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Electronic Prescription

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61. Outcomes of red blood cell transfusions prescribed in organ donors by the Digital Intern, an electronic decision support algorithm. (Abstract)

Outcomes of red blood cell transfusions prescribed in organ donors by the Digital Intern, an electronic decision support algorithm. The Digital Intern (DI) is an electronic decision support tool for the management of organ donors. One algorithm determines the dose, in units of red blood cells to be transfused, based on hematocrit (Hct) thresholds and targets. The effectiveness of the transfusion dose calculated by the DI in terms of achieving the selected Hct target and the duration (...) of the targeted dose is not known.This was a retrospective study to describe the outcomes of transfusions prescribed by the DI. Pre- and posttransfusion Hct levels were compared to define response and all posttransfusion Hct values were plotted to evaluate the duration of the prescribed dose.A total of 120 organ donors were studied and 22 donors had 28 transfusions (six were transfused twice). The transfused donors were a mix of trauma and medical admissions and brain death and cardiac death donors

2017 Transfusion

62. Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study. Full Text available with Trip Pro

Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study. Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the time of electronic (e-) prescriptions for selected (...) antibiotics.This is a retrospective, observational intervention study, conducted within a large, statewide Veterans Affairs health system. Participants are outpatients with an initial visit for ARI. A CDSS was deployed upon e-prescription of selected antibiotics during the study period. From 01/2004 to 05/2006 (pre-withdrawal period), the CDSS targeted azithromycin and the fluoroquinolone gatifloxacin. From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn

2017 BMC Infectious Diseases

63. The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study. Full Text available with Trip Pro

The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study. The aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies (...) discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1-2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8-4.7%; p = 0.04). The most common electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing

2017 BMC health services research

64. The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing. (Abstract)

The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing. OBJECTIVE The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data-including prescriptions, patient-visits, and International Classification of Disease, Tenth Revision (ICD-10) codes-could inform automated antimicrobial audits. DESIGN Outpatient visits during 2016 were retrospectively reviewed, including chart (...) abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared. SETTING Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center. RESULTS In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia

2017 Infection control and hospital epidemiology

65. Monitoring prescribing patterns using regression and electronic health records. Full Text available with Trip Pro

Monitoring prescribing patterns using regression and electronic health records. It is beneficial for health care institutions to monitor physician prescribing patterns to ensure that high-quality and cost-effective care is being provided to patients. However, detecting treatment patterns within an institution is challenging, given that medications and conditions are often not explicitly linked in the health record. Here we demonstrate the use of statistical methods together with data from (...) the electronic health care record (EHR) to analyze prescribing patterns at an institution.As a demonstration of our method, which is based on regression, we collect EHR data from outpatient notes and use a case/control study design to determine the medications that are associated with hypertension. We also use regression to determine which conditions are associated with a preferential use of one or more classes of hypertension agents. Finally, we compare our method to methods based on tabulation.Our results

2017 Medical Informatics and Decision Making

66. Data quality in electronic medical records in Manitoba: Do problem lists reflect chronic disease as defined by prescriptions? Full Text available with Trip Pro

Data quality in electronic medical records in Manitoba: Do problem lists reflect chronic disease as defined by prescriptions? To determine if the problem list (health conditions) in primary care electronic medical records (EMRs) accurately reflects the conditions for which chronic medications are prescribed in the EMR.A retrospective analysis of EMR data.Eighteen primary care clinics across rural and urban Manitoba using the Accuro EMR.Data from the EMRs of active patients seen in an 18-month (...) period (December 18, 2011, to June 18, 2013, or December 3, 2012, to June 3, 2014) were used.The likelihood of documentation in the EMR problem list of those specific chronic diseases for which drug prescriptions were documented in the EMR. Regression modeling was performed to determine the effect of clinic patient load and remuneration type on the completeness of EMR problem lists.Overall problem-list completeness was low but was highest for diabetes and lowest for insomnia. Fee-for-service clinics

2017 Canadian Family Physician

67. Increasing the uptake of electronic prescribing in primary care Full Text available with Trip Pro

Increasing the uptake of electronic prescribing in primary care Electronic prescribing is a form of paperless prescribing that is reported to reduce prescription mistakes and increases the cost effectiveness of the process. In England, around 1.5 million prescriptions are generated in general practice daily. Thus by reducing costs and increasing efficiency of this system through electronic prescribing, costs can be driven down. In this Quality Improvement project, a GP practice in London (...) electronic prescribing form saw fortnightly uptake rates increase by 20%. The addition of leaflets and posters in the practice produced a decrease of 26% in fortnightly uptake rate. The final intervention included a staff meeting, computer notes to remind staff of electronic prescribing and attaching the new forms to paper prescriptions. This saw an increase in rates of 80% over two weeks. Overall, this project has illustrated that information provision of electronic prescribing needs to be more than

2017 BMJ Quality Improvement Reports

68. Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database Full Text available with Trip Pro

Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice.Retrospective cohort register-based study including the Danish National Prescription Register.Population-based study of routine electronic antibiotic prescriptions from Danish general practice.All 975,626 patients who redeemed (...) indication was uncommon.Clinical indications from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation and optimisation of the system is preferable.

2017 Scandinavian journal of primary health care

69. PSYCHOPHARMACOLOGY IN THE AGE OF “BIG DATA”: THE PROMISES AND LIMITATIONS OF ELECTRONIC PRESCRIPTION RECORDS Full Text available with Trip Pro

PSYCHOPHARMACOLOGY IN THE AGE OF “BIG DATA”: THE PROMISES AND LIMITATIONS OF ELECTRONIC PRESCRIPTION RECORDS 28378158 2018 11 13 1179-1934 31 5 2017 05 CNS drugs CNS Drugs Psychopharmacology in the Age of "Big Data": The Promises and Limitations of Electronic Prescription Records. 417-419 10.1007/s40263-017-0419-y Rudorfer Matthew V MV Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, 20892-9629, USA. mrudorfe@mail.nih.gov. eng Z99 MH999999

2017 CNS drugs

70. Antibiotic prescribing frequency amongst patients in primary care: a cohort study using electronic health records. Full Text available with Trip Pro

Antibiotic prescribing frequency amongst patients in primary care: a cohort study using electronic health records. Reducing inappropriate antibiotic prescribing in primary care is a public health priority.We hypothesized that a subset of patients account for the majority of antibiotic prescriptions in primary care. We investigated the relationship between the total amount of antibiotics prescribed, individual-level antibiotic use and comorbidity.This was a cohort study using electronic health (...) records from 1 948 390 adults registered with 385 primary care practices in the UK in 2011-13. We estimated the average number of antibiotic prescriptions per patient and the association between prescribing and comorbidity. We modelled the impact on total prescribing of reducing antibiotic use in those prescribed antibiotics most frequently.On average 30.1% (586 194/1 948 390) of patients were prescribed at least one antibiotic per year. Nine percent (174 602/1 948 390) of patients were prescribed 53

2017 Journal of Antimicrobial Chemotherapy

71. Automation bias in electronic prescribing. Full Text available with Trip Pro

Automation bias in electronic prescribing. Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity (...) and interruptions on AB.One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system. Quality of CDS (correct, incorrect and no CDS) and task complexity (low, low + interruption and high) were varied between conditions. Omission errors (failure to detect prescribing errors) and commission errors (acceptance of false positive alerts) were measured.Compared to scenarios with no CDS, correct CDS reduced omission

2017 Medical Informatics and Decision Making

72. The impact of electronic prescriptions on medication safety in Finnish community pharmacies: A survey of pharmacists. Full Text available with Trip Pro

The impact of electronic prescriptions on medication safety in Finnish community pharmacies: A survey of pharmacists. The purpose was to explore pharmacists' opinions regarding the impacts of electronic prescriptions (ePrescriptions) on medication safety in Finnish community pharmacies. Further objectives were to explore how often and what kinds of ambiguities or errors pharmacists have perceived in ePrescriptions.A survey of randomly selected dispensers (n=1004) and pharmacists (n=228 (...) ) was conducted in 2014.Altogether 778 questionnaires were returned, yielding response rates of 64% (n=635) for dispensers and 65% (n=143) for pharmacists. The respondents felt that ePrescriptions improve medication safety in many areas: they lower the number of prescription forgeries, reduce the risk of dispensing errors, promote better management of the patient's overall medication, facilitate monitoring of duplicative therapy and drug interactions, and lessen the risk of incorrect interpretation

2017 International journal of medical informatics

73. Receipt of multiple outpatient opioid prescriptions is associated with increased risk of adverse outcomes in youth: opioid prescribing trends, individual characteristics, and outcomes from 2005 to 2016. Full Text available with Trip Pro

Receipt of multiple outpatient opioid prescriptions is associated with increased risk of adverse outcomes in youth: opioid prescribing trends, individual characteristics, and outcomes from 2005 to 2016. Data on all outpatient opioid prescriptions (N = 71,647) to youth below age 21 (N = 42,020) from 2005 to 2016 were extracted from electronic medical records within a university hospital system in New Mexico (NM) as were demographic details and markers of morbidity/mortality. Relative risk (...) was calculated for markers of morbidity/mortality based on sociodemographic characteristics. The sample was primarily male (55.0%), Hispanic/Latinx (50.1%), English-speaking (88.9%), and publicly insured (50.1%). Mean age was 13.54 (SD = 6.50). From 2005 to 2016, overall frequency of opioid prescriptions increased by 86.6% (from 2470 to 4610) with the largest increase (206.2%) observed from 2005 to 2008 (2470-7562). Patients who were older, white, and non-Hispanic were more likely to receive multiple opioid

2020 Pain

74. Effectiveness of mental health electronic medical records

care providers (PCPs) from 45 clinics Quantitative: RCT Not specified 20 EFFECTIVENESS OF MENTAL HEALTH ELECTRONIC MEDICAL RECORDS | SAX INSTITUTE care about patients seeing psychiatrists Payment incentive Huerta et al. (2015) USA Mental health clinic e-prescribing tool Alerts Intra-office messaging Task assignments 35 mental healthcare professionals Quantitative: Cross-sectional survey Not specified Jetelina et al. (2018) USA Primary Care Integrated behavioural health (BH) into primary care (...) Effectiveness of mental health electronic medical records Effectiveness of mental health electronic medical records An Evidence Check rapid review brokered by the Sax Institute for the NSW Ministry of Health. November 2019. An Evidence Check rapid review brokered by the Sax Institute for the NSW Ministry of Health. November 2019. This report was prepared by: Yvonne Zurynski, Louise A. Ellis, Huong Ly Tong, Liliana Laranjo, Robyn Clay-Williams, Luke Testa, Anne Groedahl. Australian Institute

2020 Sax Institute Evidence Check

75. Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia

Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia National Clinical Guideline No. 21 National Patient Safety Office Oi?g Náisiúnta um Shábháilteacht Othar December 2019This National Clinical Guideline has been developed by a guideline development group convened by the National Dementia Office, to fulfil priority action point 2.3 (...) . However, most evidence is based on common dementia types, particularly Alzheimer’s dementia; this needs to be borne in mind by the user when applying the evidence to other dementia types. Clinicians’ attention is also drawn to the fact that many psychotropic medications are used “off label” for people with dementia, particularly antipsychotic medication. While this is not prohibited by medicine regulations, it does require particular caution by the prescriber. This National Clinical Guideline

2019 National Clinical Guidelines (Ireland)

76. Core IM: Mind the gap on prescribing meds day vs. Night part 1

Core IM: Mind the gap on prescribing meds day vs. Night part 1 Core IM: Mind the Gap on Prescribing Meds Day vs. Night Part 1 – Clinical Correlations Search Core IM: Mind the Gap on Prescribing Meds Day vs. Night Part 1 May 12, 2019 2 min read Podcast: | Subscribe: | For a transcript of the podcast and show notes: Time Stamps Why do we dose warfarin at night? (2:45) Back to the basics – what are the pharmacodynamics of warfarin and how does vitamin K intake matter? (4:28) Practical matters – so (...) University. All rights reserved. Electronic ISSN 1944-0030. The content of this site is intended for health care professionals.

2019 Clinical Correlations

77. HTA of C-reactive protein point-of-care testing to guide antibiotic prescribing

assessment and to use the following algorithm to guide prescribing in these patients: ? not routinely offering antibiotic therapy if the CRP concentration is less than 20mg/L ? considering a delayed antibiotic prescription (a prescription for use at a later date if the symptoms worsen) if the CRP concentration is between 20mg/L and 100mg/L ? offering antibiotic therapy if the CRP concentration is greater than 100mg/L. It should be noted that semi-quantitative devices will narrow the CRP threshold choices (...) ) The subsequent effect of CRP POCT on the prescription of antibiotics has shown conflicting results, with some studies finding it significantly reduces antibiotic prescribing, (29, 30) while others have found it has little effect (27, 31) Health Technology Assessment (HTA) of CRP POCT Health Information and Quality Authority 13 or may even lead to an increase in antibiotic use (32) and hospitalisation rates. (29) However, the CRP POCT can produce false positive as well as false negative results, leading

2019 Health Information and Quality Authority

78. The Collaborative Assessment, OTCA12, on “C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs)

model to classify patients according to their risk of pneumonia. In these studies, addition of CRP testing to the prediction rule increased its discriminative power. Hopstaken et al. reported that, use of the rule could have C-reactive protein point-of-care testing to guide antibiotic prescribing for acute respiratory tract infections in primary care EUnetHTA Joint Action 3 WP4 16 saved 41% of prescriptions for antibiotics with a 2.5% risk of missing a case of pneumonia [13]. In the study as part (...) and acceptability. There were very limited data on the number of antibiotics prescribed as a delayed prescription. Based on the findings of a single study, patients who receive a delayed prescription may be less likely to redeem it. If delayed prescriptions are common in cases where CRP levels are between 20 and 99 mg/L, our effect estimate could be lower than would be seen in practice given that a higher proportion of these prescriptions may not be redeemed. The reduction in antibiotic prescribing does

2019 EUnetHTA

79. The overuse of proton pump inhibitors: implications for prescribing physicians

, an estimated 7.8% of the country’s adult population was taking prescription PPIs and use of this [1,2]. Given their demonstrated effectiveness for relieving acid-induced symptoms, patients are often started empirically for any reflux-like complaint or other complaints referable to the upper gastrointestinal (GI) tract. However, despite recommendations to reevaluate response after 8 weeks, [3]. In many cases, prescribing inertia takes over and the patient’s PPI is continued indefinitely even in cases (...) The overuse of proton pump inhibitors: implications for prescribing physicians The Overuse of Proton Pump Inhibitors: Implications for Prescribing Physicians – Clinical Correlations Search The Overuse of Proton Pump Inhibitors: Implications for Prescribing Physicians October 15, 2019 7 min read By Matthew Kingery Peer Reviewed Proton pump inhibitors (PPIs), frequently prescribed for dyspepsia and other acid-related disorders, are one of the most commonly used medications in the US. As of 2012

2019 Clinical Correlations

80. ASCIA Guidelines - Adrenaline (epinephrine) autoinjector prescription

be considered, where language barriers and lesser control over food preparation may increase the risk of accidental exposure and access to medical care may also be limited. These factors should be considered when deciding whether an adrenaline autoinjector is prescribed, as they are known risk factors for more severe or fatal allergic reactions. Adrenaline autoinjector prescription is not normally recommended as follows: Asthma without a history of anaphylaxis or generalised allergic reactions. If known (...) Action Plans for Anaphylaxis are available from and contain electronic fields to allow online completion of patient information. The Action Plan must be signed by the prescribing doctor. 5. Appropriate follow-up Yearly review by a patient’s medical practitioner (normally their GP) should occur to: Review any allergic reactions that have occurred since their last review. Examining co-factors (such as poorly controlled or persistent asthma) that may increase the risk of more serious reactions

2019 Australasian Society of Clinical Immunology and Allergy

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