Use Of Electronic Prescribing Research Articles

Impact of state mandates on electronic prescribing of acute opioid prescriptions for the treatment of pain in Kansas and Colorado

BackgroundGovernment and health care entities are seeking solutions to optimize safe opioid prescribing practices. Electronic prescribing of controlled substance (EPCS) state mandates are becoming common, but lack thorough evaluation. ObjectiveThis study aimed to evaluate whether EPCS state mandates affect opioid prescribing patterns for acute pain treatment. MethodsThis retrospective study was designed to assess prescribing patterns via percent change for quantity, day supply, and prevalence of prescribing method utilized for opioid prescriptions 3 months pre- and post-EPCS mandate. Prescription data are extracted from two regional divisions of a large community-based pharmacy chain between April 1, 2021 to October 1, 2021. Relationships of patient geographical locations and prescribing methods were assessed. Likewise, the relationship of opioids prescribed between insurance types were evaluated. Data was evaluated utilizing Chi-Square and Mann-Whitney U tests, with an a-priori alpha of 0.05. ResultsThere was an increase before to after state mandate of quantity and day supply (0.8% and 1.3% [P = 0.02; P < 0.001], respectively). There were significant decreases in total daily dose and daily morphine milligram equivalent (2.0% and 1.9% [P < 001; P = 0.254], respectively). A 16.3% increase was seen in electronic prescribing before to after state mandate for prevalence of electronic prescribing versus other prescribing methods. ConclusionThere is a correlation between EPCS and prescribing patterns for acute pain treatment with opioids. The use of electronic prescribing increased after state mandate. By promoting the use of electronic prescribing, the benefit of awareness and caution of opioid use draws attention to prescribers.

Evaluation, Remedy of Waste, Lean Hospital Method, Process of Inpatient Pharmacy Services in Hospital

Each installation in the hospital must continue to evaluate, improvement, and develop, including the pharmacy installation. Pharmacy installations as one of the medical support services in hospitals are required to improve the quality of their services on an ongoing basis. This study aims to see, the root of the problem, and provide evaluation and improvement for the reading of critical waste in the inpatient pharmacy service process of Kabupaten Karanganyar Hospital.&#x0D; This study uses a non-experimental research design and was descriptive qualitative in nature. Data techniques in qualitative and quantitative research. The value of patient data was obtained from distributing questionnaires. The pharmaceutical service process was obtained from observation and document review, then mapping in the form of value stream mapping. The determination of waste was obtained from distributing questionnaires and in-depth interviews with the 5 why method.&#x0D; The results of the reasearch show critical waste on inpatient service in pharmacy installation is waste defect and waste waiting. The root cause of critical waste is the prescription of drugs by doctors outside the formulary and the root cause of waiting for waste is a prescription from the hospital admission at the same time. The proposed improvement for the cause of critical waste is Monitoring and evaluating the implementation of the formularium on an going basis, provide special software to enter patient data, and implement the use of electronic prescribing to shorten the service process time.

Security, Privacy, and Confidentiality in Electronic Prescribing Systems: A Review Study

Introduction: The use of electronic prescribing has identified as a strategically important policy to improve health care. Therefore, the purpose of this study was to review the issues related to security, privacy and privacy of electronic copying systems.Material and Methods: A comprehensive review of studies were conducted that published in English, free access to the full text of the article and without time limitation, by searching for keywords in keywords, title and abstract of studies in valid scientific databases Web of Science, Scopus, PubMed and Embase in June 4, 2021. Two researchers reviewed the title and content of searched studies independently. 137 related studies found and finally 25 main articles selected.Results: In general, the results of the study showed that in some countries, there are still no minimum requirements and standards for these systems; But the use of security and privacy protocols has been used in various ways. However, according to other studies, most patients and physicians are concerned about the privacy and security of medical data in the context of these systems. In general, security in an electronic healthcare system includes the seven main components of user authentication, patient confidentiality, licensing issues, scalability, integrity, non-denial, and confidentiality of information sent, processed, and stored.Conclusion: In this study, different protocols were classified into 7 main components. Although there are different protocols to ensure security, privacy and confidentiality issues; But the lack of international security requirements poses a major challenge to the adoption of electronic transcription systems. Given that the majority of patients and physicians were concerned about the issues of privacy and security of medical data, it is necessary for policy makers and managers in this area to pay attention to these issues before implementing these systems and provide a safe environment for implementing these systems. Provide patient privacy.

PERBANDINGAN MEDICATION ERROR PADA PERESEPAN ELEKTRONIK DAN PERESEPAN MANUAL PADA TAHAP PRESCRIBING DI APOTEK KOTA PALU

Prescribing drugs is now growing, as evidenced by the existence of electronic prescribing that have been applied in several hospitals and pharmacies. The development of this prescribing method does not rule out the possibility of increasing the incidence of medication errors in prescribing. So, it is necessary to identify the prescribing that has been implemented, especially in drugstore at Palu City. The purpose of this study was to look at the comparison of medication errors at the prescribing stage which included aspects of prescribing completeness and therapeutic errors in electronic prescribing at Drugstore X and manual prescribing at Drugstore Y in Palu city in 2018. This type of research is a descriptive study with retrospective data collection. Samples taken in the form of secondary data are prescribing using purposive sampling method. The results obtained in this study are, the prevalence of medication error at the prescribing stage of electronic prescribing in drugstore at Palu City includes data, patient's body weight is 2%, doctor's license 100%, doctor's telephone number 100%, doctor's initial 100%, dosage form 97% and 90% strength of the drug. While the prevalence of medication error at the prescribing stage of manual prescribing in Drugstore Palu City is data, the patient's age is 2%, the patient's body weight is 99.1%, the patient's sex is 100%, the doctor's license is 91.6%, the doctor's telephone number is 80% , initial doctor 42.7%, 88% dosage form and 65% drug strength. Based on these results, it can be concluded that the use of electronic prescribing is better than manual prescribing.

PERBANDINGAN MEDICATION ERROR PADA PERESEPAN ELEKTRONIK DAN PERESEPAN MANUAL PADA TAHAP PRESCRIBING DI APOTEK KOTA PALU

Prescribing drugs is now growing, as evidenced by the existence of electronic prescribing that have been applied in several hospitals and pharmacies. The development of this prescribing method does not rule out the possibility of increasing the incidence of medication errors in prescribing. So, it is necessary to identify the prescribing that has been implemented, especially in drugstore at Palu City. The purpose of this study was to look at the comparison of medication errors at the prescribing stage which included aspects of prescribing completeness and therapeutic errors in electronic prescribing at Drugstore X and manual prescribing at Drugstore Y in Palu city in 2018. This type of research is a descriptive study with retrospective data collection. Samples taken in the form of secondary data are prescribing using purposive sampling method. The results obtained in this study are, the prevalence of medication error at the prescribing stage of electronic prescribing in drugstore at Palu City includes data, patient's body weight is 2%, doctor's license 100%, doctor's telephone number 100%, doctor's initial 100%, dosage form 97% and 90% strength of the drug. While the prevalence of medication error at the prescribing stage of manual prescribing in Drugstore Palu City is data, the patient's age is 2%, the patient's body weight is 99.1%, the patient's sex is 100%, the doctor's license is 91.6%, the doctor's telephone number is 80%, initial doctor 42.7%, 88% dosage form and 65% drug strength. Based on these results, it can be concluded that the use of electronic prescribing is better than manual prescribing.

The Adoption and Increased Use of Electronic Prescribing of Controlled Substances

ABSTRACT The electronic prescribing of controlled substances (EPCS) is now becoming implemented in most health care practices and pharmacies in the United States. This review aims to detail the steps needed for EPCS adoption and synthesize the most current literature on the benefits and challenges associated with its adoption. Our systematic review of seven published studies from 1990 to 2020 notes the benefits of EPCS in the reduction of errors, fraud, overprescribing, cost and efficiency improvements. There is limited published evidence of challenges, such as the cost of implementation and prescriber burden. With EPCS becoming a nationwide process, further research needs to be conducted to maximize the effectiveness of EPCS and explore additional benefits and challenges. We used a modified version of the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system for systematic reviews highlighted in the “Cochrane Handbook for Systematic Reviews of Interventions” to assess the quality of the primary studies reviewed.1 Each author was tasked with determining the quality of each primary study reviewed and assigning a quality score of either high, moderate or low quality. Evidence stemming from randomized controlled trials starts as high quality while evidence from observational studies starts as low quality. Quality can be lowered by five factors: risk of bias, imprecision, inconsistency, indirectness, and publication bias and can be raised by a large magnitude of effect and a clear dose-response gradient. We extracted data from the text, tables and graphs of the original publications. Appendix A illustrates the quality of the studies. Databases reviewed included PubMed, Google Scholar, Cochrane and SCOPUS. The search was started in 1990, with the first wave of the opioid epidemic and the first published studies of e-prescribing, and continued to the year of 2020. The key phrases “electronic prescribing of controlled substances,” “e-prescribing of controlled substances,” “fraudulent prescribing of controlled substances,” “EPCS with PDMP,” and “drug interactions with e-prescribing of controlled drugs” were used as an inclusion criterion to search online scholarly databases for articles. Only primary and secondary data from reports, reviews and research studies written in English were included. The Centers for Disease Control (CDC), National Institute on Drug Abuse (NIDA), Drug Enforcement Administration (DEA), Substance Abuse and Mental Health Services Administration (SAMHSA), American Academy of Family Medicine (AAFP), and nationally represented health information networks were used to obtain updated statistics regarding EPCS.

Optimizing pharmacotherapy on geriatric hospital units in Belgium – a national survey

ABSTRACT Objective Inappropriate prescribing remains highly prevalent on geriatric units. The aim of this investigation, initiated by the Belgian College for Geriatrics, was to evaluate the implementation of strategies to optimize pharmacotherapy on geriatric units in Belgium. Methods A literature search was performed to identify strategies to support the appropriate use of medications in very old inpatients. These strategies were subsequently validated based on Delphi consensus rounds and a national survey was developed. Experts were selected by the research team in collaboration with the Belgian College for Geriatrics. The survey was sent to the heads of the geriatric departments of all Belgian hospitals (n = 100). Results After 3 months a response rate of 55% was achieved. Strategies that were implemented more frequently were the use of electronic prescribing (85%), performing a structured medication review (69%) and providing patient education (76%). In a minority (24%) of hospitals, a clinical pharmacist was directly involved in the multidisciplinary geriatric team. Implementation of clinical decisions support systems (CDSS) was reported by 36% of the hospitals. Educational strategies for healthcare professionals and strategies to optimize transitional care were variable. Conclusion Taking into account the current body of evidence, strategies that include transitional care components, CDSS or ward-based clinical pharmacy services should be further promoted on Belgian geriatric units.

Association of Electronic Prescribing of Controlled Substances With Opioid Prescribing Rates

The majority of US states have passed mandates requiring the use of electronic prescribing of controlled substances (EPCS) as a tool to reduce rates of opioid prescribing. It is not known whether increasing use of EPCS will have the intended effect. To assess the association between use of EPCS and trends in opioid prescribing. In this retrospective, longitudinal cohort study of all patients and prescribers in the 50 US states and the District of Columbia from 2010 to 2018, changes in state-level use of EPCS and concurrent changes in opioid prescribing in each state are described. Then the association between changes in the use of EPCS and opioid prescribing are estimated using state and year fixed-effects models that include covariates for policy change and state demographic change. Data Analysis was performed on May 5, 2020. The proportion of controlled substances in each state prescribed using EPCS based on opioid prescriptions per 100 persons and morphine milligram equivalents (MME) of opioids. In 2018, the population-weighted percent of opioids prescribed using EPCS was 27%, up from 0% as of 2013. National rates of opioid prescriptions decreased from 78 prescriptions per 100 persons in 2013 to 53 in 2018. Over the same period, there was a decrease from 64 071 MME per 100 persons in 2013 to 40 906 MME per 100 persons in 2018, representing 36% of the 2013 level. By 2018, EPCS increased to 69.4% in states with mandates for its use and 23.6% in states without mandates. In multivariable models, a 10 percentage-point increase in the use of EPCS was associated with an additional 2 prescriptions per 100 persons (95% CI, 1.3-2.8) and a 0.8% (95% CI, 0.06%-1.5%) increase in MME per 100 persons. These data suggest that an increased use of EPCS was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing. Opioid prescribing is associated with a variety of social and public health factors, and thus, despite the appeal, EPCS adoption alone may be insufficient to reduce opioid prescribing. Policy makers should consider levers to ensure that EPCS is integrated with outside data and that information is actively used to inform prescribing decisions.

Developing a Safety Case for Electronic Prescribing.

It is now recognised that Health IT systems can bring benefits to healthcare, but they can also introduce new causes of risks that contribute to patient harm. This paper focuses on approaches to modelling and analysing potential causes of medication errors, particularly those arising from the use of Electronic Prescribing. It sets out a systematic way of analysing hazards, their causes and consequences, drawing on the expertise of a multidisciplinary team. The analysis results are used to support the development of a safety case for a large-scale Health IT system in use in three teaching hospitals. The paper shows how elements of the safety case can be updated dynamically. We show that it is valuable to use the dynamically updated elements to inform clinicians about changes in risk, and thus prompt changes in practice to mitigate the risks.

The US Opioid Crisis: Current Federal and State Legal Issues.

The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing. Other federal agencies involved with the federal regulatory effort include the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), and the Department of Justice. Each federal agency has a unique role in helping to stem the burgeoning opioid misuse epidemic. The DEA, working with the Department of Justice, has enforcement power to prosecute pill mills and physicians for illegal prescribing. The DEA could also implement use of prescription drug monitoring programs (PDMPs), currently administered at the state level, and use of electronic prescribing for schedule II and III medications. The FDA has authority to approve new and safer formulations of immediate- and long-acting opioid medications. More importantly, the FDA can also ask pharmaceutical companies to cease manufacturing a drug. Additionally, state agencies play a critical role in reducing overdose deaths, protecting the public safety, and promoting the medically appropriate treatment of pain. One of the states' primary roles is the regulation of practice of medicine and the insurance industry within their borders. Utilizing this authority, states can both educate physicians about the dangers of opioids and make physician licensure dependent on registering and using PDMPs when prescribing controlled substances. Almost every state has implemented a PDMP to some degree; however, in addition to mandating their use, increased interstate sharing of prescription information would greatly improve PDMPs' effectiveness. Further, states have the flexibility to promote innovative interventions to reduce harm such as legislation allowing naloxone access without a prescription. While relatively new, these types of laws have allowed first responders, patients, and families access to a lifesaving drug. Finally, states are at the forefront of litigation against pharmaceutical manufacturers. This approach is described as analogous to the initial steps in fighting tobacco companies. In addition to fighting for dollars to support drug treatment programs and education efforts, states are pursuing these lawsuits as a means of holding pharmaceutical companies accountable for misleading marketing of a dangerous product.

Paediatric in-patient prescribing errors in Malaysia: a cross-sectional multicentre study.

Background There is a lack of large comprehensive studies in developing countries on paediatric in-patient prescribing errors in different settings. Objectives To determine the characteristics of in-patient prescribing errors among paediatric patients. Setting General paediatric wards, neonatal intensive care units and paediatric intensive care units in government hospitals in Malaysia. Methods This is a cross-sectional multicentre study involving 17 participating hospitals. Drug charts were reviewed in each ward to identify the prescribing errors. All prescribing errors identified were further assessed for their potential clinical consequences, likely causes and contributing factors. Main outcome measures Incidence, types, potential clinical consequences, causes and contributing factors of the prescribing errors. Results The overall prescribing error rate was 9.2% out of 17,889 prescribed medications. There was no significant difference in the prescribing error rates between different types of hospitals or wards. The use of electronic prescribing had a higher prescribing error rate than manual prescribing (16.9 vs 8.2%, p<0.05). Twenty eight (1.7%) prescribing errors were deemed to have serious potential clinical consequences and 2 (0.1%) were judged to be potentially fatal. Most of the errors were attributed to human factors, i.e. performance or knowledge deficit. The most common contributing factors were due to lack of supervision or of knowledge. Conclusions Although electronic prescribing may potentially improve safety, it may conversely cause prescribing errors due to suboptimal interfaces and cumbersome work processes. Junior doctors need specific training in paediatric prescribing and close supervision to reduce prescribing errors in paediatric in-patients.

Formal prescribing errors are substantially reduced in electronic prescribing and after teaching sessions

Prescription forms enable the communication between physicians and pharmacists. Hence, incorrectly issued prescriptions may result in delay of health-care delivery, additional workload, and potentially adverse patient outcomes. We aimed to evaluate the formal prescription quality in our outpatient clinics (OC) before and after performing teaching sessions and using an electronic prescription system to replace handwritten prescriptions. All OCs of a university hospital were offered a short teaching session on how to issue prescriptions correctly and how to use the electronic prescription system. During four weeks before and after the teaching, we anonymously collected all prescriptions of the OCs in 20 surrounding community pharmacies and assessed whether they were error-free, required an intervention by the pharmacist, additional clarification by the OC, or had to be reissued. After the intervention, the absolute fraction of formally error-free prescriptions increased by 12.9% from 52.9% (516/976) to 65.8% (713/1084, p < 0.001; d = 12,9% 95% confidence interval [8,7%; 17,1%]). Largest improvements were seen in prescriptions requiring clarification by the OC (224/976 prescriptions at baseline versus 93/1084 post-intervention, p < 0.001). The fraction of electronic prescriptions increased from 34.9% (341/976) to 46.9% (509/1084, p < 0.001, d = 12,0% 95% confidence interval [7,8%; 16,2%]) with electronic prescriptions consistently being of higher formal quality than handwritten prescriptions. After increased use of electronic prescribing and teaching courses, formal prescription quality was significantly improved.

An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit.

AimTo assess the impact of the implementation of a Computerized Physician Order Entry (CPOE) associated with a pharmaceutical checking of medication orders on medication errors in the 3 stages of drug management (i.e. prescription, dispensing and administration) in an orthopaedic surgery unit.MethodsA before-after observational study was conducted in the 66-bed orthopaedic surgery unit of a teaching hospital (700 beds) in Paris France. Direct disguised observation was used to detect errors in prescription, dispensing and administration of drugs, before and after the introduction of computerized prescriptions. Compliance between dispensing and administration on the one hand and the medical prescription on the other hand was studied. The frequencies and types of errors in prescribing, dispensing and administration were investigated.ResultsDuring the pre and post-CPOE period (two days for each period) 111 and 86 patients were observed, respectively, with corresponding 1,593 and 1,388 prescribed drugs. The use of electronic prescribing led to a significant 92% decrease in prescribing errors (479/1593 prescribed drugs (30.1%) vs 33/1388 (2.4%), p < 0.0001) and to a 17.5% significant decrease in administration errors (209/1222 opportunities (17.1%) vs 200/1413 (14.2%), p < 0.05). No significant difference was found in regards to dispensing errors (430/1219 opportunities (35.3%) vs 449/1407 (31.9%), p = 0.07).ConclusionThe use of CPOE and a pharmacist checking medication orders in an orthopaedic surgery unit reduced the incidence of medication errors in the prescribing and administration stages. The study results suggest that CPOE is a convenient system for improving the quality and safety of drug management.

Barriers to mesalamine adherence in patients with inflammatory bowel disease: a qualitative analysis.

The causes for nonadherence to mesalamine in patients with inflammatory bowel disease (IBD) have been characterized using mostly indirect methods. Patient-reported barriers are lacking in this population. To identify patient-reported barriers to mesalamine adherence through direct interviews. Focus groups and one-on-one interviews were undertaken in adult patients with IBD. Transcripts from the focus groups and interviews were analyzed to identify themes and links between these themes, assisted by qualitative data software MaxQDA. Of 27 patients participating, 21 (78%) had ulcerative colitis, and 6 (22%) had Crohn's disease. Their self-reported adherence ranged from complete adherence (n = 3) to intermittent nonadherence (n = 24). Patients frequently indicated that they were resistant to taking medications for their condition. The barriers to adherence that emerged from interviews could be categorized under a number of themes: competing priorities, social stigma, refill inconvenience, costs, efficacy values, side effects, and pill characteristics. Efficacy values reported to influence adherence included doubts about efficacy, consequences of missed doses, and doubts about need for maintenance medication. Pill characteristics reported as barriers included pill size and pill frequency. Despite use of electronic prescribing, obtaining refills was reported as an obstacle to adherence in this cohort. Decanting of pills to multiple containers to increase accessibility was also reported. Patients with both ulcerative colitis and Crohn's disease report a number of common barriers to mesalamine adherence. Factors in medication-taking behavior and beliefs were reported in this study that may have implications for strategies to improve adherence by health care providers.

The Effects of Electronic Prescribing by Community-Based Providers on Ambulatory Medication Safety

US federal policies are incentivizing use of electronic prescribing (e-prescribing) to improve safety. However, little is known about e-prescribing's actual impact on medication safety over time. A study was conducted to assess the effect of implementing a commercial electronic health record (EHR) with e-prescribing on rates and types of prescribing errors. Understanding safety effects from e-prescribing will be important as providers increasingly e-prescribe. Prescriptions written by 20 community-based primary care providers in the Hudson Valley region of New York from November 2008 to November 2009 were retrospectively studied. All providers adopted a commercial EHR with robust clinical decision support and extensive technical support to aid in prescribing. Errors were identified by standardized prescription and chart review. Some 1,629 prescriptions were analyzed at three months postimplementation, and 1,738 prescriptions were analyzed at one year postimplementation. Use of e-prescribing resulted in relatively low error rates (6.0 errors per 100 prescriptions). These rates were sustained over time but without further improvement (6.0 versus 4.5 errors per 100 prescriptions, p = .15). Antibiotics were the class of medications most frequently involved (12.7% of overall errors), and direction errors were most common (24% of errors). This study is the first, as far as known, to quantitatively evaluate prescribing errors early after EHR implementation and after sustained use among community-based primary care providers. Relatively low rates of errors with e-prescribing were found early and after prolonged use. Extensive support for providers before, during, and after implementation may mitigate potential safety threats from implementation of an EHR system and result in sustained safety benefits over the long-term.

The Use and Functionality of Electronic Prescribing Systems in English Acute NHS Trusts: A Cross-Sectional Survey

ObjectivesTo describe current use of electronic prescribing (EP) in English acute NHS hospital trusts, and the use of multiple EP systems within the same hospital.DesignDescriptive cross-sectional postal survey.SettingAcute NHS hospital trusts in England.ParticipantsThe survey was sent to chief pharmacists in all acute English NHS hospital trusts in 2011. Where trusts comprised multiple hospitals, respondents were asked to complete the questionnaire for their main acute hospital.Main Outcome MeasuresPrevalence of EP use in acute NHS hospitals; number of different EP systems in each hospital; stages of the patient pathway in which EP used; extent of deployment across the hospital; comprehensiveness regarding the drugs prescribed; decision support functionalities used.ResultsWe received responses from 101 trusts (61%). Seventy (69%) respondent hospitals had at least one form of EP in use. More than half (39;56%) of hospitals with EP had more than one system in use, representing 60 different systems. The most common were systems used only for discharge prescribing, used in 48 (48% of respondent hospitals). Specialist chemotherapy EP systems were second most common (34; 34%). Sixteen specialist inpatient systems were used across 15 hospitals, most commonly in adult critical care. Only 13 (13%) respondents used inpatient electronic prescribing across all adult medical and surgical wards. Overall, 24 (40%) systems were developed ‘in-house’. Decision support functionality varied widely.ConclusionsIt is UK government policy to encourage the adoption of EP in hospitals. Our work shows that EP is prevalent in English hospitals, although often in limited clinical areas and for limited types of prescribing. The diversity of systems in use, often within the same hospital, may create challenges for staff training and patient safety.

Physicians and pharmacists call for more rapid implementation of e-prescribing in Canada

Canada should aim to have all prescriptions in the country created, signed and transmitted electronically by 2015, according to a joint statement released by the Canadian Medical Association (CMA) and the Canadian Pharmacists Association (CPhA) on May 21, 2013. The statement acknowledges that achieving this vision poses challenges, but says efforts must be made because of the extensive potential benefits to patients, providers and the health care system. These benefits will be realized when e-prescribing is integrated with Drug Information Systems (DIS) currently in place or being developed in various jurisdictions, say the 2 associations. The CMA and CPhA have laid out a 5-point plan for achieving full e-prescribing functionality by 2015. It includes the need for the provinces and Canada Health Infoway to complete electronic connectivity requirements among points of care, and for provinces, territories and regulatory bodies to develop regulatory frameworks to facilitate and govern clinicians’ use of electronic prescribing. The full e-prescribing joint statement is available at www.pharmacists.ca and www.cma.ca.

‘What are the root causes of returned medicines in hospital pharmacy?’ A lean approach.

BackgroundIn CHU Mont-Godinne, physicians prescribe medicines through a CPOE system and medicines are then delivered on an individual patient basis by the pharmacy. The amounts are generated according to a...

The effect of pharmaceutical interventions on parenteral nutrition in a neonatal intensive care unit 5 years after the introduction of electronic prescribing

BackgroundParenteral nutrition (PN) prescriptions are not error-free regarding calculations. The errors are more important the more premature the patient. Electronic prescribing aims to automate the process and therefore reduce errors,...

Early Adopters of Electronic Prescribing Struggle to Make Meaningful Use of Formulary Checks and Medication History Documentation

Use of electronic prescribing (e-prescribing) can improve safety and reduce costs of care by alerting prescribers to drug-drug interactions, patient nonadherence to therapies, and insurance coverage information. Deriving these benefits will require clinical decision support based on presentation of accurate and complete formulary and benefit (F&B) and medication history (RxH) data to prescribers, but relatively little is known about how this information is used in primary care. This is a multimethod comparative case study of 8 practices, which were selected to ensure practice size and physician specialty variation, implementing a stand-alone e-prescribing program. Field researchers observed prescription workflow and interviewed physicians and office staff. Before implementation, few prescribers reported using F&B references when making medication choices; all used paper-based methods for tracking medication history. After implementation, some prescribers reported using F&B data to inform medication choices but missing information reduced confidence in these resources. Low confidence in RxH data led to paper-based workarounds. Challenges experienced with formulary checks and RxH documentation led to prescriber distrust and unwillingness to rely on e-prescribing-based information. Greater data accuracy and completeness must be assured if e-prescribing is to meet meaningful use objectives to improve the efficiency and safety of prescribing in primary care settings.