scholarly journals Nature and management of duplicate medication alerts

2015 ◽  
Vol 22 (4) ◽  
pp. 831-837 ◽  
Author(s):  
Mette Heringa ◽  
Annemieke Floor ◽  
Willemijn M Meijer ◽  
Peter A G M De Smet ◽  
Marcel L Bouvy
Keyword(s):  
Observational Study ◽  
Electronic Patient Record ◽  
Community Pharmacists ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
External Action ◽  
Patient Record ◽  
Community Pharmacies ◽  
Patient Instruction ◽  
Concurrent Use

Abstract Objective: To investigate the nature of duplicate medication (DM) alerts, their management by community pharmacists, and potential characteristics of DM alerts that lead to interventions by pharmacists. Methods: Observational study in 53 community pharmacies. Each pharmacist registered the nature and management of 24 DM alerts on a structured form. Results: On average, the clinical decision support systems generated 20.4 DM alerts per 100 dispensed drugs. In half of the 1272 registered alerts, the pharmacists judged that there was no risk for concurrent use of both prescriptions. In 32% of the alerts, the DM alert was generated for an intentional combination. In 17% of the alerts, there was a risk for unintentional concurrent use. In 32% of the alerts the pharmacists decided that one or more actions were needed: the electronic patient record was updated in 15% of the alerts and in 19% of the alerts the pharmacists performed an external action—for example, informing the patient or modifying the prescription (including 5 therapeutic prescription modifications and 22 logistic prescription modifications). Alerts concerning first dispensing were more likely to be followed by an external action than alerts concerning refills (40% vs 14%, P < .001). Discussion and Conclusion: In community pharmacy, prescription modifications based on DM alerts are rare, but DM alerts lead with some regularity to other actions—for example, patient instruction and update of the electronic patient record. As the current DM alerts are diverse and nonspecific in detecting situations where external action is considered relevant, other ways of alerting should therefore be considered.

SP10.2.12 Information Sustainability: The revitalisation and upcycling of 373,342 historic surgical pathology records into the contemporary electronic patient record in one UK NHS Hospital Trust

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Fatima Rahman ◽  
Alan Hales ◽  
David Cable ◽  
Keith Burrill ◽  
Adrian Bateman ◽  
...  
Keyword(s):  
Electronic Patient Record ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Record ◽  
Clinical Use ◽  
Data Resource ◽  
Cancer Data ◽  
Transition Points ◽  
Pathology Reports ◽  
Cellular Pathology

Abstract Aims Surgical and Cellular pathology (‘e-pathology’) record sets are a valuable data resource with which to populate the Electronic Patient Record (EPR). Accessible reports, even decades old, can be of great value in contemporary clinical decision making and as a resource for longitudinal clinical research. They commonly identify the operation, the location and the pathology, even if not to modern reporting standards. Methods Since 2010, we have built and implemented a timeline structured EPR for the ‘whole-of-life’ visualisation of the electronic documents (e-Docs) of 2.5M+ patients on our Master Index. Prior to this project, our earliest e-Docs dated to 1995. We tracked down 373,342 inert e-pathology reports from our legacy Ferranti (1990-1997) and Masterlab (1997-2004) systems. These were uploaded into our active file servers, following appropriate data quality and patient identity reconciliation checks. Results We have progressively restored 373,342 previously inaccessible e-pathology records to clinical use and to immediacy of access, and in the process extending our “addressable EPR” back to 1990 for living and deceased patients. This process has also allowed us to populate and validate an EPR-integral breast cancer data system of 20,000 cases with e-pathology records dating back to 1990. Conclusions The sustainable revitalisation of old e-pathology reports into a timeline structured EPR creates preserves and upcycles the investment in pathology reporting which is otherwise progressively lost to clinical use. E-pathology records provide reliable, life-long evidence of critical transition points in individual lives and disease progression for clinical and research use, when they can be instantly accessed.

scholarly journals 147. Pharmacist Attitudes Towards Using Clinical Decision Support in Community Pharmacies to Promote Antibiotic Stewardship in the Treatment of Uncomplicated UTI

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S84-S84
Author(s):  
Sena Sayood ◽  
Katie Suda ◽  
Michael Durkin
Keyword(s):  
Decision Support ◽  
Community Pharmacy ◽  
Clinical Decision Support ◽  
Community Pharmacists ◽  
Clinical Decision ◽  
Community Pharmacies ◽  
Uncomplicated Urinary Tract Infection ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
Pharmacist Attitudes

Abstract Background Prior studies of prescribing practices have shown that providers frequently choose non-guideline concordant treatment regimens to treat uncomplicated urinary tract infection (UTI). It has also been shown that uncomplicated UTI can be treated safely, and in a guideline concordant manner, by non-physician providers using an algorithm over the phone. The purpose of this study was to assess pharmacist attitudes towards using a clinical decision support (CDS) tool that would be used to evaluate and manage patients presenting with complaints of UTI in the community pharmacy setting. Methods We conducted semi-structured interviews of community pharmacists (n = 21) from 2019 to 2020 until thematic saturation was reached. Pharmacists were questioned about their attitudes towards stewardship, workflow, interactions with patients and providers, and interest in using a computerized CDS tool. Interviews were recorded, transcribed, and de-identified. Coding and analysis of the interviews was performed using NVivo version 12. Results Pharmacists were interviewed with practice experience ranging from 2 to 54 years (median 13, IQR 6, 27). All pharmacists expressed interest in using CDS to assist with patient evaluations and stewardship. They reported that patients routinely use the community pharmacy as a first stop for medical advice and that they have several interactions per day with patients in which they counsel them on a variety of issues, including UTI. Their assessment and management decisions of UTIs were based on personal knowledge and not on any standard of care. Communication difficulties with primary care offices often delayed management of these patients and lack of information sharing made it difficult for pharmacists to engage in stewardship practices. Conclusion Community pharmacies are an important point of contact for patients and represent a significant opportunity to implement outpatient stewardship interventions. Pharmacists had an overwhelmingly favorable response to the prospect of using a CDS tool, both to help in patient evaluation and to promote antimicrobial stewardship. Based on these results we can conclude that it would be feasible to pilot a CDS tool in community pharmacies to further evaluate its safety and efficacy in the treatment of UTI. Disclosures All Authors: No reported disclosures

scholarly journals Lower alert rates by clustering of related drug interaction alerts

2016 ◽  
Vol 24 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Mette Heringa ◽  
Hidde Siderius ◽  
Annemieke Floor-Schreudering ◽  
Peter A G M de Smet ◽  
Marcel L Bouvy
Keyword(s):  
Renal Function ◽  
Drug Interaction ◽  
Cardiovascular Diseases ◽  
Clinical Decision Support Systems ◽  
Daily Practice ◽  
Clinical Decision ◽  
Community Pharmacies ◽  
Random Data ◽  
Related Drug ◽  
Management Recommendations

Objective: We aimed to investigate to what extent clustering of related drug interaction alerts (drug-drug and drug-disease interaction alerts) would decrease the alert rate in clinical decision support systems (CDSSs). Methods: We conducted a retrospective analysis of drug interaction alerts generated by CDSSs in community pharmacies. Frequently generated combinations of alerts were analyzed for associations in a 5% random data sample (dataset 1). Alert combinations with similar management recommendations were defined as clusters. The alert rate was assessed by simulating a CDSS generating 1 alert per cluster per patient instead of separate alerts. The simulation was performed in dataset 1 and replicated in another 5% data sample (dataset 2). Results: Data were extracted from the CDSSs of 123 community pharmacies. Dataset 1 consisted of 841 572 dispensed prescriptions and 298 261 drug interaction alerts. Dataset 2 was comparable. Twenty-two frequently occurring alert combinations were identified. Analysis of these associated alert combinations for similar management recommendations resulted in 3 clusters (related to renal function, electrolytes, diabetes, and cardiovascular diseases). Using the clusters in alert generation reduced the alert rate within these clusters by 53–70%. The overall number of drug interaction alerts was reduced by 11% in dataset 1 and by 12% in dataset 2. This corresponds to a decrease of 21 alerts per pharmacy per day. Discussion and conclusion: Using clusters of drug interaction alerts with similar management recommendations in CDSSs can substantially decrease the overall alert rate. Further research is needed to establish the applicability of this concept in daily practice.

Improving Coded Data Entry by an Electronic Patient Record System

1996 ◽  
Vol 35 (02) ◽  
pp. 108-111 ◽  
Author(s):  
F. Puerner ◽  
H. Soltanian ◽  
J. H. Hohnloser
Keyword(s):  
Phase I ◽  
Electronic Patient Record ◽  
Data Entry ◽  
Discharge Summary ◽  
Patient Record ◽  
Phase Iii ◽  
Electronic Patient Record System ◽  
Record System ◽  
Data Encoding ◽  
Discharge Summaries

AbstractData are presented on the use of a browsing and encoding utility to improve coded data entry for an electronic patient record system. Traditional and computerized discharge summaries were compared: during three phases of coding ICD-9 diagnoses phase I, no coding; phase II, manual coding, and phase III, computerized semiautomatic coding. Our data indicate that (1) only 50% of all diagnoses in a discharge summary are encoded manually; (2) using a computerized browsing and encoding utility this percentage may increase by 64%; (3) when forced to encode manually, users may “shift” as much as 84% of relevant diagnoses from the appropriate coding section to other sections thereby “bypassing” the need to encode, this was reduced by up to 41 % with the computerized approach, and (4) computerized encoding can improve completeness of data encoding, from 46 to 100%. We conclude that the use of a computerized browsing and encoding tool can increase data quality and the percentage of documented data. Mechanisms bypassing the need to code can be avoided.

Architectures for Architects

1993 ◽  
Vol 32 (01) ◽  
pp. 12-13 ◽  
Author(s):  
M. A. Musen
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Design And Development

Abstract:Response to Heathfield HA, Wyatt J. Philosophies for the design and development of clinical decision-support systems. Meth Inform Med 1993; 32: 1-8.

Characterizing Decision Support Telemedicine Systems

2006 ◽  
Vol 45 (05) ◽  
pp. 523-527 ◽  
Author(s):  
A. Abu-Hanna ◽  
B. Nannings
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Literature Search ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Problem Dimension ◽  
Process Dimension

Summary Objectives: Decision Support Telemedicine Systems (DSTS) are at the intersection of two disciplines: telemedicine and clinical decision support systems (CDSS). The objective of this paper is to provide a set of characterizing properties for DSTSs. This characterizing property set (CPS) can be used for typing, classifying and clustering DSTSs. Methods: We performed a systematic keyword-based literature search to identify candidate-characterizing properties. We selected a subset of candidates and refined them by assessing their potential in order to obtain the CPS. Results: The CPS consists of 14 properties, which can be used for the uniform description and typing of applications of DSTSs. The properties are grouped in three categories that we refer to as the problem dimension, process dimension, and system dimension. We provide CPS instantiations for three prototypical applications. Conclusions: The CPS includes important properties for typing DSTSs, focusing on aspects of communication for the telemedicine part and on aspects of decisionmaking for the CDSS part. The CPS provides users with tools for uniformly describing DSTSs.

COUNSELLING ACTIVITIES OF DRUG USE IN 58 COMMUNITY PHARMACIES AT HUE CITY

2017 ◽  
pp. 75-80
Author(s):  
Quoc Duong Doan ◽  
Thi Ha Vo
Keyword(s):  
Blood Pressure ◽  
Drug Use ◽  
Community Pharmacy ◽  
Key Words ◽  
Community Pharmacists ◽  
Community Pharmacies ◽  
Cough Headache ◽  
Rational Drug ◽  
Question Survey

Background: Community pharmacists play an important role in counseling of rational drug use for population. The study aimed to characterize counselling activities of drug use and demand of counselling tools at some community pharmacies at Hue City. Materials and method: A 17-question survey were asked to fill pharmacy staffs of a convenient sample of 100 community pharmacies at Hue City from 2/2017 to 7/2017. Results: There were 58 pharmacies (58.0%) answered this survey. Cough, headache, fever, high blood pressure and diabetes were the most popular symptoms/diseases presented in pharmacies. Patients often need counselling about dose (82.8%) and when to take medicine (79.3%). The main bariers for counselling were a lack of time (53.4%), and of skills/medthods for counseling (31.7%). About 96.6% pharmacies demanded counselling tools and favorite formats were book (32.9%) or pocket handbook (29.3%). Conclusion: Most pharmacies demanded counselling tools. Other studies should be conducted to develop supporting tools for counseling and to assess the quality of counseling in pharmacies. Key words: community pharmacy, counseling of drug use, pharmacist, Hue

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