Impact of clinical indications on inpatient prescriptions.

Introduction and aims: The clinical indication for a prescribed medicine in secondary care is not always clear, accurate or easy to locate within patients' medical notes, making it difficult to assess the appropriateness of the medicine. This study sought to determine the impact of including clinical indications for prescribed medicines in paper and electronic prescribing systems in acute hospitals in England. Methods: This mixed-methods study involved semi-structured telephone interviews with 64 chief pharmacists, 11 focus groups with multidisciplinary healthcare teams (MDTs) from three NHS trusts and a review of medical documentation of 89 patients (who were under the care of MDTs participating in the focus groups). Results: Participants described the inclusion of a clinical indication as "helpful" or "useful". However, from a prescriber's perspective, providing an indication for all medicines would be time consuming and unrealistic, especially with pre-admission medicines where it is more of a transcribing process than a prescribing process and where accuracy may be an issue. Mandatory input of indications in electronic systems was considered impractical unless the systems assisted the prescriber. Only 4 of the 64 trusts (6%) required an indication for all medicines, while 15 trusts (23%) did not require an indication for any medicines because of governance and patient confidentiality issues. Discussion: The inclusion of clinical indications on inpatient prescriptions varies across a range of trusts, which affects clinical workflow, regulation and patient safety. Adding clinical indications to prescriptions impacted negatively on healthcare professionals' clinical workflow, but was viewed favourably in certain circumstances (e.g. for a newly initiated medicine). Conclusion: Current requirements for clinical indications on inpatient prescriptions is variable and the role of electronic systems in enforcing standards is unclear. Management and frontline practitioners recognise both the positives and negatives, but systems that force prescribers through mandatory fields to document clinical indications may be counterproductive. If incorporation of clinical indications on hospital prescriptions is to be successful, health IT systems must embrace user-centred design. [ABSTRACT FROM AUTHOR]