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Electronic Prescription

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1. Effect of New York State Electronic Prescribing Mandate on Opioid Prescribing Patterns. (Abstract)

Effect of New York State Electronic Prescribing Mandate on Opioid Prescribing Patterns. Drug overdose was the leading cause of injury and death in 2013, with drug misuse and abuse causing approximately 2.5 million emergency department (ED) visits in 2011. The Electronic Prescriptions for Controlled Substances (EPCS) program was created with the goal of decreasing rates of prescription opioid addiction, abuse, diversion, and death by making it more difficult to "doctor-shop" and alter (...) prescriptions.In this study, we describe the opioid-prescribing patterns of emergency physicians after the introduction of the New York State EPCS mandate.We conducted a retrospective, single-center, descriptive study with a pre-/post-test design. The pre-implementation period used for comparison was April 1-July 31, 2015 and the post-implementation period was April 1-July 31, 2016. All ED discharge prescriptions for opioid medications prior to and after the initiation of New York State EPCS were

2019 Journal of Emergency Medicine

2. Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial. Full Text available with Trip Pro

Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial. To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections.Open label, two arm, cluster randomised controlled trial.UK general practices (...) in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017.79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered

2019 BMJ Controlled trial quality: predicted high

3. Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study. Full Text available with Trip Pro

Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study. Unnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance.To develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory (...) infections (RTIs).A multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing.A parallel-group, cluster randomised controlled trial.The trial was conducted in 79 general practices in the UK Clinical Practice Research Datalink (CPRD).All registered patients were included.The primary outcome was the rate of antibiotic prescriptions

2019 Health technology assessment (Winchester, England) Controlled trial quality: predicted high

4. Electronic prescribing: risk of potentially harmful errors

physician order entry, CPOE). Some of these errors are similar to those seen with handwritten prescriptions, while others are specific to electronic prescribing and arise through complex mechanisms. Software bugs, computer failure and unreliable or slow internet connections can lead to errors and data loss. The way information is displayed on the screen, often too dense, is also a source of errors. Inputting text outside a field subject to checks – which is often used to bypass a problem – runs the risk (...) Electronic prescribing: risk of potentially harmful errors Prescrire IN ENGLISH - Spotlight ''Electronic prescribing: risk of potentially harmful errors'', 1 July 2016 {1} {1} {1} | | > > > Electronic prescribing: risk of potentially harmful errors Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most recent :  |   |   |   |   |   |   |   |   |  Spotlight Electronic prescribing: risk of potentially harmful

2016 Prescrire

5. Evaluation of computerized provider order entry systems: assessing the usability of systems for electronic prescription Full Text available with Trip Pro

Evaluation of computerized provider order entry systems: assessing the usability of systems for electronic prescription The field of medicine has been influenced by the growth and development of information systems such as the Computerized Provider Order Entry (CPOE) System.This study aimed to evaluate the usability of CPOE systems for electronic prescription in Tehran, Iran.This was an evaluation study conducted in 2017. The research population consisted of the CPOE systems used in hospitals (...) of usability (3.42+0.10) compared to those in public hospitals (2.91+0.25).Two main functions of the studied CPOE systems i.e., decision support and prescription support should be developed to make electronic prescription safer and more intuitive. Addressing usability aspects of CPOE systems in practice could improve the usability of these systems for prescription.

2018 Electronic physician

6. Communication failure: analysis of prescribers' use of an internal free-text field on electronic prescriptions. Full Text available with Trip Pro

Communication failure: analysis of prescribers' use of an internal free-text field on electronic prescriptions. Electronic prescribing promises to improve the safety and clarity of prescriptions. However, it also can introduce miscommunication between prescribers and pharmacists. There are situations where information that is meant to be sent to pharmacists is not sent to them, which has the potential for dangerous errors.To examine how frequently prescribers or administrative personnel put (...) information intended for pharmacists in a field not sent to pharmacists, classify the type of information included, and assess the potential harm associated with these missed messages.Medication record data from our legacy electronic health record were requested for ambulatory care patients seen at an academic medical center from January 1, 2000, to May 31, 2015 (20 123 881 records). From this database, 6 060 272 medication orders met our inclusion criteria. We analyzed a random sample of 10 000

2018 Journal of the American Medical Informatics Association

7. Prescription opioids are associated with higher mortality in patients diagnosed with sepsis: A retrospective cohort study using electronic health records. Full Text available with Trip Pro

Prescription opioids are associated with higher mortality in patients diagnosed with sepsis: A retrospective cohort study using electronic health records. Sepsis continues to be a major problem for hospitalized patients. Opioids are widely used medications for pain management despite recent evidence revealing their adverse effects. The present study evaluates survival differences between opioid-treated patients and non-opioid-treated patients hospitalized with a diagnosis of sepsis. Clinical (...) data was extracted from the University of Minnesota's Clinical Data Repository, which includes Electronic Health Records (EHRs) of the patients seen at 8 hospitals. Among 5,994 patients diagnosed with sepsis, 4,540 opioid-treated patients and 1,454 non-opioid patients were included based on whether they are exposed to prescription opioids during their hospitalization. Cox proportional hazards regression showed that after adjustments for demographics, clinical comorbidities, severity of illness

2018 PLoS ONE

8. Leg ulcer infection: antimicrobial prescribing

Leg ulcer infection: antimicrobial prescribing Leg ulcer infection: antimicrobial prescribing NICE guideline Published: 11 February 2020 www.nice.org.uk/guidance/ng152 © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Your responsibility Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement (...) . Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Leg ulcer infection: antimicrobial prescribing (NG152) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 28Contents Contents Overview 4 Who is it for? 4 Recommendations 5 1.1 Managing leg ulcer

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

9. Large-scale implementation of electronic Integrated Management of Childhood Illness (eIMCI) at the primary care level in Burkina Faso: a qualitative study on health worker perception of its medical content, usability and impact on antibiotic prescription Full Text available with Trip Pro

Large-scale implementation of electronic Integrated Management of Childhood Illness (eIMCI) at the primary care level in Burkina Faso: a qualitative study on health worker perception of its medical content, usability and impact on antibiotic prescription Electronic clinical decision algorithms (eCDAs) that guide clinicians during patient management are being deployed in resource-limited settings to improve the quality of care and rational use of medicines (especially antimicrobials). Little

2019 BMC Public Health

10. The impact of electronic prescription on reducing medication errors in an Egyptian outpatient clinic. (Abstract)

The impact of electronic prescription on reducing medication errors in an Egyptian outpatient clinic. To assess the impact of electronic prescription on the types and rates of medication errors in prescribing and dispensing phases, and to formulate recommendations on the use of electronic prescriptions in Egyptian outpatient practice.Medication errors and correction interventions were collected by reviewing the incident reports obtained from the outpatient pharmacy in a specialized hospital (...) in Egypt. A data collection form was used to classify the errors. The Main outcome measures are prescribing and prescription errors, dispensing errors, error free prescriptions, pharmacy call-backs and phone calls for five months before and five months after the electronic system implementation.3512 incident reports were reviewed for errors in the hand-written and electronic phases. The use of electronic system led to a minor significant 2% reduction in prescribing errors, significant 1.2% decrease

2019 International journal of medical informatics

11. Electronic prescribing in paediatric secondary care: are harmful errors prevented? (Abstract)

Electronic prescribing in paediatric secondary care: are harmful errors prevented? The aim of this research was to ascertain the effectiveness of current electronic prescribing (EP) systems to prevent a standardised set of paediatric prescribing errors likely to cause harm if they reach the patient.Semistructured survey.UK hospitals using EP in the paediatric setting.Number and type of erroneous orders able to be prescribed, and the level of clinical decision support (CDS) provided during (...) the prescribing process.90.7% of the erroneous orders were able to be prescribed across the seven different EP systems tested. Levels of CDS varied between systems and between sites using the same system.EP systems vary in their ability to prevent harmful prescribing errors in the hospital paediatric setting. Differences also occur between sites using the same system, highlighting the importance of how a system is set up and optimised.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights

2019 Archives of Disease in Childhood

12. Risk of mortality and cardiovascular events following macrolide prescription in chronic rhinosinusitis patients: a cohort study using linked primary care electronic health records. Full Text available with Trip Pro

Risk of mortality and cardiovascular events following macrolide prescription in chronic rhinosinusitis patients: a cohort study using linked primary care electronic health records. Macrolide antibiotics have demonstrated important anti-inflammatory and immunomodulatory properties in chronic rhinosinusitis (CRS) patients. However, reports of increased risks of cardiovascular events have led to safety concerns. We investigated the risk of all-cause and cardiac death, and cardiovascular outcomes (...) , associated with macrolide use.Observational cohort (1997-2016) using linked data from the Clinical Practice Research Datalink, Hospital Episodes Statistics, and the Office for National Statistics. Patients aged 16-80 years with CRS prescribed a macrolide antibiotic or penicillin were included, comparing prescriptions for macrolide antibiotics to penicillin. Outcomes were all-cause mortality, cardiac death, myocardial infarction, stroke, diagnosis of peripheral vascular disease, and cardiac

2019 Rhinology

13. 'Warning: allergic to penicillin': association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes. (Abstract)

'Warning: allergic to penicillin': association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes. The prevalence of reported penicillin allergy (PenA) and the impact these records have on health outcomes in the UK general population are unknown. Without such data, justifying and planning enhanced allergy services is challenging.To determine: (i) prevalence of PenA records; (ii) patient characteristics (...) associated with PenA records; and (iii) impact of PenA records on antibiotic prescribing/health outcomes in primary care.We carried out cross-sectional/retrospective cohort studies using patient-level data from electronic health records. Cohort study: exact matching across confounders identified as affecting PenA records. Setting: English NHS general practices between 1 April 2013 and 31 March 2014. Participants: 2.3 million adult patients. Outcome measures: prevalence of PenA, antibiotic prescribing

2019 Journal of Antimicrobial Chemotherapy

14. The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists' activities - a mixed methods study. Full Text available with Trip Pro

The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists' activities - a mixed methods study. The increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists' activities

2019 BMC health services research

15. Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the "Five Moments of Antimicrobial Prescribing". (Abstract)

Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the "Five Moments of Antimicrobial Prescribing". The primary objective of this study was to examine the impact of an electronic medical record (EMR)-driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed "5 Moments (...) of Antimicrobial Prescribing" metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS

2019 Infection control and hospital epidemiology

16. Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurses and pharmacists: intervention development and feasibility study protocol. Full Text available with Trip Pro

Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurses and pharmacists: intervention development and feasibility study protocol. Nurse and pharmacist independent prescribers manage patients with respiratory tract infections and are responsible for around 8% of all primary care antibiotic prescriptions. A range of factors influence the prescribing behaviour of these professionals, however, there are no interventions available specifically to support (...) appropriate antibiotic prescribing behaviour by these groups. The aims of this paper are to describe (1) the development of an intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers and (2) an acceptability and feasibility study designed to test its implementation with these prescribers. METHOD AND ANALYSIS: Development of intervention: a three-stage, eight-step method was used to identify relevant determinants of behaviour change and intervention

2019 BMJ open

17. The Effect of Cognitive Load and Task Complexity on Automation Bias in Electronic Prescribing. (Abstract)

The Effect of Cognitive Load and Task Complexity on Automation Bias in Electronic Prescribing. Determine the relationship between cognitive load (CL) and automation bias (AB).Clinical decision support (CDS) for electronic prescribing can improve safety but introduces the risk of AB, where reliance on CDS replaces vigilance in information seeking and processing. We hypothesized high CL generated by high task complexity would increase AB errors.One hundred twenty medical students prescribed (...) medicines for clinical scenarios using a simulated e-prescribing system in a randomized controlled experiment. Quality of CDS (correct, incorrect, and no CDS) and task complexity (low and high) were varied. CL, omission errors (failure to detect prescribing errors), and commission errors (acceptance of false positive alerts) were measured.Increasing complexity from low to high significantly increased CL, F(1, 118) = 71.6, p < .001. CDS reduced CL in high-complexity conditions compared to no CDS, F(2

2019 Human factors Controlled trial quality: uncertain

18. Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records. Full Text available with Trip Pro

Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records. Quality improvement (QI) is a priority for general practice, and GPs are expected to participate in and provide evidence of QI activity. There is growing interest in harnessing the potential of electronic health records (EHR) to improve patient care by supporting practices to find cases that could benefit from a medicines review.To develop scalable and reproducible prescribing safety (...) Vision and EMIS software systems. Benchmarking reports with patient-level case review lists for two prescribing safety indicators were sent to 457 practices in December 2017 following the initial scale-up (Figure 2).Two indicators were selected from the Royal College of General Practitioners Patient Safety Toolkit following stakeholder consultations for the pilot phase involving 12 GP practices. Pilot phase interviews showed that reports were used to review individual patient care, implement wider QI

2019 British Journal of General Practice

19. Translating Data From an Electronic Prescribing and Medicines Administration System into Knowledge: Application to Doctor-Nurse Time Discrepancy in Antibiotic Ordering and Administration. (Abstract)

Translating Data From an Electronic Prescribing and Medicines Administration System into Knowledge: Application to Doctor-Nurse Time Discrepancy in Antibiotic Ordering and Administration. Electronic Prescribing and Medicines Administration (EPMA) systems are being widely implemented to facilitate medication safety improvement. However, translating the resulting big data into actionable knowledge has received relatively little attention.The objective of this study was to use routinely collected (...) EPMA data in the study of exact time discrepancy between physicians' order and nurses' administration of systemic antibiotics. We evaluated first and follow-up dose administration and dose intervals and examined multifactorial determinants in ordering and administration explaining potential discrepancy.We conducted an observational study of electronic health records for all medical patient stays with antibiotic treatment from January to June 2018 (n=4392) in a large Belgian tertiary care hospital

2019 Medical Care

20. Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD). Full Text available with Trip Pro

Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD). In primary care there is uncertainty about which patients with acute exacerbations of COPD (AECOPD) benefit from antibiotics.To identify which types of COPD patients get the most antibiotics in primary care to support targeted antibiotic stewardship.Observational study of COPD patients using a large English (...) primary care database with 12 month follow-up. We estimated the incidence of and risk factors for antibiotic prescribing relative to the number of AECOPD during follow-up, considering COPD severity, smoking, obesity and comorbidity.From 157 practices, 19594 patients were diagnosed with COPD, representing 2.6% of patients and 11.5% of all prescribed antibiotics. Eight hundred and thirty-three (4.5%) patients with severe COPD and frequent AECOPD were prescribed six to nine prescriptions per year

2019 Journal of Antimicrobial Chemotherapy

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