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Background: Digital weight loss services (DWLSs) that use Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential in contributing to a shift in global obesity rates. However, reasonable concerns have been raised about the prescribing safety of these services. Prior to this study, electronic prescribing safety had only been investigated in hospital settings and community clinics. Methods: This study retrospectively analyzed prescribing errors committed over a 6-month period in 2023 at Australia's largest GLP-1 RA-supported DWLS. Results: The analysis found that 1654 (4.4%) of the 37323 audited GLP-1 RA prescriptions contained an error. Most errors pertained to insufficient safety counselling (49.15%) and inadequate investigations of potential contraindications (30.29%). Although a large portion of prescribing errors were detected via the automated query method (64.9%), the other three auditing methods all detected a significant number of true errors (>100). Patients from the highest body mass index category (40+ kg/m2) were overrepresented in the service's prescribing error data. Conclusions: These findings lay a vital foundation in the emerging literature on GLP-1 RA-supported DWLSs. [ABSTRACT FROM AUTHOR]

Background: Electronic prescribing (e-prescribing) is an essential technology in the modern health system. This technology has made many changes in the prescription process, which have advantages and disadvantages and have created opportunities for transforming the health system. This study aimed to investigate the strengths, weaknesses, opportunities, and threats of the e-prescribing system implemented in Iran from the physician's viewpoint. Methods: This phenomenological qualitative study was conducted in 2022. The participants were 15 Iranian specialist physicians working at Urmia University of Medical Sciences, selected purposively and deliberately. Data was collected through in-depth semi-structured interviews using an interview guide comprising 16 questions. Interviews were conducted until data saturation was reached. The audio data was transcribed into text and analyzed using the thematic analysis. To ensure the validity and reliability of the findings, the criteria introduced by Lincoln and Guba were employed. Results: The results of this study showed that the e-prescribing system executed in Iran has diverse and multidimensional strengths, weaknesses, opportunities, and threats. In the strengths section, the analysis of the interviews led to the extraction of semantic units in the categories of prescription process, prescriber, patient, technical, economic, communication, and insurance. Also, the weaknesses in the three categories of the prescriber, patient, and technical were debatable. The opportunities extracted from the narratives of the interviewees were placed in four categories including technical, national macro policies, Ministry of Health macro-policies, and socio-cultural issues. Finally, the discussed threats are classified into two technical and macro policies of the Ministry of Health categories. On the other hand, technical issues played an effective role in all aspects of the SWOT model. Conclusion: The e-prescribing system in Iran has strengths, weaknesses, opportunities, and threats. An overarching factor across all aspects of the SWOT model was technical infrastructure. A robust technical infrastructure is considered a strength and an opportunity for the growth of the electronic prescribing system in Iran. Conversely, any shortcomings in these systems are viewed as weaknesses and pose a threat to the system's sustainability. [ABSTRACT FROM AUTHOR]

Abstract Background Electronic prescribing (e-prescribing) is an essential technology in the modern health system. This technology has made many changes in the prescription process, which have advantages and disadvantages and have created opportunities for transforming the health system. This study aimed to investigate the strengths, weaknesses, opportunities, and threats of the e-prescribing system implemented in Iran from the physician’s viewpoint. Methods This phenomenological qualitative study was conducted in 2022. The participants were 15 Iranian specialist physicians working at Urmia University of Medical Sciences, selected purposively and deliberately. Data was collected through in-depth semi-structured interviews using an interview guide comprising 16 questions. Interviews were conducted until data saturation was reached. The audio data was transcribed into text and analyzed using the thematic analysis. To ensure the validity and reliability of the findings, the criteria introduced by Lincoln and Guba were employed. Results The results of this study showed that the e-prescribing system executed in Iran has diverse and multidimensional strengths, weaknesses, opportunities, and threats. In the strengths section, the analysis of the interviews led to the extraction of semantic units in the categories of prescription process, prescriber, patient, technical, economic, communication, and insurance. Also, the weaknesses in the three categories of the prescriber, patient, and technical were debatable. The opportunities extracted from the narratives of the interviewees were placed in four categories including technical, national macro policies, Ministry of Health macro-policies, and socio-cultural issues. Finally, the discussed threats are classified into two technical and macro policies of the Ministry of Health categories. On the other hand, technical issues played an effective role in all aspects of the SWOT model. Conclusion The e-prescribing system in Iran has strengths, weaknesses, opportunities, and threats. An overarching factor across all aspects of the SWOT model was technical infrastructure. A robust technical infrastructure is considered a strength and an opportunity for the growth of the electronic prescribing system in Iran. Conversely, any shortcomings in these systems are viewed as weaknesses and pose a threat to the system’s sustainability.

Objectives: This study investigates how physicians in Iran's Social Security Organization outpatient clinics utilize EPS functionalities to optimize the system and enhance patient care.Methods: This descriptive cross-sectional study was conducted in Iran in 2020, involving a population of 118 physicians working in outpatient clinics of the Social Security Organization. A researcher-developed questionnaire was employed to assess five different functionalities of the EPS. The validity and reliability of the questionnaire were established through expert evaluation and Cronbach's alpha calculations. Participants' responses were scored on a scale from 0 to 4 (never=0, rarely=1, sometimes=2, often=3, always=4).Results: Physicians most frequently utilized the EPS functionalities for: "Recording and displaying patient medication history" (86.5%), "Selecting drugs from the medication list" (86.3%), "Providing pre-defined doses for selection by the physician" (66.6%), and "Alerts for repetitive treatments" (65.3%). Additionally, they reported using "Viewing and verifying prescribing information before sending electronically" (83.9%) and "Patient laboratory results" (82.2%). While features related to patient identification and data access were widely used, functionalities pertaining to alerts and decision support were utilized less frequently.Conclusion: Physicians demonstrated a strong reliance on the core functionalities of EPS, particularly for managing medication histories, drug selection, and reviewing prescriptions prior to transmission. This reliance underscores the importance of these functionalities in streamlining workflows, reducing errors, and improving patient care. Further development of EPS can enhance their potential benefits.

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

Abstract Background The national e-prescription system in Greece is one of the most important achievements in the e-health sector. Healthcare professionals’ feedback is essential to ensure the introduced system tends to their needs and reduces their everyday workload. The number of surveys collecting the users’ views is limited, while the existing studies include only a small number of participants. Methods In this study, healthcare professionals’ perceptions on e-prescription are explored. For this, a questionnaire was distributed online, containing closed- and open-ended questions aiming to address strengths and identify drawbacks in e-prescription. Answers were collected from primary health care physicians, specialized medical doctors and pharmacists. Results In total, 430 answers were collected (129 from primary health care physicians, 164 responses from specialized medical doctors and 137 pharmacists). Analysis of the collected answers reveals that the views of the three groups of healthcare professionals mostly converge. The positive impact e-prescribing systems have on the overall prescribing procedure in preventing errors and providing automation is commented. Among gaps identified and proposed improvements, health care professionals note the need for access to information on adverse drug reactions, side effects, drug-to-drug interactions and allergies. Flexible interaction with Therapeutic Prescription Protocols is desired to ameliorate monitoring and decision-making, while drug dosing features, and simplified procedures for copying, repeating, canceling a prescription, are perceived as useful to incorporate. Conclusions Collecting healthcare professionals’ feedback is important, as their views can be transcribed to system requirements, to further promote e-prescribing and improve the provided health care services by facilitating decision making through safer and more efficient e-prescription. Introduction of the identified improvements can simplify the everyday workflow of healthcare professionals. To the best of our knowledge, a survey with more than 400 answered questionnaires on the use of e-prescription systems by healthcare professionals has never been conducted in Greece before.

Saskia Herrmann,1,2 Jana Giesel-Gerstmeier,1 Annika Demuth,1 Dominic Fenske1 1Hospital Pharmacy, Helios Kliniken Gmbh, Berlin, Berlin, Germany; 2Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Jena, Thuringia, GermanyCorrespondence: Dominic Fenske, Krankenhausapotheke, Helios Klinikum Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Thuringia, Germany, Tel +49 361 781 71100, Fax +49 361 781 71105, Email dominic.fenske@helios-gesundheit.dePurpose: Computerized physician order entry (CPOE) and clinical decision support systems (CDSS) are used internationally since the 1980s. These systems reduce costs, enhance drug therapy safety, and improve quality of care. A few years ago, there was a growing effort to digitize the healthcare sector in Germany. Implementing such systems like CPOE-CDSS requires training for effective adoption and, more important, acceptance by the users. Potential improvements for the software and implementation process can be derived from the users’ perspective. The implementation process is globally relevant and applicable across professions due to the constant advancement of digitalization. The study assessed the implementation of medication software and overall satisfaction.Methods: In an anonymous voluntary online survey, physicians and nursing staff were asked about their satisfaction with the new CPOE-CDSS. The survey comprised single-choice queries on a Likert scale, categorizing into general information, digital medication administration, drug safety, and software introduction. In addition multiple-choice questions are mentioned. Data analysis was performed using Microsoft Office Excel 2016 and GraphPad PRISM 9.5.0.Results: Nurses and physicians’ satisfaction with the new software increased with usage hours. The software’s performance and loading times have clearly had a negative impact, which leads to a low satisfaction of only 20% among physicians and 17% among nurses. 53% of nurses find the program’s training period unsuitable for their daily use, while 57% of physicians approve the training’s scope for their professional group. Both professions agree that drug-related problems are easier to detect using CPOE-CDSS, with 76% of nurses and 75% of physicians agreeing. The study provides unbiased feedback on software implementation.Conclusion: In conclusion, digitizing healthcare requires managing change, effective training, and addressing software functionality concerns to ensure improved medication safety and streamlined processes. Interfaces, performance optimization, and training remain crucial for software acceptance and effectiveness.Keywords: computerized physician order entry, clinical decision support system, change management, feedback, electronic prescribing

Background: The national e-prescription system in Greece is one of the most important achievements in the e-health sector. Healthcare professionals' feedback is essential to ensure the introduced system tends to their needs and reduces their everyday workload. The number of surveys collecting the users' views is limited, while the existing studies include only a small number of participants. Methods: In this study, healthcare professionals' perceptions on e-prescription are explored. For this, a questionnaire was distributed online, containing closed- and open-ended questions aiming to address strengths and identify drawbacks in e-prescription. Answers were collected from primary health care physicians, specialized medical doctors and pharmacists. Results: In total, 430 answers were collected (129 from primary health care physicians, 164 responses from specialized medical doctors and 137 pharmacists). Analysis of the collected answers reveals that the views of the three groups of healthcare professionals mostly converge. The positive impact e-prescribing systems have on the overall prescribing procedure in preventing errors and providing automation is commented. Among gaps identified and proposed improvements, health care professionals note the need for access to information on adverse drug reactions, side effects, drug-to-drug interactions and allergies. Flexible interaction with Therapeutic Prescription Protocols is desired to ameliorate monitoring and decision-making, while drug dosing features, and simplified procedures for copying, repeating, canceling a prescription, are perceived as useful to incorporate. Conclusions: Collecting healthcare professionals' feedback is important, as their views can be transcribed to system requirements, to further promote e-prescribing and improve the provided health care services by facilitating decision making through safer and more efficient e-prescription. Introduction of the identified improvements can simplify the everyday workflow of healthcare professionals. To the best of our knowledge, a survey with more than 400 answered questionnaires on the use of e-prescription systems by healthcare professionals has never been conducted in Greece before. [ABSTRACT FROM AUTHOR]

Aims: We aim to examine and understand the work processes of antimicrobial stewardship (AMS) teams across 2 hospitals that use the same digital intervention, and to identify the barriers and enablers to effective AMS in each setting. Methods: Employing a contextual inquiry approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) model, observations and semistructured interviews were conducted with AMS team members (n = 15) in 2 Australian hospitals. Qualitative data analysis was conducted, mapping themes to the SEIPS framework. Results: Both hospitals utilized similar systems, however, they displayed variations in AMS processes, particularly in postprescription review, interdepartmental AMS meetings and the utilization of digital tools. An antimicrobial dashboard was available at both hospitals but was utilized more at the hospital where the AMS team members were involved in the dashboard's development, and there were user champions. At the hospital where the dashboard was utilized less, participants were unaware of key features, and interoperability issues were observed. Establishing strong relationships between the AMS team and prescribers emerged as key to effective AMS at both hospitals. However, organizational and cultural differences were found, with 1 hospital reporting insufficient support from executive leadership, increased prescriber autonomy and resource constraints. Conclusion: Organizational and cultural elements, such as executive support, resource allocation and interdepartmental relationships, played a crucial role in achieving AMS goals. System interoperability and user champions further promoted the adoption of digital tools, potentially improving AMS outcomes through increased user engagement and acceptance. [ABSTRACT FROM AUTHOR]

SUMMARY: 'Digital' is an omnipresent yet often vague, misunderstood or feared topic in health services. There are many current and potential gains for individual patients and local populations, clinicians and organisations through optimisation of digital technologies. We argue that understanding the various aspects of digital psychiatry is an essential contemporary need. This is the first of two articles on the subject, exploring the gains and challenges of virtual/online assessments, including ethical considerations and the use of virtual reality and electronic prescribing. [ABSTRACT FROM AUTHOR]

Introduction: Considering the beginning of the implementation of electronic prescription in the country, this study endeavored to explain the challenges during the implementation of electronic prescription. Methods: This study was conducted using a qualitative method through interviews with physicians working in Mashhad University of Medical Sciences in the year 2022. The participants were selected through purposive sampling, after conducting three in-depth interviews, questions were extracted. As the semi-structured interviews were conducted, they were recorded and implemented. To analyze the data, content analysis method and MAXQDA version 10 were used. Results: In this study, the challenges were categorized into two main categories, including the organizational category and the infrastructure category. Organizational challenges are related to insurance, referral of patients, education and information to beneficiaries, monitoring and infrastructure challenges; infrastructure, user interface and database. The main challenges of implementing electronic prescription were related to the outage and slowness of systems and the Internet and the existence of multiple systems for insurances. Conclusion: The infrastructure challenges which are among the important obstacles in the path of the implementation of the electronic prescribing plan should be resolved, to improve the implementation problems, the continuous monitoring of the prescribing systems should be considered and the results should be applied immediately, as it is recommended to reform infrastructures, integrate insurance systems, use electronic signatures and electronic version standards, and provide practical training. [ABSTRACT FROM AUTHOR]

Background: Although electronic prescription cancellation such as via CancelRx can facilitate critical communication between prescribers and pharmacy staff about discontinued medications, there is little work that explores whether CancelRx meets the needs of pharmacy staff users. Objective: This study leverages qualitative interviews with pharmacy staff to address the following question: When medication changes are made by a prescriber using CancelRx, what information is needed by pharmacy staff to make correct and effective decisions in their roles in medication management? Methods: We conducted an inductive thematic analysis of interviews with 11 pharmacy staff members (pharmacists and pharmacy technicians) across three outpatient community pharmacy sites within an academic health care system. Results: Three information needs themes were consistently identified by both pharmacists and pharmacy technicians: prescriber intent when initiating the CancelRx, clinical rationale for the medication change, and intended medication regimen. Notably, both pharmacists and pharmacy technicians often reported seeking multiple information needs not fully addressed by CancelRx in the electronic health record (EHR) to achieve the shared goals of correct dispensing of medications and supporting patient self-management. Conclusions: Our qualitative analysis reveals that outpatient community pharmacy staff in an academic health care system often seek additional information from the (EHR) following medication changes communicated by CancelRx to meet their information needs. Ideally, the prescriber would provide sufficient information through CancelRx to automatically identify all discontinued prescriptions. These limitations highlight the need for design features that support routine communication of needed information at the time of a medication change, such as structured data elements.

With the prosperous development of Internet medical care and increasing flow of electronic prescriptions, electronic prescription review has become an important guarantee for rational drug use in the online medication environment. However, in the Internet scenario, inefficient manual review with low quality increases the risk of adverse drug events. The application of the intelligent auxiliary prescription review system can significantly reduce the working pressure of pharmacists reviewing prescriptions and improve the efficiency of review, but there is a lack of setting standards and standardized management measures in the system architecture, system functions and prescription review rules setting of the Internet medical intelligent auxiliary prescription review system at present, which cannot meet the rapidly developing needs of Internet medical care. Using the construction experience of the prescription review system in medical institutions as a reference, this expert consensus makes recommendations on the construction and application of the Internet medical intelligent auxiliary prescription review system based on the functions and methods of formulating prescription review rules of the existing prescription review system, to further promote the standardization of the Internet medical prescription review work and ensure rational drug use.

ObjectiveTo explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development.Materials and methodsWe conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes.ResultsProviders lacked access to information about: patients' ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information's quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges.DiscussionThese findings can inform the next generation of informatics tools for minimizing patients' out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources.ConclusionResults identified opportunities to fill multidisciplinary providers' information gaps and ways in which new tools could better support medication affordability for patients.

Uncontrolled use of antibiotics (antibacterial, antimicrobial agents) leads to the growth of antibiotic resistance, which has become a global health problem. E-prescribing should increase the population's access to medical and pharmaceutical care. The purpose of the study: to establish the general trends of electronic prescribing of antibacterial drugs in Ukraine since its introduction in August 2022 and the impact of receipt e-prescribing on the controllability of antibiotic use, as well as to analyze the dynamics of the number of prescribed and dispensed electronic prescriptions for antibacterial drugs. We used the following research methods: informative, comparative and retrospective analysis of the dynamics of e-prescriptions for antibiotics. For this purpose, we used the e-data dashboards of the National Health Service of Ukraine (NHSU) and the data of the ENT KP «Pharmacy No.1» in Lviv for the period 08. 2022–05. 2023. In general, Lviv region is consistently in the top three, five or ten regions according to certain indicators. It was established that Lviv region is on the third place in Ukraine in terms of the number of issued e-prescriptions for antibiotics, on the first place in terms of the number of dispensed specified prescriptions, but in terms of the ratio of the number of issued e-prescriptions to those issued, Lviv region is in tenth place. The e-data of the National Health Service of Ukraine shows the nomenclature and number of electronic prescriptions of antibacterial drugs, the number of e-prescriptions that have been released, which are registered in the e-healthcare system. However, during the period of martial law, data on antibacterial drugs dispensed according to paper prescriptions or information certificates, equivalent to them, are not recorded. Thus, the e-data reflect the actual consumption of only those antibiotics that are recorded through the redemption of e-prescriptions, i.e. cover only one prescription segment. It is shown that although e-prescribing increases the control over the prescription of antibiotics, however, in force majeure circumstances of wartime, e-dispensing does not reflect the real picture of antibiotic consumption in general, but only one segment that is recorded in the e-system of health care. However, it is impractical to introduce an exclusively electronic prescription for antibiotics under martial law, as this carries the risk of limiting access to medical care. The use of the e-system allows to establish control over the quantitative indicators and assortment composition of antibiotics prescribed by doctors, which is definitely a necessary stage for improving the rational use of antibacterial drugs and combating antibiotic resistance.

The rapidly developing Information and Communication Technologies (ICT) introduce a wide range of digital applications in the field of health, in the context of electronic health (e-health) and aim at the prolepsis, diagnosis and management of various diseases. Electronic prescribing is a basic e-health service. However, the digitalization, elaboration and data transfer relating to physical condition and health of citizens lurks the risk of their malicious use. Greek legislation has been harmonized with the General Data Protection Regulation (GDPR) established by the European Union to protect individuals against these risks. The present study describes the applications of e-health and attempts to highlight the improvements that electronic prescribing is amenable to the context of its evolution. In addition, it focuses on problems faced by Greek medical institutions in the implementation of the GDPR and classifies them in general issues, which concern organizational and institutional deficiencies and specifically refer to the need to develop consent forms. [ABSTRACT FROM AUTHOR]

Background: Electronic prescribing systems (e-prescription) for medications have many benefits, including patient safety, increase in patient satisfaction, efficiency of pharmacy work, and quality of patient care. However, few studies have been conducted to evaluate the national e-prescription system "Wasfaty" service in Saudi Arabia, which was recently adopted. Objective: The aims of this study were to explore the benefits observed through the use of the system and most frequent challenges experienced by community pharmacists in the Qassim region of Saudi Arabia. Methods: This study was conducted using a descriptive survey on a web-based platform. The target population of the study included community pharmacists in the Qassim region of Saudi Arabia who worked in pharmacy chains utilizing the e-prescription service between September 2022 and November 2022. Descriptive statistics along with multiple ordinal regression were used for data analysis. Results: The study population consisted of 124 pharmacists, of which 62.9% (78/124) were males and 37.1% (46/124) were females. Most of the participants had a positive perception of the e-prescription system with regard to medication safety, with 68.6% (85/124) indicating that e-prescriptions reduce the risk of dispensing errors. However, 81.5% (101/124) did not agree that the e-prescription system resulted in a reduction in workload, and 70.2% (87/124) disagreed that the service increased patient satisfaction. Conclusions: The results of this study indicated that the national e-prescription system has many benefits to healthcare employees and improves their work, particularly for patient safety, reducing medication errors, and improving the management of patient medications. The participants believe that there is a need to improve communication with prescribers, showing concern about the unavailability of some medications; thus, it is important for policymakers to encourage other pharmacy chains and suppliers to join the service to increase patient access to medications. [ABSTRACT FROM AUTHOR]

Introduction: A National Cancer Information System is planned for phased implementation in Irish cancer centres to enable electronic prescribing (ePrescribing) of systemic anti-cancer therapy. This study aimed to capture the opinions of healthcare professionals in a hospital setting relating to the current paper-based workflow for systemic anti-cancer therapy prescribing and their attitudes and expectations of the new ePrescribing system to develop recommendations, which assist in the planning and implementation of future ePrescribing systems. Methods: A mixed methods study of concurrent design was conducted. Interviews with healthcare professionals primarily aimed to evaluate processes and identify areas requiring improvement within the current paper-based workflow for systemic anti-cancer therapy prescribing. An online questionnaire adapted from the Information Systems Expectations and Experiences tool primarily aimed to capture expectations of the new ePrescribing system and attitudes towards the transition. Results: Twelve healthcare professionals were interviewed, and 50 healthcare professionals responded to the online questionnaire (response rate: 33.3%). Eight major themes emerged from interview transcripts relating to opinions on the paper-based workflow. Questionnaire respondents reported positive attitudes towards ePrescribing implementation and had high expectations for workflow improvements and functionalities of the new system. Seven recommendations for ePrescribing implementation were developed: (1) prioritise specific processes; (2) plan for changes in communication; (3) repeat research in the post-implementation setting; (4) ensure good information technology infrastructure and system support; (5) ensure optimum training; (6) outline limitations of clinical decision support; (7) provide clear instructions on local configurability. Conclusion: This study identifies potential challenges in transitioning to ePrescribing and provides recommendations, which assist stakeholders in ensuring safe and effective transitions, thus informing future ePrescribing systems' implementation in haematology/oncology settings. [ABSTRACT FROM AUTHOR]

Resumen: Objetivo: Analizar si informar la frecuencia de administración (FA) en el módulo de prescripción de la estación clínica de atención primaria (ECAP) del Institut Català de la Salut (ICS) mejora la adecuación de la FA de las prescripciones. Diseño: Estudio de adecuación antes-después con control no equivalente de prescripciones sin cambios en la FA. El periodo de estudio incluye desde el 1 de septiembre de 2019 hasta el 29 de febrero de 2020. Emplazamiento: Ámbito de atención primaria. Participantes: Se incluyen las prescripciones de los medicamentos con una única FA adecuada o mayoritariamente adecuada realizadas por los médicos de familia del ICS durante el periodo de estudio. Intervención: Recomendar la FA adecuada en el módulo de prescripción. Mediciones principales: Adecuación definida como la coincidencia entre la FA prescrita y la FA adecuada. Resultados: Tras la intervención se produjo un aumento del 22,75% de prescripciones con FA adecuada. El mayor aumento se dio en los medicamentos del sistema genitourinario y hormonas sexuales. En términos absolutos, el grupo de antiinfecciosos es el que obtuvo más prescripciones con FA adecuada entre los dos periodos. Conclusiones: La intervención aumentó la adecuación en la FA de las prescripciones, lo que supone una mejora en la seguridad y en la eficacia de los tratamientos. Se evidencia que el diseño y la implantación de mejoras en los sistemas de prescripción electrónica contribuye a aumentar la calidad de la prescripción. Abstract: Objective: To assess whether reporting the dosing frequency into the prescription module of the Institut Català de la Salut (ICS) primary care electronic clinical workstation improves the dosing frequency's adequacy of the prescriptions. Design: Before and after study with non-equivalent control of prescriptions without any change in the dosing frequency. The study periods includes from September 1st, 2019 to February 29th, 2020. Location: Primary care setting. Participants: Prescriptions issued by ICS General Practitioner, during the study period of those medicines which indications have a single appropriate dosing frequency or mostly appropriate, are included. Intervention: Recommendation of the appropriate dosing frequency in the prescription module. Main measurements: Adequacy defined as the coincidence between the prescribed dosing frequency and the appropriate dosing frequency. Results: After the intervention there was a 22.75% increase in prescriptions with adequate dosing frequency. The largest increase occurred in the medicines for the genitourinary system and sex hormones. In absolute terms, the group of anti infective for systemic use is the one that obtained more prescriptions with an adequate dosing frequency between the two periods. Conclusions: The intervention increased the dosing frequency's adequacy leading to improvements in the safety and effectiveness of the treatments. It is evident that the design and implementation of improvements in electronic prescription systems contributes to increasing the quality of the prescription.

In our hospital, adherence to the guidelines for peri-operative antimicrobial prophylaxis (PAP) is suboptimal, with overly long courses being common. This practice does not offer any incremental benefit, and it only adds to the burden of antimicrobial consumption, promotes the emergence of antimicrobial resistance, and it is associated with adverse events. Our objective was to study the effect of an electronic reminder on the adherence to each element of PAP after cardiac surgery. We conducted a single center, before and after intervention, prospective cohort study from 1 June 2014 to 30 September 2017. The intervention consisted of a reminder of the hospital guidelines when ordering PAP through the hospital information system. The primary outcome was adherence to the suggested duration of PAP, while secondary outcomes included adherence to the other elements of PAP and incidence of surgical site infections (SSI). We have studied 1080 operations (400 pre-intervention and 680 post-intervention). Adherence to the appropriate duration of PAP increased significantly after the intervention [PRE 4.0% (16/399) vs. POST 15.4% (105/680), chi-square p < 0.001]; however, it remained inappropriately low. Factors associated with inappropriate duration of PAP were pre-operative hospitalization for <3 days, and duration of operation >4 h, while there were significant differences between the chief surgeons. Unexpectedly, the rate of SSIs increased significantly during the study (PRE 2.8% (11/400) vs. POST 5.9% (40/680), chi-square p < 0.019). The implemented intervention achieved a relative increase in adherence to the guideline-recommended PAP duration; however, adherence was still unacceptably low and further efforts to improve adherence are needed. [ABSTRACT FROM AUTHOR]

Background: Obtaining accurate medication histories at transitions of care is challenging, but important for patient safety. Prescription exchange services (PES) securely transfer electronic prescription and dispensing records between prescribers and pharmacies, which is potentially useful data for determining medication histories. Aim: To evaluate the accuracy of PES‐derived medication histories. Methods: Prospective observational study, at two Australian tertiary‐referral health services. A convenience sample of adult inpatients was recruited. The main outcome measure was: proportion of patients with ≥1 errors in their PES‐derived pre‐admission medication histories, compared with gold‐standard best‐possible medication histories, including prescribed and non‐prescribed medications, obtained by pharmacists using multiple sources including patient/carer interview. Results: Of 154 patients (median age 76 years; interquartile range (IQR) 64–84 years; median 10.0 pre‐admission medications; IQR 6.0–14.0), 153 (99.4%) had ≥1 errors in their PES‐derived medication history (median 6.0 errors per patient; IQR 4.0–9.0). Excluding when‐required medications, 146 (94.8%) patients had >1 errors (median 4.0 errors per patient; IQR 2.0–6.0). Omission was the most common error, affecting 549 (33.3%) of 1648 current medications (median 3.0; IQR 1.0–5.0 per patient); 396 (72.1%) omissions were over‐the‐counter medicines. Dose‐regimen errors affected 276 (25.1%) of 1099 current medications captured in PES‐derived medication histories (median 1.0 error per patient; IQR 0.0–3.0). Commission errors (medications in PES‐derived histories that were not current) affected 224 (16.9%) of 1323 medications (median 1.0 error per patient; IQR 1.0–2.0). Conclusions: Medication histories derived solely from a cloud‐based medication record repository had a high error rate compared with patients' actual medication use. Like all medication history sources, data from cloud‐based repositories need to be verified with additional sources including the patient and/or their carer. [ABSTRACT FROM AUTHOR]

Background: One of the most critical steps in the medication process on pediatric wards is the medical prescription. This study aims to investigate the impact of a computerized physician order entry (CPOE) system on Adverse Drug Events (ADEs) and potentially harmful ADEs (pot ADEs) in comparison with paper‐based documentation in a general pediatric ward at a German University hospital. Methods: A prospective pre–post study was conducted. All patients aged 17 years or younger were observed during the study periods (5 months pre‐ and postimplementation). Issues Regarding Medication (IRM) were identified by intensive chart review. Events were assessed regarding causality (WHO), severity (WHO; Dean & Barber for MEs), and preventability (Shumock) and classified into (pot) ADEs, (pot) Medication errors (ME), Adverse drug Reactions (ADR), and Other incidents (OI) accordingly. Results: Total of 333 patients with medication were included in the paper‐based prescribing cohort (phase I) and 320 patients with medication in the electronic prescribing cohort (phase II). In each cohort, patients received a median number of four different drugs (IQR 5 and IQR 4). A total of 3966 IRM was observed. During the hospitalization, 2.7% (n = 9) patients in phase I and 2.8% (n = 9) in phase II experienced an ADE. Potentially harmful MEs were less often observed in the cohort with electronic prescribing (n = 228 vs. n = 562). The mean number per patient significantly decreased from 1.69 to 0.71 (p <.01). Conclusion: The implementation of a CPOE system resulted in a reduction of issues regarding medication, particularly MEs with the potential to harm patients decreased significantly. [ABSTRACT FROM AUTHOR]

We aimed to develop and validate an instrument to detect hospital medication prescribing errors using repurposed clinical decision support system data. Despite significant efforts to eliminate medication prescribing errors, these events remain common in hospitals. Data from clinical decision support systems have not been used to identify prescribing errors as an instrument for physician-level performance. We evaluated medication order alerts generated by a knowledge-based electronic prescribing system occurring in one large academic medical center's acute care facilities for patient encounters between 2009 and 2012. We developed and validated an instrument to detect medication prescribing errors through a clinical expert panel consensus process to assess physician quality of care. Six medication prescribing alert categories were evaluated for inclusion, one of which - dose - was included in the algorithm to detect prescribing errors. The instrument was 93% sensitive (recall), 51% specific, 40% precise, 62% accurate, with an F1 score of 55%, positive predictive value of 96%, and a negative predictive value of 32%. Using repurposed electronic prescribing system data, dose alert overrides can be used to systematically detect medication prescribing errors occurring in an inpatient setting with high sensitivity.

The primary medication non-adherence occurs when a patient does not collect his or her newly prescribed medication. Various studies give estimates that this occurs between 0.2 percent and 74 percent. Recently, this topic has been researched by analyzing data in national electronic prescription systems. The database of the Czech electronic prescription system was used to obtain the number of all prescriptions issued and collected in 2021 for fifty particular substances (associated with six medication groups). Additionally, a similar query was performed with an additional criterion that the same substance had not been prescribed within the last 365 days. The data were obtained separately in five age categories. The total number of prescriptions analyzed in this study was over 21 million, which represents almost 30 percent of all prescriptions issued in the Czech Republic in 2021. The primary medication non-adherence in the selected substances was 4.56 percent, which negatively correlates (rxy = 0.707) with the age of a patient. There is a higher primary non-adherence in the Psychoanaleptics and Lipid modifying medication groups than in the whole studied sample (p < 0.05). Lipid-modifying medication group and several other particular substances showed a larger difference between primary non-adherence and overall nonadherence, indicating issues in the initiation of these drugs. The results of our study are following earlier studies with similar methodologies from other countries. However, the difference between primary non-adherence and overall non-adherence had not been observed in other studies before. The electronic prescription system proved to be a valuable tool for conducting this type of research. [ABSTRACT FROM AUTHOR]

Abstract Background One of the most critical steps in the medication process on pediatric wards is the medical prescription. This study aims to investigate the impact of a computerized physician order entry (CPOE) system on Adverse Drug Events (ADEs) and potentially harmful ADEs (pot ADEs) in comparison with paper‐based documentation in a general pediatric ward at a German University hospital. Methods A prospective pre–post study was conducted. All patients aged 17 years or younger were observed during the study periods (5 months pre‐ and postimplementation). Issues Regarding Medication (IRM) were identified by intensive chart review. Events were assessed regarding causality (WHO), severity (WHO; Dean & Barber for MEs), and preventability (Shumock) and classified into (pot) ADEs, (pot) Medication errors (ME), Adverse drug Reactions (ADR), and Other incidents (OI) accordingly. Results Total of 333 patients with medication were included in the paper‐based prescribing cohort (phase I) and 320 patients with medication in the electronic prescribing cohort (phase II). In each cohort, patients received a median number of four different drugs (IQR 5 and IQR 4). A total of 3966 IRM was observed. During the hospitalization, 2.7% (n = 9) patients in phase I and 2.8% (n = 9) in phase II experienced an ADE. Potentially harmful MEs were less often observed in the cohort with electronic prescribing (n = 228 vs. n = 562). The mean number per patient significantly decreased from 1.69 to 0.71 (p

OBJECTIVE: The study sought to determine availability and use of structured override reasons for drug-drug interaction (DDI) alerts in electronic health records. MATERIALS AND METHODS: We collected data on DDI alerts and override reasons from 10 clinical sites across the United States using a variety of electronic health records. We used a multistage iterative card sort method to categorize the override reasons from all sites and identified best practices. RESULTS: Our methodology established 177 unique override reasons across the 10 sites. The number of coded override reasons at each site ranged from 3 to 100. Many sites offered override reasons not relevant to DDIs. Twelve categories of override reasons were identified. Three categories accounted for 78% of all overrides: will monitor or take precautions, not clinically significant, and benefit outweighs risk. DISCUSSION: We found wide variability in override reasons between sites and many opportunities to improve alerts. Some override reasons were irrelevant to DDIs. Many override reasons attested to a future action (eg, decreasing a dose or ordering monitoring tests), which requires an additional step after the alert is overridden, unless the alert is made actionable. Some override reasons deferred to another party, although override reasons often are not visible to other users. Many override reasons stated that the alert was inaccurate, suggesting that specificity of alerts could be improved. CONCLUSIONS: Organizations should improve the options available to providers who choose to override DDI alerts. DDI alerting systems should be actionable and alerts should be tailored to the patient and drug pairs.

BackgroundComputerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety. Previous reviews show limited effect on patient outcomes. Our objective was to assess the impact of electronic prescribing strategies on medication errors and patient harm in hospitalized patients.MethodsMEDLINE, EMBASE, CENTRAL, and CINAHL were searched from January 2007 to January 2018. We included prospective studies that compared hospital-based electronic prescribing strategies with control, and reported on medication error or patient harm. Data were abstracted by two reviewers and pooled using random effects model. Study quality was assessed using the Effective Practice and Organisation of Care and evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation.ResultsThirty-eight studies were included; comprised of 11 randomized control trials and 27 non-randomized interventional studies. Electronic prescribing strategies reduced medication errors (RR 0.24 (95% CI 0.13, 0.46), I2 98%, n = 11) and dosing errors (RR 0.17 (95% CI 0.08, 0.38), I2 96%, n = 9), with both risk ratios significantly affected by advancing year of publication. There was a significant effect of electronic prescribing strategies on adverse drug events (ADEs) (RR 0.52 (95% CI 0.40, 0.68), I2 0%, n = 2), but not on preventable ADEs (RR 0.55 (95% CI 0.30, 1.01), I2 78%, n = 3), hypoglycemia (RR 1.03 (95% CI 0.62-1.70), I2 28%, n = 7), length of stay (MD - 0.18 (95% - 1.42, 1.05), I2 94%, n = 7), or mortality (RR 0.97 (95% CI 0.79, 1.19), I2 74%, n = 9). The quality of evidence was rated very low.DiscussionElectronic prescribing strategies decrease medication errors and adverse drug events, but had no effect on other patient outcomes. Conservative interpretations of these findings are supported by significant heterogeneity and the preponderance of low-quality studies.

OBJECTIVE:Alert fatigue limits the effectiveness of medication safety alerts, a type of computerized clinical decision support (CDS). Researchers have suggested alternative interactive designs, as well as tailoring alerts to clinical roles. As examples, alerts may be tiered to convey risk, and certain alerts may be sent to pharmacists. We aimed to evaluate which variants elicit less alert fatigue. MATERIALS AND METHODS:We searched for articles published between 2007 and 2017 using the PubMed, Embase, CINAHL, and Cochrane databases. We included articles documenting peer-reviewed empirical research that described the interactive design of a CDS system, to which clinical role it was presented, and how often prescribers accepted the resultant advice. Next, we compared the acceptance rates of conventional CDS-presenting prescribers with interruptive modal dialogs (ie, "pop-ups")-with alternative designs, such as role-tailored alerts. RESULTS:Of 1011 articles returned by the search, we included 39. We found different methods for measuring acceptance rates; these produced incomparable results. The most common type of CDS-in which modals interrupted prescribers-was accepted the least often. Tiering by risk, providing shortcuts for common corrections, requiring a reason to override, and tailoring CDS to match the roles of pharmacists and prescribers were the most common alternatives. Only 1 alternative appeared to increase prescriber acceptance: role tailoring. Possible reasons include the importance of etiquette in delivering advice, the cognitive benefits of delegation, and the difficulties of computing "relevance." CONCLUSIONS:Alert fatigue may be mitigated by redesigning the interactive behavior of CDS and tailoring CDS to clinical roles. Further research is needed to develop alternative designs, and to standardize measurement methods to enable meta-analyses.

The primary medication non-adherence occurs when a patient does not collect his or her newly prescribed medication. Various studies give estimates that this occurs between 0.2 percent and 74 percent. Recently, this topic has been researched by analyzing data in national electronic prescription systems. The database of the Czech electronic prescription system was used to obtain the number of all prescriptions issued and collected in 2021 for fifty particular substances (associated with six medication groups). Additionally, a similar query was performed with an additional criterion that the same substance had not been prescribed within the last 365 days. The data were obtained separately in five age categories. The total number of prescriptions analyzed in this study was over 21 million, which represents almost 30 percent of all prescriptions issued in the Czech Republic in 2021. The primary medication non-adherence in the selected substances was 4.56 percent, which negatively correlates (rxy = 0.707) with the age of a patient. There is a higher primary non-adherence in the Psychoanaleptics and Lipid modifying medication groups than in the whole studied sample (p < 0.05). Lipid-modifying medication group and several other particular substances showed a larger difference between primary non-adherence and overall non-adherence, indicating issues in the initiation of these drugs. The results of our study are following earlier studies with similar methodologies from other countries. However, the difference between primary non-adherence and overall non-adherence had not been observed in other studies before. The electronic prescription system proved to be a valuable tool for conducting this type of research.

Background: Discrepancies in medication lists are common and can contribute to drug-related problems. This study was performed before the implementation of the National Medication List in Sweden, an intervention expected to improve the accuracy of medication lists. Aim: The aim of the study was to examine the number and type of discrepancies in the medication list from pharmacies in Sweden. The secondary aim was to describe the information sources Swedish patients used as their medication lists and how confident they were with the information. Method: Structured interviews were conducted with patients at 13 community pharmacies in Sweden during the period October 5, 2020, to April 16, 2021. The printed medication list was reviewed together with the patient to identify any discrepancies and missing information. Results: A total of 327 patients were included in the study (response rate 51%). The printed medication list from pharmacies was the most common information source for patients to know which medications to use. Two thirds (n = 215) of the patients had at least one discrepancy among their prescriptions and 32% (n = 106) were missing at least one prescription medication. Among all prescriptions (n = 2567) 10% (n = 264) were non-current prescriptions, 9% (n = 238) were duplicates and 3% (n = 88) had the wrong dose. The proportion of prescriptions with discrepancies differed between drug-groups. Conclusion: The discrepancies described in this study can have serious consequences, and results provide a baseline for studies after the implementation of the National Medication List. [ABSTRACT FROM AUTHOR]

Standardized order sets are a pragmatic type of clinical decision support that can improve adherence to clinical guidelines with a list of recommended orders related to a specific clinical context. We developed a structure facilitating the creation of order sets and making them interoperable, to increase their usability. Various orders contained in electronic medical records in different hospitals were identified and included in different categories of orderable items. Clear definitions were provided for each category. A mapping to FHIR resources was performed to relate these clinically meaningful categories to FHIR standards to assure interoperability. We used this structure to implement the relevant user interface in the Clinical Knowledge Platform. The use of standard medical terminologies and the integration of clinical information models like FHIR resources are key factors for creating reusable decision support systems. The content authors should be provided with a clinically meaningful system to use in a non-ambiguous context. [ABSTRACT FROM AUTHOR]

There is scarce information on the adoption of e-commerce among retail pharmacists in developing countries. E-pharmacy is defined as community pharmacies provide either singular or a combination of online pharmacy services e.g., virtual dispensing of controlled medicines, online medicinal product consultation, medication-health related online services, health supplements and beauty product online consultation and product delivery services. This study aimed to explore the interest among licensed retail pharmacists to adopt e-commerce as part of their business provisions and to determine key determinants of their interest in providing e-pharmacy services. A self-administered online survey was distributed to 3858 licensed community pharmacists using an email list which was provided by the Pharmacy Enforcement Division, Ministry of Health. The response rate was 9.15% (N=353). Findings showed that 78.2% of the respondents were interested in providing e-pharmacy services. The key determinants of their interest were influenced by community pharmacists' perceptions towards consumer norms in subscribing to online services, socio-technology trends, pressure from competition and readiness to comply with e-pharmacy regulatory requirements. This study urges the pharmacy authority to formulate business-friendly requirements in empowering community pharmacists to adopt e-pharmacy services and establish a conducive environment for community pharmacists to innovate pharmacy practices. E-pharmacy will benefit the public by providing access to quality medicinal products at competitive prices. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic triggered rapid, fundamental changes, notably increased remote delivery of primary care. While the impact of these changes on medication safety is not yet fully understood, research conducted before the pandemic may provide evidence for possible consequences. To examine the published literature on medication safety incidents associated with the remote delivery of primary care, with a focus on telemedicine and electronic prescribing. Methods: A rapid review was conducted according to the Cochrane Rapid Reviews Methods Group guidance. An electronic search was carried out on Embase and Medline (via PubMed) using key search terms 'medication error', 'electronic prescribing', 'telemedicine' and 'primary care'. Identified studies were synthesised narratively; reported medication safety incidents were categorised according to the WHO Conceptual Framework for the International Classification for Patient Safety. Key Findings: Fifteen studies were deemed eligible for inclusion. All 15 studies reported medication incidents associated with electronic prescribing; no studies were identified that reported medication safety incidents associated with telemedicine. The most commonly reported medication safety incidents were 'wrong label/instruction' and 'wrong dose/strength/frequency'. The frequency of medication safety incidents ranged from 0.89 to 81.98 incidents per 100 electronic prescriptions analysed. Summary: This review of medication safety incidents associated with the remote delivery of primary care identified common incident types associated with electronic prescriptions. There was a wide variation in reported frequencies of medication safety incidents associated with electronic prescriptions. Further research is required to determine the impact of the COVID-19 pandemic on medication safety in primary care, particularly the increased use of telemedicine. [ABSTRACT FROM AUTHOR]

Electronic communication of prescription discontinuation, or CancelRx, has the potential to improve medication safety. We aimed to describe the proportion of discontinued outpatient medications that would result in a CancelRx message to understand its impact on medication safety. We used a data report to identify all outpatient medications discontinued in the electronic health record (EHR) of an academic health system in 1 month (October 2018). Among all 63 485 medications discontinued, 23 118 (36.4%) were e-prescribed, 25 982 (40.9%) were patient-reported or reconciled, and the remainder prescribed nonelectronically. Discontinued high-risk medications were more likely to be e-prescribed (2768 of 5896, 47.0%). A discontinuation reason was specified in 37 353 (58.9%) of all discontinued medications. Approximately one-third to one-half of discontinued medications were e-prescribed within the same EHR and would result in a CancelRx message to the pharmacy. Extension of this functionality to medications reconciled in the EHR could significantly expand the impact of CancelRx on medication safety. In addition, complete and accurate discontinuation reasons are needed to optimize CancelRx implementation. [ABSTRACT FROM AUTHOR]

To explore antimicrobial management processes in Australian residential aged care facilities (RACFs), including antimicrobial prescribing, supply, administration, and documentation to inform surveillance activities. Voluntary, online cross-sectional survey. The survey was disseminated to all South Australian RACFs (n = 237) seeking participation from an infection prevention and control lead (preferred respondent), a nurse or senior RACF staff member, or an aged care pharmacist. The survey was open during May-June 2023. Questions aimed to understand clinical and medication management systems, sources of antimicrobial prescription and supply, management by external health care providers and documentation of antimicrobial administration. A process map of antimicrobial management in RACFs was developed. Of the 54 RACFs included in the analysis (29.5% response rate), most used an electronic clinical documentation system (74.1%) or a hybrid electronic paper-based system (22.2%). Medication charts were either electronic (81.0%), hybrid (5.6%), or paper-based (13.0%). Antimicrobials were prescribed by the resident's usual general practitioner, but also by locums, hospital or specialist physicians, nurse practitioners, virtual care physicians, and dentists. Oral, topical, and inhaled antimicrobial formulations were usually supplied by community pharmacies, and intravenous formulations were predominately supplied by hospitals for administration by outreach nurses. Almost all RACFs (96.2%) had imprest stock of antimicrobials that included both oral and intravenous formulations. Antimicrobials were predominately administered by an enrolled nurse or a registered nurse. Antimicrobial management in RACFs is complex, particularly during care transitions. Multiple prescribers and sources of antimicrobials, use of different systems for clinical documentation, particularly by external health care providers, and clinical governance relating to imprest supplies were identified as key areas where medication management could be improved. Addressing these gaps will facilitate comprehensive, real-time antimicrobial surveillance in Australian RACFs. [ABSTRACT FROM AUTHOR]

Background: Electronic prescribing systems (e-prescription) for medications have many benefits, including patient safety, increase in patient satisfaction, efficiency of pharmacy work, and quality of patient care. However, few studies have been conducted to evaluate the national e-prescription system “Wasfaty” service in Saudi Arabia, which was recently adopted. Objective: The aims of this study were to explore the benefits observed through the use of the system and most frequent challenges experienced by community pharmacists in the Qassim region of Saudi Arabia. Methods: This study was conducted using a descriptive survey on a web-based platform. The target population of the study included community pharmacists in the Qassim region of Saudi Arabia who worked in pharmacy chains utilizing the e-prescription service between September 2022 and November 2022. Descriptive statistics along with multiple ordinal regression were used for data analysis. Results: The study population consisted of 124 pharmacists, of which 62.9% (78/124) were males and 37.1% (46/124) were females. Most of the participants had a positive perception of the e-prescription system with regard to medication safety, with 68.6% (85/124) indicating that e-prescriptions reduce the risk of dispensing errors. However, 81.5% (101/124) did not agree that the e-prescription system resulted in a reduction in workload, and 70.2% (87/124) disagreed that the service increased patient satisfaction. Conclusions: The results of this study indicated that the national e-prescription system has many benefits to healthcare employees and improves their work, particularly for patient safety, reducing medication errors, and improving the management of patient medications. The participants believe that there is a need to improve communication with prescribers, showing concern about the unavailability of some medications; thus, it is important for policymakers to encourage other pharmacy chains and suppliers to join the service to increase patient access to medications.

Paper-based prescriptions have been used for several decades by many healthcare practitioners. The literature suggests that several challenges are associated with handwritten prescriptions that might impact patients’ safety and medication errors. Electronic prescribing (e-prescribing) has been developed to phase out handwritten and computer-generated prescriptions that are printed on paper or faxed directly to a dispensing pharmacy. This research aimed to examine pharmacists’ thoughts about the e-prescribing impact on their practice. We also evaluated the adoption rate of e-prescribing by assessing the proportion of electronic prescriptions (e-Rx) received in community pharmacies across the Canadian provinces. This research was conducted as a secondary analysis of the 2016 National Survey of Community-Based Pharmacists: Use of Digital Health Technology in Practice by Nielson. The survey was conducted in collaboration between Canada Health Infoway and the Canadian Pharmacy Association. The target population of the survey was Canadian pharmacists who were in community practice. The provinces included in this research were Ontario, Quebec, Saskatchewan, Alberta, and British Columbia (n = 450). The findings of this study suggest that community pharmacists in Canada were willing to embrace e-prescribing to support their practice. Most of pharmacists thought that e-prescribing was a useful tool to reduce medication errors and improve efficiency in pharmacies. However, the largest proportion of prescriptions issued by prescribers continue to be in paper form, whether handwritten or computer-generated. Further research is needed to investigate the barriers to the adoption of e-prescribing systems among primary care practitioners in Canada.

Objectives: To assess the impact of an electronic prescribing template with decision support upon the frequency of prescription errors, guideline adherence (relating to dose ranges), and prescription legality when prescribing continuous subcutaneous infusions (CSCI) in a palliative demographic. Design, setting, and participants: Before-and-after study across a large UK city utilizing local prescribing data taken from patients receiving end-of-life care. Intervention: An electronic prescribing template with decision support. Main outcome measures: The following were assessed: (1) the rate of prescription errors; (2) the proportion of prescriptions specifying a dose range and if the specified range complied with local recommendations; and (3) the proportion of prescriptions specifying legal mixing directions. Results: The intervention was associated with a significant reduction in errors of omission, with all prescriptions clearly stating drug indication, route of administration, drug dose, and infusion duration. The numbers of continuous subcutaneous infusion prescriptions that specified dose ranges were similar at baseline and post-intervention, at 71% (n = 122) and 72% (n = 179), respectively. At baseline, 69% (n = 84) of CSCI prescriptions specifying a dose range were deemed safe, and post-intervention, 97% (n = 173) were determined to be safe. At baseline, mixing directions were not specified correctly on any continuous subcutaneous infusion prescriptions, while post-intervention, such directions were correct on 75% (n = 157; p < 0.05) of the prescriptions. Conclusions: The intervention eliminated errors of omission, ensured the safety of prescribed dose ranges, and improved compliance with legislation surrounding the mixing of multicomponent infusions. Overall, the intervention has the potential to improve patient safety at the end of life and to increase the efficiency of community services. [ABSTRACT FROM AUTHOR]

The perspectives of the Compounded Drug Preparation Information Exchange Expert Panel of the United States Pharmacopeia (CDPIE-EP) on the urgent need to create and maintain data standards to support the electronic transmission of an interoperable dataset for compounded nonsterile preparations (CNSPs) for children and the elderly is presented. The CDPIE-EP encourages all stakeholders associated with the generation, transmission, and preparation of CNSPs, including standards-setting and informatics organizations, to discern the critical importance of accurate transmission of prescription to dispensing the final product and an urgent need to create and adopt a seamless, transparent, interoperable, digitally integrated prescribing and dispensing system benefiting of all patients that need CNSPs, especially for children with special healthcare needs and medical complexity (CSHCN-CMC) and for adults with swallowing difficulties. Lay summary: Current electronic prescription processing standards do not permit the complete transmission of compounded nonsterile preparations (CNSPs) from a prescriber to dispenser. This lack creates multiple opportunities for medication errors, especially at transitions of care for children with medical complexity and adults that cannot swallow tablets and capsules. The United States Pharmacopeia Expert Panel on Compounded Drug Preparation Information Exchange aims to reduce this source of error by creating ways and means for CNSPs to be transmitted within computer systems across the continuum of care. Twitter: Digitizing compounded preparation monographs and NDC-like formulation identifiers in computerized prescription systems will minimize error. [ABSTRACT FROM AUTHOR]

Background: Excess prescription and use of short-acting beta-agonist (SABA) inhalers is associated with poor asthma control and increased risk of hospital admission. Aim: To quantify the prevalence and identify the predictors of SABA overprescribing. Design and setting: A cross-sectional study using anonymised clinical and prescribing data from the primary care records in three contiguous East London boroughs. Method: Primary care medical record data for patients aged 5–80 years, with 'active' asthma were extracted in February 2020. Explanatory variables included demography, asthma management, comorbidities, and prescriptions for asthma medications. Results: In the study population of 30 694 people with asthma, >25% (1995/7980), were prescribed ≥6 SABA inhalers in the previous year. A 10-fold variation between practices (<6% to 60%) was observed in the proportion of patients on ≥6 SABA inhalers/year. By converting both SABAs and inhaled corticosteroids (ICSs) to standard units the accuracy of comparisons was improved across different preparations. In total, >25% of those taking ≥6 SABAs/year were underusing ICSs, this rose to >80% (18 170/22 713), for those prescribed <6 SABAs/year. Prescription modality was a strong predictor of SABA overprescribing, with repeat dispensing strongly linked to SABA overprescribing (odds ratio 6.52, 95% confidence interval = 4.64 to 9.41). Increasing severity of asthma and multimorbidity were also independent predictors of SABA overprescribing. Conclusion: In this multi-ethnic population a fifth of practices demonstrate an overprescribing rate of <20% a year. Based on previous data, supporting practices to enable the SABA ≥12 group to reduce to 4–12 a year could potentially save up to 70% of asthma admissions a year within that group. [ABSTRACT FROM AUTHOR]

Objective: To determine the variability of ingredient, strength, and dose form information from drug product descriptions in real-world electronic prescription (e-prescription) data.Materials and Methods: A sample of 10 399 324 e-prescriptions from 2019 to 2021 were obtained. Drug product descriptions were analyzed with a named entity extraction model and National Drug Codes (NDCs) were used to get RxNorm Concept Unique Identifiers (RxCUI) via RxNorm. The number of drug product description variants for each RxCUI was determined. Variants identified were compared to RxNorm to determine the extent of matching terminology used.Results: A total of 353 002 unique pairs of drug product descriptions and NDCs were analyzed. The median (1st-3rd quartile) number of variants extracted for each standardized expression in RxNorm, was 3 (2-7) for ingredients, 4 (2-8) for strength, and 41 (11-122) for dosage forms. Of the pairs, 42.35% of ingredients (n = 328 032), 51.23% of strengths (n = 321 706), and 10.60% of dose forms (n = 326 653) used matching terminology, while 16.31%, 24.85%, and 13.05% contained nonmatching terminology, respectively.Discussion: A wide variety of drug product descriptions makes it difficult to determine whether 2 drug product descriptions describe the same drug product (eg, using abbreviations to describe an active ingredient or using different units to represent a concentration). This results in patient safety risks that lead to incorrect drug products being ordered, dispensed, and used by patients. Implementation and use of standardized terminology may reduce these risks.Conclusion: Drug product descriptions on real-world e-prescriptions exhibit large variation resulting in unnecessary ambiguity and potential patient safety risks. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the number and burden of medication errors associated with prescription information transfer within the National Health Service (NHS) in England and the impact of implementing an interoperable prescription information system (a single digital prescribing record shared across NHS settings) in reducing these errors., Methods: We constructed a probabilistic mathematical model. We estimated the number of transition medication errors that would be undetected by standard medicines reconciliation, based on published literature, and scaled this up based on the annual number of hospital admissions. We used published literature to estimate the proportion of errors that lead to harm and applied this to the number of errors to estimate the associated burden (healthcare resource use and deaths). Finally, we used reported effect sizes for electronic prescription information sharing interventions to estimate the impact of implementing an interoperable prescription information system on number of errors and resulting harm., Results: Annually, around 1.8 million (95% credibility interval (CrI) 1.3 to 2.6 million) medication errors were estimated to occur at hospital transitions in England, affecting approximately 380 000 (95% CrI 260 397 to 539 876) patient episodes. Harm from these errors affects around 31 500 (95% CrI 22 407 to 42 906) patients, with 36 500 (95% CrI 25 093 to 52 019) additional bed days of inpatient care (costing around £17.8 million (95% CrI £12.4 to £24.9 million)) and >40 (95% CrI 9 to 146) deaths. Assuming the implementation of an interoperable prescription information system could reduce errors by 10% and 50%, there could be 180 000-913 000 fewer errors, 3000-15 800 fewer people who experience harm and 4-22 lives saved annually., Conclusions: An interoperable prescription information system could provide major benefits for patient safety. Likely additional benefits include healthcare professional time saved, improved patient experience and care quality, quicker discharge and enhanced cross-organisational medicines optimisation. Our findings provide vital safety and economic evidence for the case to adopt interoperable prescription information systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Antibiotic resistant infections cause over 700,000 deaths worldwide annually. As antimicrobial stewardship (AMS) helps minimise the emergence of antibiotic resistance resulting from inappropriate use of antibiotics in healthcare, we developed ePAMS+ (ePrescribing-based Anti-Microbial Stewardship), an ePrescribing and Medicines Administration (EPMA) system decision-support tool complemented by educational, behavioural and organisational elements., Methods: We conducted a non-randomised before-and-after feasibility trial, implementing ePAMS+ in two English hospitals using the Cerner Millennium EPMA system. Wards of several specialties were included. Patient participants were blinded to whether ePAMS+ was in use; prescribers were not. A mixed-methods evaluation aimed to establish: acceptability and usability of ePAMS+ and trial processes; feasibility of ePAMS+ implementation and quantitative outcome recording; and a Fidelity Index measuring the extent to which ePAMS+ was delivered as intended. Longitudinal semi-structured interviews of doctors, nurses and pharmacists, alongside non-participant observations, gathered qualitative data; we extracted quantitative prescribing data from the EPMA system. Normal linear modelling of the defined daily dose (DDD) of antibiotic per admission quantified its variability, to inform sample size calculations for a future trial of ePAMS+ effectiveness., Results: The research took place during the SARS-CoV-2 pandemic, from April 2021 to November 2022. 60 qualitative interviews were conducted (33 before ePAMS+ implementation, 27 after). 1,958 admissions (1,358 before ePAMS+ implementation; 600 after) included 24,884 antibiotic orders. Qualitative interviews confirmed that some aspects of ePAMS+ , its implementation and training were acceptable, while other features (e.g. enabling combinations of antibiotics to be prescribed) required further development. ePAMS+ uptake was low (28 antibiotic review records from 600 admissions; 0.047 records per admission), preventing full development of a Fidelity Index. Normal linear modelling of antibiotic DDD per admission showed a residual variance of 1.086 (log-transformed scale). Unavailability of indication data prevented measurement of some outcomes (e.g. number of antibiotic courses per indication)., Conclusions: This feasibility trial encountered unforeseen circumstances due to contextual factors and a global pandemic, highlighting the need for careful adaptation of complex intervention implementations to the local setting. We identified key refinements to ePAMS+ to support its wider adoption in clinical practice, requiring further piloting before a confirmatory effectiveness trial., Trial Registration: ISRCTN Registry ISRCTN13429325, 24 March 2022., (© 2024. The Author(s).)

Introduction: Preventable medication errors have been proven to cause significant public health burden, and ePrescription is a key part of the process where medication errors and adverse effects could be prevented. Information systems and "intelligent" computational approaches could provide a valuable tool to prevent such errors with profound impact in clinical practice., Objectives: The PrescIT platform is a Clinical Decision Support System (CDSS) that aims to facilitate the prevention of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in the phase of ePrescription in Greece. The proposed platform could be relatively easily localized for use in other contexts too., Methods: The PrescIT platform is based on the use of Knowledge Engineering (ΚΕ) approaches, i.e., the use of Ontologies and Knowledge Graphs (KGs) developed upon openly available data sources. Open standards (i.e., RDF, OWL, SPARQL) are used for the development of the platform enabling the integration with already existing IT systems or for standalone use. The main KG is based on the use of DrugBank, MedDRA, SemMedDB and OpenPVSignal. In addition, the Business Process Management Notation (BPMN) has been used to model long-term therapeutic protocols used during the ePrescription process. Finally, the produced software has been pilot tested in three hospitals by 18 clinical professionals via in-person think-aloud sessions., Results: The PrescIT platform has been successfully integrated in a transparent fashion in a proprietary Hospital Information System (HIS), and it has also been used as a standalone application. Furthermore, it has been successfully integrated with the Greek National ePrescription system. During the pilot phase, one psychiatric therapeutic protocol was used as a testbed to collect end-users' feedback. Summarizing the feedback from the end-users, they have generally acknowledged the usefulness of such a system while also identifying some challenges in terms of usability and the overall user experience., Conclusions: The PrescIT platform has been successfully deployed and piloted in real-world environments to evaluate its ability to support safer medication prescriptions., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

In our hospital, adherence to the guidelines for peri-operative antimicrobial prophylaxis (PAP) is suboptimal, with overly long courses being common. This practice does not offer any incremental benefit, and it only adds to the burden of antimicrobial consumption, promotes the emergence of antimicrobial resistance, and it is associated with adverse events. Our objective was to study the effect of an electronic reminder on the adherence to each element of PAP after cardiac surgery. We conducted a single center, before and after intervention, prospective cohort study from 1 June 2014 to 30 September 2017. The intervention consisted of a reminder of the hospital guidelines when ordering PAP through the hospital information system. The primary outcome was adherence to the suggested duration of PAP, while secondary outcomes included adherence to the other elements of PAP and incidence of surgical site infections (SSI). We have studied 1080 operations (400 pre-intervention and 680 post-intervention). Adherence to the appropriate duration of PAP increased significantly after the intervention [PRE 4.0% (16/399) vs. POST 15.4% (105/680), chi-square p < 0.001]; however, it remained inappropriately low. Factors associated with inappropriate duration of PAP were pre-operative hospitalization for 4 h, while there were significant differences between the chief surgeons. Unexpectedly, the rate of SSIs increased significantly during the study (PRE 2.8% (11/400) vs. POST 5.9% (40/680), chi-square p < 0.019). The implemented intervention achieved a relative increase in adherence to the guideline-recommended PAP duration; however, adherence was still unacceptably low and further efforts to improve adherence are needed.

Background: The medication‐related death of a hospitalized older adult elucidated the inappropriateness of medication default doses in our electronic health record (EHR) for older adults. In response, we created and implemented the Geriatric Prescribing Context (GPC), an EHR‐based set of age‐specific dose and frequency defaults for patients 75 years and older, in July 2017. Inpatient medication orders aligned with GPC defaults and showed significant dose decreases at one year for nine of ten most commonly used medications. This follow‐up investigation examined GPC alignment of dose and frequency over the 42‐month time period after its implementation. Methods: Order data for the ten most commonly used medications at OHSU Hospital were collected retrospectively from July 2016 through December 2020. We used Statistical Process Control charts to assess the proportion of medication orders aligning with the GPC's recommendations. Signals of special cause were evaluated to identify time periods when shifts in process averages likely occurred and suspected shifts were assessed using binomial proportion tests. We used RStudio (RStudio, Inc., version 1.2.5001) and Microsoft Excel (2016) to perform statistical analyses and control charts, respectively. Results: The preimplementation phase of all medications displayed no special causes. After significant initial improvement in 2017, control charts revealed three different patterns of performance. Eight medications maintained the initial improvement with one medication displaying a second significant improvement at a later date. Two medications showed a subsequent decline in performance not statistically different from baseline. Overall, eight of the ten medications were prescribed at more age‐friendly doses and frequencies compared to baseline after 42 months. Conclusions: The GPC is an effective method to support safer prescribing for hospitalized older patients, but long‐term impacts may be medication‐specific. Further investigation is needed to ensure appropriate prescribing across drug classes and understand the GPC's impact on patient outcomes like adverse drug events. [ABSTRACT FROM AUTHOR]