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Electronic Prescription

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61. 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

62. 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

63. 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

64. 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

65. 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

66. 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

67. 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

68. Secondary use of data from hospital electronic prescribing and pharmacy systems to support the quality and safety of antimicrobial use: a systematic review. Full Text available with Trip Pro

Secondary use of data from hospital electronic prescribing and pharmacy systems to support the quality and safety of antimicrobial use: a systematic review. Electronic prescribing (EP) and electronic hospital pharmacy (EHP) systems are increasingly common. A potential benefit is the extensive data in these systems that could be used to support antimicrobial stewardship, but there is little information on how such data are currently used to support the quality and safety of antimicrobial use.To (...) to SuD in this context.Ninety-four full-text articles were obtained; 14 met our inclusion criteria. Only two described interventions based on SuD; seven described SuD to evaluate other antimicrobial stewardship interventions and five described descriptive or exploratory studies of potential applications of SuD. Types of data used were quantitative antibiotic usage data ( n  =   9 studies), dose administration data ( n  =   4) and user log data from an electronic dashboard ( n  = 1). Barriers included

2017 The Journal of antimicrobial chemotherapy

69. 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

70. 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

71. The use of electronic alerts in primary care computer systems to identify the over-prescription of short-acting beta2-agonists in people with asthma: a protocol for a systematic review. Full Text available with Trip Pro

The use of electronic alerts in primary care computer systems to identify the over-prescription of short-acting beta2-agonists in people with asthma: a protocol for a systematic review. 28446776 2018 11 13 2055-1010 27 1 2017 Apr 26 NPJ primary care respiratory medicine NPJ Prim Care Respir Med The use of electronic alerts in primary care computer systems to identify the over-prescription of short-acting beta 2 -agonists in people with asthma: a protocol for a systematic review. 30 10.1038

2017 NPJ primary care respiratory medicine

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. 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

74. 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)

75. 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

76. 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

77. 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

78. 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

79. 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

80. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. Full Text available with Trip Pro

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records.  To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs). Cohort study. 610 UK general practices from the UK Clinical Practice (...) Research Datalink. Registered patients with 45.5 million person years of follow-up from 2005 to 2014. Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients. Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice

2016 BMJ

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