scholarly journals Analysis of medication therapy discontinuation orders in new electronic prescriptions and opportunities for implementing CancelRx

2018 ◽  
Vol 25 (11) ◽  
pp. 1516-1523 ◽  
Author(s):  
Yuze Yang ◽  
Stacy Ward-Charlerie ◽  
Nitu Kashyap ◽  
Richelle DeMayo ◽  
Thomas Agresta ◽  
...  
Keyword(s):  
Patient Safety ◽  
Alternative Therapy ◽  
Electronic Prescribing ◽  
Electronic Prescription ◽  
User Training ◽  
Medication Therapy ◽  
Search Terms ◽  
Medication Discontinuation ◽  
Representative Random Sample ◽  
Nationally Representative

Abstract Objective To illustrate the need for wider implementation of the CancelRx message by quantifying and characterizing the inappropriate usage of new electronic prescription (NewRx) messages for communicating discontinuation instructions to pharmacies. Materials and Methods A retrospective analysis on a nationally representative random sample of 1 400 000 NewRx messages transmitted over 7 days to identify e-prescriptions containing medication discontinuation instructions in NewRx text fields. A vocabulary of search terms signifying cancellation instructions was formulated and then iteratively refined. True-positives were subsequently identified programmatically and through manual reviews. Two independent reviewers identified incidences in which these instructions were associated with high-alert or look-alike-sound-like (LASA) medications. Results We identified 9735 (0.7% of the total) NewRx messages containing prescription cancellation instructions with 78.5% observed in the Notes field; 35.3% of identified NewRxs were associated with high-alert or LASA medications. The most prevalent cancellation instruction types were medication strength or dosage changes (39.3%) and alternative therapy replacement orders (39.0%). Discussion While the incidence of prescribers using the NewRx to transmit cancellation instructions was low, their transmission in NewRx fields not intended to accommodate such information can produce significant potential patient safety concerns, such as duplicate or inaccurate therapies. These findings reveal the need for wider industry adoption of the CancelRx message by electronic health record (EHR) and pharmacy systems, along with clearer guidance and improved end-user training, particularly as states increasingly mandate electronic prescribing of controlled substances. Conclusion Encouraging the use of CancelRx and reducing the misuse of NewRx fields would reduce workflow disruptions and unnecessary risks to patient safety.

scholarly journals P044 Can an electronic prescribing system ensure clear anticoagulation discharge communication?

2019 ◽  
Vol 104 (7) ◽  
pp. e2.49-e2
Author(s):  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Discharge Summary ◽  
Electronic Prescribing ◽  
List Type ◽  
Heparin Infusion ◽  
National Patient Safety Agency ◽  
High Dependency ◽  
National Patient ◽  
Discharge Summaries

AimThe National Patient Safety Agency (NPSA)1 identified heparin as a major cause of adverse events associated with adverse incidents, including some fatalities. By ensuring good communication, this should be associated with risk reduction.1 The aim of this study was to ensure there is clear anticoagulation communication on discharge, from the paediatric intensive care unit (PICU) electronic prescribing system (Philips), to the paediatric cardiac high dependency unit and paediatric cardiac ward. To investigate whether the heparin regimen complies with the hospital’s anticoagulant guidelines and if there is any deviation; that this is clearly documented. To find out if there is an indication documented for the heparin regimen chosen and if there is a clear long term plan documented for the patient, after heparin cessation.MethodsA report was generated for all patients who were prescribed a heparin infusion on PICU, between 1st January 2018 and 30th June 2018, from the Philips system. All discharge summaries from the PICU Philips system were reviewed. Only paediatric cardiac patients were included that had a heparin infusion prescribed on discharge, all other discharge summaries were excluded from the study. Each discharge summary was reviewed in the anticoagulant section; for the heparin regimen chosen, whether it complies with the hospital’s anticoagulant guidelines and if there was any deviation whether this was documented. The indication documented of which heparin regimen was chosen and whether a clear long term plan was documented after heparin cessation; for example if the patient is to be transferred onto aspirin, clopidogrel, warfarin or enoxaparin.Results82 discharge summaries were reviewed over the 6 month period between 1st January 2018 and 30th June 2018; 16 were excluded as were not paediatric cardiac, leaving 66 paediatric cardiac discharge summaries that were reviewed. 45 out of 66 (68%) complied with the hospital’s heparin anticoagulation guidelines. Of the 32% that deviated from the protocol; only 33% (7 out of 21) had a reason documented. Only 50% (33) of the summaries reviewed had an indication for anticoagulation noted on the discharge summary and 91% of discharge summaries had a long term anticoagulant plan documented.ConclusionThe electronic prescribing system can help to ensure a clear anticoagulation communication as shown by 91% of the anticoagulation long term plan being clearly documented; making it a more seamless patient transfer. On the Philips PICU electronic prescribing system there is an anticoagulant section on the discharge summary that has 3 boxes that need to be completed; heparin regimen, indication and anticoagulation long term plan. However, despite these boxes; deviations from the anticoagulant protocol were poorly documented as highlighted by only 33% having the reason highlighted in the discharge summary, only 50% of the indications were documented. Despite having prompts for this information on the discharge summary, the medical staffs needs to be aware to complete this information, in order to reduce potential medication errors and risk.ReferenceThe National Patient Safety Agency (NPSA). Actions that make anticoagulant therapy safer. NPSA; March 2007.

scholarly journals Surveillance of Adverse Drug Events Associated with Tocilizumab in Hospitalized Veterans with COVID-19 to Inform Patient Safety and Pandemic Preparedness

2021 ◽  
pp. 1-12
Author(s):  
Rupak Datta ◽  
Alexis Barrett ◽  
Muriel Burk ◽  
Cedric Salone ◽  
Anthony Au ◽  
...  
Keyword(s):  
Patient Safety ◽  
Median Time ◽  
Concomitant Medication ◽  
Chart Review ◽  
Adverse Drug Events ◽  
National Sample ◽  
Pandemic Preparedness ◽  
Medication Discontinuation

Abstract We evaluated adverse drug events (ADE) by chart review in a random national sample of 428 Veterans with COVID-19 who received tocilizumab (n=173/428). ADEs (median time=5 days) occurred in 51/173 (29%) and included hepatoxicity (n=29) and infection (n=13). Concomitant medication discontinuation occurred in 22% of ADE patients; mortality was 39%.

Influence of Income on Health Status and Healthcare Utilization in Working Adults: an Illustration of Health among the Working Poor in Japan

2009 ◽  
Vol 10 (1) ◽  
pp. 79-92 ◽  
Author(s):  
YASUHARU TOKUDA ◽  
SACHIKO OHDE ◽  
OSAMU TAKAHASHI ◽  
SHIGEAKI HINOHARA ◽  
TSUGUYA FUKUI ◽  
...  
Keyword(s):  
Health Status ◽  
Healthcare Utilization ◽  
Income Group ◽  
Working Poor ◽  
Linear Regression Models ◽  
Working Adults ◽  
Co Morbidity ◽  
Representative Random Sample ◽  
Nationally Representative ◽  
The Government

AbstractLittle is known about health of the growing subpopulation of the working poor in Japan. We aimed to evaluate health status and healthcare utilization in relation to income among Japanese working adults. We conducted a one-month prospective cohort study using a health diary in working adults from a nationally representative random sample in Japan. Based on the government criterion, the working poor group was defined as earning an equivalent annual income of less than 1.48 million Japanese-yen. For health status, we measured symptomatic episodes and health-related quality of life (HRQOL). For healthcare utilization, we measured frequencies of visits to a physician or pharmacy, and use of complementary and alternative medicine (CAM). We constructed multiple linear regression models for these measures adjusted for age, gender, and co-morbidity, using annual equivalent income as a 4-level categorical variable.Of 3,568 participants originally enrolled in the study panel, 3,477 completed the survey (response rate 97%). For the purpose of the study, of the 3,568 participants, we analyzed 1,406 working adults who were 20–65 years old (mean age, 40.8 yr: 58.4% men). There were 106 (7.5%) working poor: 56 men (6.8% of working men) and 50 women (8.5% of working women). Compared to the highest income group, the working poor reported the greater number of symptomatic episodes and a slightly lower score of physical component of HRQOL (PCS8). The numbers of symptomatic episodes among the working poor and the highest income group during the 1-month study period were 9.79 (SD, 8.77) and 7.01 (SD, 7.34), respectively (p < 0.01). The PCS8 among the working poor was 48.71 (SD, 7.05) and it was 50.34 (SD, 6.55) among the highest income group (p < 0.01). There was no difference of healthcare utilization by the different levels of income.We concluded that the working poor (7.5% of all working adults) more frequently report symptomatic episodes and show slightly poorer physical health status, compared to the highest income group. Healthcare utilization is not affected by income.

scholarly journals Understanding if, How, and Why Women with Prior Spontaneous Preterm Births are Treated with Progestogens: A National Survey of Obstetrician Practice Patterns

2018 ◽  
Vol 08 (04) ◽  
pp. e315-e324
Author(s):  
Jack Gallagher ◽  
Jennifer Gudeman ◽  
Kylee Heap ◽  
Joy Vink ◽  
Susan Carroll
Keyword(s):  
Eligible Patient ◽  
Preterm Births ◽  
Physician Education ◽  
Maternal Fetal Medicine ◽  
Fetal Medicine ◽  
Vaginal Progesterone ◽  
Hydroxyprogesterone Caproate ◽  
Representative Random Sample ◽  
Nationally Representative

Objective In 2017, the Society for Maternal-Fetal Medicine (SMFM) Guideline Committee reaffirmed that 17α-hydroxyprogesterone caproate (17-OHPC) to prevent preterm birth (PTB) is underutilized. We sought to determine what drove progestogen treatment choice of obstetricians managing pregnant women with histories of 1+ singleton spontaneous PTBs (< 37 weeks) who then delivered singleton gestations within the previous 12 months. Subjects We recruited a nationally representative random sample of obstetricians to abstract medical records of study-qualified patients. Of the 423 study-qualified physicians contacted, 358 (85%) participated; 56 (16%) maternal fetal medicine specialists and 302 (84%) general obstetrician/gynecologists (OB/GYNs) extracted data from 991 eligible patient charts. Results Almost three-fourths of patients (73.6%) were treated with 17-OHPC; 18.6% received vaginal progesterone, and 11.8% were not treated. Key drivers of physicians' choice to (1) prescribe branded 17-OHPC were “FDA (Food and Drug Administration) approval” (52% relative influence [RI]) and “SMFM guidelines” (24% RI); (2) prescribe vaginal progesterone were “ease of administration” (32% RI) and “shortened cervix” (16% RI); and (3) not provide prophylaxis were “patient not informed of risk” (35% RI) and “no shortened cervix” (29% RI). Conclusion Study findings support SMFM's contention of continued 17-OHPC underutilization to prevent PTB. Need for additional physician education merits assessment along with appropriate follow-up actions.

scholarly journals Clinician Perceptions of Timing and Presentation of Drug-Drug Interaction Alerts

2020 ◽  
Vol 11 (03) ◽  
pp. 487-496
Author(s):  
Kate E. Humphrey ◽  
Maria Mirica ◽  
Shobha Phansalkar ◽  
Al Ozonoff ◽  
Marvin B. Harper
Keyword(s):  
Patient Safety ◽  
Information Needs ◽  
Visual Cues ◽  
Rating Scales ◽  
Improve Patient Safety ◽  
General Medicine ◽  
Clinical Decision ◽  
Essential Information ◽  
Medication Discontinuation ◽  
Medication Selection

Abstract Objective Alert presentation of clinical decision support recommendations is a common method for providing information; however, many alerts are overridden suggesting presentation design improvements can be made. This study attempts to assess pediatric prescriber information needs for drug–drug interactions (DDIs) alerts and to evaluate the optimal presentation timing and presentation in the medication ordering process. Methods Six case scenarios presented interactions between medications used in pediatric specialties of general medicine, infectious disease, cardiology, and neurology. Timing varied to include alert interruption at medication selection versus order submission; or was noninterruptive. Interviews were audiotaped, transcribed, and independently analyzed to derive central themes. Results Fourteen trainee and attending clinicians trained in pediatrics, cardiology, and neurology participated. Coders derived 8 central themes from 929 quotes. Discordance exists between medication prescribing frequency and DDI knowledge; providers may commonly prescribe medications for which they do not recognize DDIs. Providers wanted alerts at medication selection rather than at order signature. Alert presentation themes included standardizing text, providing interaction-specific incidence/risk information, DDI rating scales, consolidating alerts, and providing alternative therapies. Providers want alerts to be actionable, for example, allowing medication discontinuation and color visual cues for essential information. Despite alert volume, participants did not “mind being reminded because there is always the chance that at that particular moment (they) do not remember it” and acknowledged the importance of alerts as “essential in terms of patient safety.” Conclusion Clinicians unanimously agreed on the importance of receiving DDI alerts to improve patient safety. The perceived alert value can be improved by incorporating clinician preferences for timing and presentation.

scholarly journals Audit and feedback of antibiotic use

2013 ◽  
Vol 04 (04) ◽  
pp. 583-595 ◽  
Author(s):  
K. Oliver ◽  
B. Egan ◽  
L. Li ◽  
K. Richardson ◽  
I. Sandaradura ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Audit And Feedback ◽  
Electronic Prescribing ◽  
Full Potential ◽  
Prescription Data ◽  
Approval Process ◽  
Electronic Prescription ◽  
Antibiotic Policy ◽  
Roles And Responsibilities ◽  
Reliable Monitoring

SummaryBackground: There is now little doubt that improving antimicrobial use is necessary for the containment of resistance.Objective: To determine whether providing individualised feedback to doctors about their recent compliance with the hospital’s antibiotic policy improves compliance with the policy.Methods: This study was conducted at a teaching hospital in Sydney, Australia. Computerised alerts integrated into the electronic prescribing system (ePS) inform prescribers of the local antibiotic policy. We utilised prescribing data extracted from the ePS for ‘audit and feedback’. Thirty-six prescribers were sent feedback letters via email. We also interviewed doctors who had received letters to explore their views of the feedback and the policy in general.Results: There was no significant change in compliance with the policy following implementation of the feedback intervention (0% compliant vs 11.9%; p = 0.07). Several problems with the policy and the approval process were identified by researchers during auditing and by prescribers during interviews. Some problems identified made it difficult to accurately assess compliance and for doctors to comply with the policy.Conclusions: Our intervention did not result in improved compliance with the antibiotic policy but revealed practical problems with the policy and approval process that had not been identified prior to the trial. Greater support for the policy by senior doctors and the assignment of more clearly defined roles and responsibilities associated with antibiotic use and approval may result in improved compliance. Harnessing the full potential of technology would streamline the antimicrobial approval process and allow more efficient and reliable monitoring of antibiotic use and compliance. Many of the problems we identified are generic issues of importance to all organisations seeking to integrate antimicrobial stewardship into ePS.Citation: Baysari MT, Oliver K, Egan B, Li L, Richardson K, Sandaradura I, Westbrook J I, Day RO. Audit and feedback of antibiotic use: Utilising electronic prescription data. Appl Clin Inf 2013; 4: 583–595http://dx.doi.org/10.4338/ACI-2013-08-RA-0063

scholarly journals Study protocol of a population-based cohort investigating Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth: the PASOS study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036210
Author(s):  
Santiago Felipe Gómez ◽  
Clara Homs ◽  
Julia Wärnberg ◽  
Maria Medrano ◽  
Marcela Gonzalez-Gross ◽  
...  
Keyword(s):  
Physical Activity ◽  
Children And Adolescents ◽  
Diet Quality ◽  
Physical Inactivity ◽  
Smoking Habit ◽  
Population Based ◽  
Sedentary Behaviours ◽  
Registration Number ◽  
Representative Random Sample ◽  
Nationally Representative

IntroductionPhysical activity (PA) is essential to healthy mental and physical development in early life. However, the prevalence of physical inactivity, which is considered a key modifiable driver of childhood obesity, has reached alarming levels among European youth. There is a need to update the data for Spain, in order to establish if current measures are effective or new approaches are needed.Methods and analysisWe present the protocol for Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth (PASOS). This observational, nationally representative, multicentre study aims to determine the PA levels, sedentary behaviours and prevalence of physical inactivity (defined as <60 min of moderate to vigorous PA per day) in a representative sample of Spanish children and adolescents. The PASOS study has recruited a representative random sample of children and adolescents aged 8–16 years from 242 educational centres in the 17 ‘autonomous regions’ into which Spain is divided. The aim is to include a total of 4508 youth participants and their families. Weight, height and waist circumference will be measured by standardised procedures. Adherence to the Mediterranean diet, quality of life, sleep duration, PA and sedentary behaviour are being measured by validated questionnaires. PA is measured by the Physical Activity Unit 7-item Screener. A representative subsample (10% of participants) was randomly selected to wear accelerometers for 9 days to obtain objective data on PA. Parents are asked about their educational level, time spent doing PA, diet quality, self-perceived stress, smoking habit, weight, height, their child’s birth weight and if the child was breast fed.Ethics and disseminationThe study was approved by the Ethics Committee of the Fundació Sant Joan de Déu, Barcelona, Spain. Main findings of the study will be disseminated to the scientific community and to general public by media conferences, social media and a website.Trial registration numberISRCTN34251612.

Perspectives on Electronic Prescribing and Terminologies

2013 ◽  
pp. e370-e373
Author(s):  
David Liebovitz
Keyword(s):  
Patient Safety ◽  
Electronic Medical Records ◽  
Medical Records ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Electronic Prescribing ◽  
Medication History ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Potential Benefits

Electronic medical records provide potential benefits and also drawbacks. Potential benefits include increased patient safety and efficiency. Potential drawbacks include newly introduced errors and diminished workflow efficiency. In the patient safety context, medication errors account for significant patient harm. Electronic prescribing (e-prescribing) offers the promise of automated drug interaction and dosage verification. In addition, the process of enabling e-prescriptions also provides access to an often unrecognized benefit, that of viewing the dispensed medication history. This information is often critical to understanding patient symptoms. Obtaining significant value from electronic medical records requires use of standardized terminology for both targeted decision support and population-based management. Further, generating documentation for a billable encounter requires usage of proper codes. The emergence of International Classification of Diseases (ICD)-10 holds promise in facilitating identification of a more precise patient code while also presenting drawbacks given its complexity. This article will focus on elements of e-prescribing and use of structured chart content, including diagnosis codes as they relate to physician office practices.

Prevalence of Total Daily Walking Among US Adults, 2002–2003

2008 ◽  
Vol 5 (3) ◽  
pp. 337-346 ◽  
Author(s):  
Jared P. Reis ◽  
Caroline A. Macera ◽  
Barbara E. Ainsworth ◽  
Deborah A. Hipp
Keyword(s):  
United States ◽  
Body Mass Index ◽  
Random Sample ◽  
Leisure Time ◽  
The United States ◽  
Time Activity ◽  
Representative Random Sample ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Weekly Frequency

Background:Walking for exercise is a popular leisure-time activity pursuit among US adults; however, little information is available about total daily walking.Methods:A nationally representative random sample of 10,461 US adults (4438 men and 6023 women) was surveyed via telephone between 2002 and 2003. Weekly frequency and daily duration of walking for all purposes in bouts of at least 10 min were measured. Regular walking was defined as walking ≥5 d/wk, ≥30 min/d.Results:Overall, 49% of adults (51% of men and 47% of women) were regular walkers, and approximately 17% reported no walking. Regular walking was significantly higher in employed adults and decreased with increasing age in women and body mass index in both sexes. Total walking was significantly higher among adults with lower levels of educational attainment and did not vary significantly by race/ethnicity.Conclusions:These results affirm the popularity of walking in the United States.

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