophanol were selected. The ratio of drug dosage to excipient dosage and the amount of organic solvents were evaluated by single‐factor test. Based on the single‐factor test, the optimal prescription was obtained by screening the formulation and optimizing the preparation process using the central composite design method with the encapsulation efficiency as the index. Chrysophanol‐Pluronic F127 nanomicelles were prepared according to the optimal prescription, and their particle size, potential, appearance, and in vitro release experiments were carried out. Chrysophanol and Chrysophanol‐Pluronic F127 nanomicelles were injected intravenously through the ear margins to rabbits, and the drug concentrations in the blood were measured at different time points by HPLC. The obtained blood concentration data were fitted with PK Solver 2.0 program to obtain pharmacokinetic parameters. Results. In the preexperimental study, ultrasonic method was selected as the physical solubilization method, and acetone was selected as the organic solvent. In single‐factor test, the highest encapsulation efficiency was achieved when the ratio of drug dosage to excipient dosage was 1 : 15; the highest encapsulation efficiency was achieved when the amount of organic solvent (acetone) was 8 mL. The equation fitted to the model for the optimized prescription by the central composite design method is as follows: R1 = −166.93629 + 16.86478A + 32.55582B − 0.169750AB − 0.4826752 − 2.25797B2(R2 = 0.9457). The best prescription for the preparation of Chrysophanol‐Pluronic F127 nanomicelles was obtained in the ratio of drug dosage to excipient dosage of 1 : 16.309 and the dosage of organic solvent was 6.595 mL. The prepared nanomicelles have a particle size of 152.8 nm and a potential of ‐23.9 mV. It was observed by transmission electron microscope that the prepared nanomicelles are uniform and spherical in appearance. The drug metabolism of Chrysophanol and nanomicelles in rabbits conforms to the two‐compartment open model, and both of them show linear kinetics in the drug dose range. T(1/2α) was 0.31 ± 0.21 h and 0.47 ± 0.35 h, and T(1/2β) was 2.06 ± 1.14 h and 7.72 ± 2.04 h for Chrysophanol and Chrysophanol‐Pluronic F127 nanomicelles, respectively. Conclusions. The adopted central composite design method can well optimize the prescription process of Chrysophanol‐Pluronic F127 nanomicelles prepared by dialysis, and the method is simple and easy to be prepared in the laboratory. The prepared nanomicelles have uniform particle size and good zeta potential and appear as uniform black spherical shape under transmission electron microscopy. In vitro release studies showed that the Chrysophanol‐Pluronic F127 nanomicelles released significantly better than Chrysophanol. The results of pharmacokinetics of Chrysophanol and Chrysophanol‐Pluronic F127 nanomicelles in rabbits showed that the Chrysophanol‐Pluronic F127 nanomicelles did not change the metabolic process of the drug in vivo but could stay in vivo for a longer period of time and exert longer effects. It is hoped that this study can provide a laboratory basis for the preparation of Chrysophanol‐Pluronic F127 nanomicelles and a reference for further in vivo studies of Chrysophanol.

RecoMed: A knowledge-aware recommender system for hypertension medications

Background & ObjectiveHigh medicine diversity has always been a significant challenge for prescription, causing confusion or doubt in physicians’ decision-making process. This paper aims to develop a medicine recommender system called RecoMed to aid the physician in the prescription process of hypertension by providing information about what medications have been prescribed by other doctors and figuring out what other medicines can be recommended in addition to the one in question. MethodsThere are two steps to the developed method: First, association rule mining algorithms are employed to find medicine association rules. The second step entails graph mining and clustering to present an enriched recommendation via ATC code, which itself comprises several steps. First, the initial graph is constructed from historical prescription data. Then, data pruning is performed in the second step, after which the medicines with a high repetition rate are removed at the discretion of a general medical practitioner. Next, the medicines are matched to a well-known medicine classification system called the ATC code to provide an enriched recommendation. And finally, the DBSCAN and Louvain algorithms cluster medicines in the final step. ResultsA list of recommended medicines is provided as the system's output, and physicians can choose one or more of the medicines based on the patient's clinical symptoms. Only the medicines of class #2, related to high blood pressure medications, are used to assess the system's performance. Unlike other research studies, in this work, the framework proposed is entirely based on unsupervised learning methods and so it is more likely to be used in real-world applications as medical data are generally unlabeled, and supervised learning models cannot be directly built using these types of data. The results obtained from this system have been reviewed and confirmed by an expert in this field.

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

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

Fire now, fire later: alarm-based systems for prescriptive process monitoring

Predictive process monitoring is a family of techniques to analyze events produced during the execution of a business process in order to predict the future state or the final outcome of running process instances. Existing techniques in this field are able to predict, at each step of a process instance, the likelihood that it will lead to an undesired outcome. These techniques, however, focus on generating predictions and do not prescribe when and how process workers should intervene to decrease the cost of undesired outcomes. This paper proposes a framework for prescriptive process monitoring, which extends predictive monitoring with the ability to generate alarms that trigger interventions to prevent an undesired outcome or mitigate its effect. The framework incorporates a parameterized cost model to assess the cost–benefit trade-off of generating alarms. We show how to optimize the generation of alarms given an event log of past process executions and a set of cost model parameters. The proposed approaches are empirically evaluated using a range of real-life event logs. The experimental results show that the net cost of undesired outcomes can be minimized by changing the threshold for generating alarms, as the process instance progresses. Moreover, introducing delays for triggering alarms, instead of triggering them as soon as the probability of an undesired outcome exceeds a threshold, leads to lower net costs.

A pilot study about methods to reduce prescription errors in a chemotherapy day unit - Aspects to consider in pharmacist verification process.

Prescribing errors can happen unintentionally during the prescribing process, or when choosing a treatment therapy. Prescribing errors have the highest prevalence amongst common error types related to chemotherapy medication in outpatient settings. According to the Joint Commission International (JCI), prescriptions should be reviewed for appropriateness by someone else than the prescriber or practitioner to prevent medication errors. The study was aimed to map out the existing type and amount of occurring deviations in prescribing and to clarify the current chemotherapy prescribing practices at the Comprehensive Cancer Center at Helsinki University Hospital. Similar research has not been published in Finland before. The researcher selected patients randomly from the daily outpatient attendance list following a predetermined numerical order. Data was collected by conducting a medication verification review in line with the JCI guidance by a clinical pharmacist the day before the patient's clinic appointment using the available medical documentation. A clinical pharmacist evaluated findings from prescriptions and contacted an oncologist if the findings were considered clinically significant. A clinical pharmacist verified prescriptions from 101 patients for appropriateness and found discrepancies in four percent of the prescriptions (n = 4/101). The oncologist approved 50 percent of the suggested amendments by the pharmacist as clinically significant (n = 2/4). The study revealed that patient's regular home medications were not always correctly recorded into the database, so verification of medicine interactions could not be trusted as completely accurate. It took on average 16 min per patient to perform a medication verification review. The process was slowed down by the lack of detailed enough protocols for this purpose and the current patient care record system not having structural formatting of data entry. Verification of prescriptions provides a tool to identify prescribing discrepancies and to prevent unintended medication errors affecting patients. The development of detailed protocols and guidelines, as well as an appropriate training program, would support pharmacists in compiling clinical medication reviews for chemotherapy patients. More research is needed to further develop the operating model in Finland. Information gathered from this study can be used for identifying training requirements.

Novel Nanocrystal Injection of Insoluble Drug Anlotinib and Its Antitumor Effects on Hepatocellular Carcinoma.

The molecularly targeted agent anlotinib offers a novel therapeutic strategy against advanced hepatocellular carcinoma (HCC). With this study, we aimed to solve the technical problem of anlotinib being insoluble in injectable solutions; we also aimed to assess the antitumor activity of anlotinib on hepatocellular carcinoma cells. We prepared an anlotinib nanocrystal injection by wet grinding, and we optimized the prescription process using a transmission electron microscope (TEM) and a laser particle size analyzer (LPSA). The release of anlotinib from the injected nanocrystals was evaluated using LC-MS/MS in vitro, and the drug’s anti-tumor effects were assessed in a nude mice tumor model. The anlotinib nanocrystals had a uniform particle size distribution (the average nanoparticle size was ~200 nm). The preparation of anlotinib into nanocrystals did not change the original crystal structure. The intravenous injection of anlotinib nanocrystals achieved anti-tumor activity at very low doses compared to those required for oral administration of an anlotinib suspension: anlotinib nanocrystals at a dose of 50 μg/kg inhibited the subcutaneous growth of the HCC cell line MHCC97-H; whereas the dose of anlotinib suspension required for an equivalent effect was 1 mg/kg. Therefore, our novel anlotinib nanocrystal injection preparation provides an option for achieving a safe and effective molecularly targeted therapy against advanced HCC.

Changing the process of prescribing to procuring lymphoedema compression garments: a service evaluation

Compression garments are the mainstay of lymphoedema treatment, yet the process of obtaining by prescription is lengthy, governed by funding, involves numerous professionals with little patient value and often involes copious inaccuracies, delays and errors. This service evaluation estimates the potential impact of changing the way compression garments are accessed from a prescription to a procurement process. The main objective was to estimate the impact and costs of altering the process within the NHS Wales setting. A service evaluation was formally supported by Medicine Management and Lymphoedema Wales Strategy Board to compare the prescription process to a new procuring route. A form was devised so that data was could be collected over 12 months by lymphoedema therapists on each compression garment issued to patients attending two lymphoedema services in NHS Wales. The data collected included information on the garment ordered, costs (prescribed compared to procured), timing between garment ordered and received plus a comparison of the processes. All non-patient identifiable data was entered into a database and comparison analysis was completed to identify any correlations between the variables collected. The project was ratified by research and development as service evaluation. There was a total of 5392 completed patient data forms were included, which when compared to the processes indicated that using a prescription route is overwhelmingly more costly than procuring. Overall costs suggest the potential for substantial savings to NHS Wales (£71.10 per patient) were statistically significant (P<0.001). Potential for improved patient outcomes was observed as garments were provided directly on appointment instead of significant delays promoting value-based healthcare.

In search of lost time: A timing evaluation of antimicrobial prescribing with and without a computerized decision support system using clinical vignettes

BackgroundWe implemented a computerized decision support system (CDSS) integrated in the in-house computerized physician order entry (CPOE) system to assist physicians with antimicrobial prescribing decisions in the context of the multicenter cluster-randomized COMPASS trial (NCT03120975). Some physicians in the intervention wards complained about the perceived extra-time associated with the use of the CDSS compared with routine prescribing through CPOE. The aim of this study was to compare the time needed to prescribe antimicrobials with and without the CDSS. MethodsPhysicians with and without previous experience with the COMPASS CDSS working at our hospital in Geneva, Switzerland, were recruited to prescribe antimicrobials using clinical vignettes. Physicians without experience received a brief explanation of the CDSS. Each physician received 2 groups of 5–7 clinical vignettes randomly selected from a pool of 28. Each group of vignettes included prescriptions with different levels of complexity (empiric versus targeted or pre-defined treatment, dose adjustment for renal function, oral switch, treatments for which COMPASS does not provide recommendations or where a deviation was necessary). Prescriptions were completed using the standard CPOE (first set), then using COMPASS (second set). A print version of the local antimicrobial guidelines was available for consultation. Time to complete each prescription was recorded (including time needed to consult paper guidelines). The Mann-Whitney test was used for comparisons. Consultation of guidelines booklet and concordance with local guidelines were assessed. ResultsTwenty-five physicians were recruited. Thirteen (52%) had previously used COMPASS. Among them, 11 (85%) estimated the extra-time being above 1 min. We evaluated a total of 296 vignettes. Overall, the median time to complete a prescription was 55.5 s (IQR 38–86) using COMPASS and 50 s (IQR 31–88) using the standard CPOE (p = 0.24). Concordance of prescriptions with local guidelines was similar with the 2 systems (127/148, 85.8% for both), but consultation of paper guidelines was more frequent when prescribing without the CDSS (49.3% (73/148) vs 22.3% (33/148)). ConclusionsThe increased time required for prescribing using COMPASS is overestimated by end-users. Information collected in the study will be used to streamline the prescribing process via COMPASS and increase acceptance.

Antibiotics prescription in the elderly across different clinical areas; A real-life clinical audit

Ageing of the population represents a great challenge to the national health system (NHS) in the UK. Patients in this age group have multiple comorbidities and use polypharmacy. They also have alterations in the absorption, metabolism and excretion of drugs. These factors make them susceptible to developing side effects and drug interactions on using antibiotics.Our team audited the safety of antibiotic prescription in elderly patients (above 85 years of age) in regards to the selection of the appropriate antibiotics, and the documentation of the indication and duration of them. We also compared the prescription process during working hours and out of hours. We recruited 20 patients from each of the three departments involved in their care: The Old people admission unit (OPAU), the geriatric wards and other hospital wards. Our minimum compliance rate was 95% in each of the studied parameters. We spotted a significant compromise in the antibiotic prescription on non-geriatric wards and out of hours. This goes with the concerns raised by other studies. We recommend continuous education and the setting up of campaigns to increase the awareness of the medical staff on this aspect.

The effect of a decision support system on the incidence of prescription errors in a PICU.

What is known and objectivePaediatric intensive care patients are at high risk for prescription errors due to the more complex process of medication prescribing. Clinical decision support systems (CDSS) have shown good results in effectively reducing prescription errors. A specific dosing CDSS was developed that can check and suggest normal dose, dose limits and administration frequencies. This study aimed to assess the effect of this CDSS on protocol deviation (as measure of prescription error) types and frequency in a paediatric intensive care unit (PICU).MethodsA retrospective observational study was conducted evaluating 9342 prescriptions in a 4‐month period before and after the implementation of a CDSS in the PICU of the University Medical Center Utrecht. Medication forms were reviewed to identify protocol deviations (and therefore possible prescription errors). The incidence and nature of deviations from evidence‐based protocols that were unintended and needed to be adjusted, were determined.Results and discussionIn the period before the dosing CDSS, we identified 45 protocol deviations in 5034 prescriptions (0.89%), 28 of which could not be justified (0.56%) and 11 needed to be adjusted (0.22%). In the period after the implementation of the CDSS, there were 21 protocol deviations in 4308 prescriptions (0.49%) of which ten without a valid reason (0.23%) of which two were adjusted (0.05%).What is new and conclusionThe specific dosing CDSS was able to significantly reduce unintentional prescription dose deviations and the number of prescriptions that needed to be adjusted, in an existing low incidence situation.