Alert Types and Frequencies During Bar Code-Assisted Medication Administration: A Systematic Review.

BACKGROUND: Existing literature explores the effectiveness of bar code-assisted medication administration (BCMA) on the reduction of medication administration error as well as on nurse workarounds during BCMA. However, there is no review that comprehensively explores types and frequencies of alerts generated by nurses during BCMA. PURPOSE: The purpose was to describe alert generation type and frequency during BCMA. METHODS: A systematic review of the literature using PRISMA guidelines was conducted using CINAHL, PubMed, EMBASE, and Ovid Medline databases. RESULTS: After screening for inclusion and exclusion criteria, a total of 8 articles were identified and included in the review. Alert types included patient mismatch, wrong medication, and wrong dose, though other alert types were also reported. The frequency of alert generation varied across studies, from 0.18% to 42%, and not all alerts were clinically meaningful. CONCLUSIONS: This systematic review synthesized literature related to alert type and frequency during BCMA. However, further studies are needed to better describe alert generation patterns as well as factors that influence alert generation.

Perspectives of Oncology Nursing and Investigational Pharmacy in Oncology Research.

OBJECTIVES: This article will provide an overview of the purpose, structure, and function of an investigational pharmacy in oncology clinical research. It will also discuss the role of the oncology nurse in managing investigational drugs (ID) when caring for a patient receiving treatment on a clinical trial and the importance of their role in the trial process. DATA SOURCES: Government regulations, professional guidelines, and best practices. CONCLUSION: ID management for clinical trials is a multidisciplinary process requiring input from various professionals to ensure safe, accurate, and study-specific administration. The nurse's role in the process of clinical trial ID management is dependent on each institution's expectations of clinical research nurses and the scope of their role. IMPLICATIONS FOR NURSING PRACTICE: Multiple nursing roles may be involved in caring for patients who are being treated as part of a clinical trial, including clinical research nurses, infusion nurses, or as nurses providing direct patient care (inpatient or outpatient). Providing education on ID management, specific to the nurse's involvement, is a responsibility of the study team. Ensuring proper safeguards, accurate and protocol-specific delivery and documentation of ID, and completion of patient education are key in the conduct of oncology clinical research.

Pediatric medication safety considerations for pharmacists in an adult hospital setting.

PURPOSE: Risks and vulnerabilities of the medication-use process in nonpediatric institutions that also serve pediatric patients are reviewed, and guidance on risk mitigation strategies is provided. SUMMARY: There are many risks and vulnerabilities in the medication-use process as it relates to pharmacotherapy for pediatric patients admitted to adult institutions. Mitigation of these risks is critical and should encompass various available resources and strategies. Special emphasis should be placed on use of technology to improve overall safety. Available literature recommends optimization of technology and resource use, institutional support for pediatric pharmacists' involvement in managing pediatric medication use, and provision of early exposure to pediatric patients in pharmacist training programs as additional methods of mitigating risks associated with pediatric medication use in adult institutions. Adult hospitals that provide care for pediatric patients should assess their processes in order to identify hospital-specific interventions to promote pediatric medication safety. CONCLUSION: Pediatric medication safety frameworks in U.S. adult institutions vary widely. Treating pediatric patients involves risks in all areas of the medication-use process. Optimizing technology, utilizing external resources, supporting a pediatric pharmacist, and providing early-career exposure to pediatric patients are methods to mitigate risks in institutions that primarily serve adult patients.

Evaluation of the implementation of a clinical pharmacy service on an acute internal medicine ward in Italy.

BACKGROUND: Successful implementation of clinical pharmacy services is associated with improvement of appropriateness of prescribing. Both high clinical significance of pharmacist interventions and their high acceptance rate mean that potential harm to patients could be avoided. Evidence shows that low acceptance rate of pharmacist interventions can be associated with lack of communication between pharmacists and the rest of the healthcare team. The objective of this study was to evaluate the effect of a structured communication strategy on acceptance rate of interventions made by a clinical pharmacist implementing a ward-based clinical pharmacy service targeting elderly patients at high risk of drug-related problems. Characteristics of interventions made to improve appropriateness of prescribing, their clinical significance and intervention acceptance rate by doctors were recorded. METHODS: A clinical pharmacy intervention study was conducted between September 2013 and December 2013 in an internal medicine ward of a teaching hospital. A trained clinical pharmacist provided pharmaceutical care to 94 patients aged over 70 years. The clinical pharmacist used the following communication and marketing tools to implement the service described: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis; Specific, Measurable, Achievable, Realistic and Timely (SMART) goals; Awareness, Interest, Desire, Action (AIDA) model. RESULTS: A total of 740 interventions were made by the clinical pharmacist. The most common drug classes involved in interventions were: antibacterials for systemic use (11.1%) and anti-parkinson drugs (10.8%). The main drug-related problem categories triggering interventions were: no specific problem (15.9%) and prescription writing error (12.0%). A total of 93.2% of interventions were fully accepted by physicians. After assessment by an external panel 63.2% of interventions (96 interventions/ per month) were considered of moderate clinical significance and 23.4% (36 interventions/ per month) of major clinical significance. The most frequent interventions were to educate a healthcare professional (20.4%) and change dose (16.1%). CONCLUSIONS: To our knowledge this is the first study evaluating the effect of a structured communication strategy on acceptance rate of pharmacist interventions. Pharmaceutical care delivered by the clinical pharmacist is likely to have had beneficial outcomes. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.

Pharmacy informatics in multihospital health systems: Opportunities and challenges.

PURPOSE: Challenges and opportunities in managing pharmacy-related technology in a multihospital health system are reviewed. SUMMARY: With electronic medical record (EMR) implementations, pharmacy technology deployments, and increased numbers of hospitals merging into single health systems, opportunities and challenges for pharmacy informatics (PI) teams have grown. Pharmacy leaders must consider the implications of using technology in a multihospital health-system environment, as well as the impact of the health system's organizational structures on technology implementations and dedicated support teams. Common challenges in achieving EMR and other technology implementation and standardization initiatives in multihospital health systems include harmonization of practices across hospitals of various sizes and types and issues of platform compatibility and interoperability. PI teams must collaborate with information technology teams at the system level to identify practical strategies for making the best use of available resources to implement pharmacy automation and software to help pharmacists continue to provide safe and effective patient care. The organizational structures that affect informatics teams, pharmacy integration and standardization initiatives, formulary management practices, data management and analytics, and clinical decision support systems all must be areas of focus. CONCLUSION: An integrated pharmacy enterprise can be well positioned to leverage operational efficiencies gained from appropriate use of technology to enhance patient care. Careful attention must be paid to the manner in which these systems are designed, implemented, and managed in order to make the best use of the technological resources used by the health system.

Implementation of a new method to track propofol in an endoscopy unit.

AIM: Propofol is a widely used anesthesia induction agent and is easily accessible in most healthcare facilities. Unlike regulated or schedule drugs, propofol is inconsistently tracked, leading to inaccurate inventories, incorrect billing, and unrecognized diversion. The goal of this project was to implement a new method of tracking propofol in a single setting, with the aim of accounting for 100% of the drug. METHODS: For two, 2-week observation periods, data were extracted from an automated medication management system or pharmacy inventory system, anesthesia records, and pharmacy billing sheets for cases in a Gastrointestinal (GI) Endoscopy Unit, and compared pre-implementation and post-implementation of a new tracking and accounting protocol. Variables included amount of propofol inventoried, dispensed, administered, returned, billed, wasted, and missing. RESULTS: Pre-implementation (n = 300), 10% cases had no record of propofol removal from the automated medication system. Of the 90% that did, 25% had an amount signed out that did not match the amount administered. Thirty-one percent of all propofol was unaccounted for during this 2-week period. Furthermore, 19.7% of cases did not have a billing form located. Post-implementation of the process change, unaccounted for propofol decreased to 26% of all cases (P = ns). The percentage of missing billing forms decreased from 19.7 to 5.8% (P = 0.00). CONCLUSION: Data suggest notable amounts of propofol were unaccounted for and not billed for in the GI Endoscopy Unit prior to the protocol change. Post-protocol change data reveal modest improved accounting of the medication and significant cost-capture. Improvements may enhance inventory reconciliation, availability of drug stock, and potentially result in a decreased risk of unrecognized diversion.

Information systems in clinical pharmacy applied to parenteral nutrition management and traceability: a systematic review / Sistemas de información en farmacia clínica aplicados a la gestión y trazabilidad de la nutrición parenteral: revisión sistemática

Objective: To review the scientific literature on clinical pharmacy information systems applied to parenteral nutrition (PN) management and traceability. Method: A systematic review of the documents retrieved from the MEDLINE (PubMed), Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts (IPA) and Google Scholar databases up to May, 2016. The terms used, as descriptors and free text, were: ‘Parenteral Nutrition’ and ‘Drug Information Services’. The quality of the articles was assessed using the STROBE Questionnaire. The search was completed through consultation with experts and the bibliographic review of the articles selected. Results: From the 153 references retrieved in our search, after applying inclusion and exclusion criteria, only 6 articles were selected for review. In three of them, flowcharts or some kind of graphical notation were designed in order to develop standard management systems, while three were based on computer programs. In two of the articles selected, a comprehensive management system had been designed for PN control and traceability. Conclusions: PN must be integrated within a standardized system, to ensure its quality and reduce the risks associated with this therapy. The development of technologies applied to PN would enable to set up management systems that are more complete and easier to apply in a real setting. Therefore, we think it will be necessary to generate new specific articles and developments associated with PN management and traceability, in order to allow their constant monitoring and assessment (AU)

Objetivo: Revisar la literatura científica sobre los sistemas de información en farmacia clínica aplicados a la gestión y trazabilidad de la nutrición parenteral (NP). Método: Revisión sistemática de los documentos recuperados en las bases de datos MEDLINE (PubMed), Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts (IPA) y Google Académico hasta mayo de 2016. Los términos utilizados, como descriptores y texto libre, fueron: ‘Parenteral Nutrition’ y ‘Drug Information Services’. La calidad de los artículos se evaluó mediante el cuestionario STROBE. Se completó la búsqueda con la consulta a expertos y la revisión de la bibliografía de los artículos seleccionados. Resultado: De las 153 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron para la revisión seis artículos. Tres trabajos diseñaban diagramas de flujo, o algún tipo de notación gráfica, para desarrollar sistemas normalizados de gestión, y tres se basaban en programas informáticos. Dos de los trabajos seleccionados dise- ñaban un sistema de gestión integral de control y trazabilidad para la NP. Conclusiones: La NP debe integrarse en un sistema estandarizado con el fin de asegurar la calidad y la minimización de los riesgos asociados a esta terapia. Disponer de tecnologías aplicadas a la NP permitiría configurar sistemas de gestión más completos y fáciles de aplicar en un contexto real. Por ende, se cree necesario la generación de nuevos trabajos y desarrollos específicos en relación a la gestión y trazabilidad de la NP que permitan su control y evaluación constante (AU)

'International Centres of Excellence in Hospital Pharmacy'; a SEFH new initiative; the role of the clinical pharmacist in the hospital antibiotic stewardship in Northern Ireland / 'Centros de Excelencia Internacionales en Farmacia Hospitalaria'; una nueva iniciativa de la SEFH; el papel del farmacéutico clínico en la optimización de los antimicrobianos en Irlanda del Norte

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Organizational Benefits of Computerized Physican Order Entry (CPOE) System in Pakistan.

Electronic prescribing is also known as Computerized Physician Order Entry (CPOE). It is a computer-aided system which offers the health professionals a robust platform for entering the prescription electronically. Due to paucity of facilities in Pakistan which are available around the world, there is an observable overburden on the health professionals and practitioners. CPOE system has shown to be very effective in minimizing medication errors. CPOE is beneficial for both patient and health organizations. There is great deal of interest in the adoption of this system in our healthcare system. The results state clearly that this system is equally beneficial for organizations who want to adopt this system as perceived by the health professionals. It supports the idea of adoption and implementation of CPOE in healthcare facilities healthcare institutes. CPOE must be adopted to ease and optimize nursing services in Pakistani healthcare system.

From Usability Engineering to Evidence-based Usability in Health IT.

Usability is a critical factor in the acceptance, safe use, and success of health IT. The User-Centred Design process is widely promoted to improve usability. However, this traditional case by case approach that is rooted in the sound understanding of users' needs is not sufficient to improve technologies' usability and prevent usability-induced use-errors that may harm patients. It should be enriched with empirical evidence. This evidence is on design elements (what are the most valuable design principles, and the worst usability mistakes), and on the usability evaluation methods (which combination of methods is most suitable in which context). To achieve this evidence, several steps must be fulfilled and challenges must be overcome. Some attempts to search evidence for designing elements of health IT and for usability evaluation methods exist and are summarized. A concrete instance of evidence-based usability design principles for medication-related alerting systems is briefly described.

Control en la gestión de las Unidades de Radiofarmacia Hospitalarias: Revisión de las variables a considerar en el uso de Cuadros de Mando Integrales Management control in / Radiopharmacy Hospital Units: Review of the variables to consider using Balanced Scorecards In

Objetivos: Listar las variables imprescindibles en los cuadros de mando integrales para abarcar todas las áreas básicas de trabajo en una Unidad de Radiofarmacia hospitalaria, cuya adecuada gestión puede ser clave para optimizar los recursos disponibles. En segundo lugar, enumerar los beneficios que redundan en la práctica de trabajo diario tras su integración. Métodos: Revisión de la bibliografía publicada sobre cuadros de mando integrales, seleccionando las variables para que el radiofarmacéutico asuma un papel activo en la mejora de su área de trabajo. Se utilizan programas construídos en Microsoft Access para la gestión integral. Se administran en varios módulos toda la información desde la prescripción y citación de los pacientes (asignándoles un código) hasta que se les realiza la exploración. Se recogen también variables como: fecha y hora límites de tramitación de radiofármaco al proveedor; fecha prueba médica; gestión de eluciones de generadores y kits fríos; turnos de trabajo del personal; registro de incidencias tipificadas y de datos de recepción, marcaje, control de calidad y dispensación de cada radiofármaco (asegurando la trazabilidad); detección de desviaciones entre actividad calibrada y medida; la actividad dispensada y la disponible a tiempo real; gestión de eliminación de residuos radiactivos, de existencias y caducidades; fechas de próximas revisiones de equipos; archivado de PNT; sistemas conversores de unidades y registro de informes clínicos. Resultados: Los programas especializados gestionan la información que se maneja en la Unidad de Radiofarmacia, facilitando tomar decisiones coste-efectivas. Los parámetros analizados son: número de preparaciones elaboradas y actividad manejada; posibles incidencias en cualquiera de los procesos cotidianos; porcentaje de resolución satisfactoria sin que derive en falta de disponibilidad; correcta trazabilidad de los radiofármacos; porcentaje de controles de calidad satisfactorios; evolución en el consumo por tipo de radiofármaco, etc. La mejora en la gestión de pedidos asegura la presencia del radiofármaco necesario para cada exploración. Conclusiones: Estos nuevos cuadros de mando integrales son útiles para optimizar pedidos y radiofármacos, asegurar trazabilidad, gestionar inventario, informes clínicos, residuos radiactivos y para evaluar la eficiencia de la Unidad de radiofarmacia, permitiendo la integración de estos datos con otros softwares de gestión sanitaria. Esta metodología puede aplicarse en Centros Sanitarios de Atención Primaria para enfocar al personal en sus funciones asistenciales y operativas

Objetives: We list the essential variables in Balanced Scorecards to cover all basic areas of work in a Radiopharmacy Hospital Unit, whose proper management can be key in optimizing the resources that are available. Secondly, to list the benefits in the practice of daily work that result after integration. Methods: A review of the published literature about Balanced Scorecards, selecting the variables to be collected for the radiopharmaceutical to take an active role in improving his work area. Applications built in Microsoft Access for comprehensive management are used. They are administered in various modules all the information from the prescription and citation patients (assigning a code) until they perform medical test. Also collected variables such as date and time limits for processing radiopharmaceutical supplier; medical test date; management elutions of generators and cold kits; staff work shifts; typified record incidents and receive data, labeling, quality control and dispensing of each radiopharmaceutical (ensuring traceability); detecting deviations between calibrated and measured activity; to know the dispensed activity and available in real time; management of radioactive waste disposal, inventory and expiration dates; dates of upcoming reviews of equipment; SOP filed; converter systems units and registration of clinical reports. Results: These specialized software manage the information handled in daily practice in Radiopharmacy Hospital Unit, facilitating cost-effective decisions. These parameters analyzed are usually: number of elaborate preparations and managed activity; possible incidents in any of the everyday processes; percentage of satisfactory resolution without resulting in unavailability; correct traceability of radiopharmaceuticals; percentage of satisfactory quality controls; evolution in consumption by type of radiopharmaceutical, etc. The improved order management ensures the presence of the radiopharmaceutical needed for each medical test. Conclusions: These new Balanced Scorecards are useful to optimize orders and radiopharmaceuticals, ensure traceability, inventory management, clinical reports, radioactive waste and to evaluate the efficiency of the Radiopharmacy Hospital Unit, allowing the integration of these data with others software health management. This methodology can be applied in Primary Care Health Centers to focus on its healthcare staff and operational functions

Utilization of a Pharmacy Clinical Surveillance System for Pharmacist Alerting and Communication at a Tertiary Academic Medical Center.

The objective of this analysis is to describe the utilization metrics of a pharmacy clinical surveillance system (PCSS) at a tertiary, academic medical center.We performed a retrospective database analysis assessing rule-based alerts (RBA), interventions and pharmacist communication notes documented in the PCSS from January 1, 2014 to December 31, 2014. Reports were generated on 92 unique RBAs sent to clinicians for evaluation. Metrics assessed included the number of RBAs that were triggered, clinically evaluated, intervened on by pharmacists, and therapeutic category of interventions. Pharmacy communication notes were also evaluated.A total of 399,979 RBAs were triggered through the PCSS. During that time, pharmacists documented a total of 17,733 interventions. The most common RBAs were related to lab abnormalities (132,487; 33 %) and anticoagulation/antiplatelet therapy (126,425; 32.1 %). Interventions were most frequently related to RBAs regarding anticoagulation/antiplatelet therapy (6412; 36 %) and antimicrobial therapy (3320; 19 %). Pharmacist communication was most commonly related to clarification of medication and lab orders, and therapeutic drug monitoring.Based on utilization metrics presented, the implementation of a PCSS has successfully generated RBAs to aid pharmacists in clinical practice and improved departmental documentation and communication. Further analysis is warranted to assess the impact of the RBAs, interventions, and communication notes on outcomes such as hospital cost and adverse drug events.

Inhibidores de la bomba de protones: análisis de su utilización en una oficina de farmacia / Proton pump inhibitors: analysis of its usage in a community pharmacy

Introducción: Los inhibidores de la bomba de protones (IBP) son uno de los grupos de medicamentos que más se dispensan en la farmacia comunitaria. Actúan sobre los síntomas derivados de una excesiva acidez gástrica. Objetivos: Analizar el uso de los IBP en una oficina de farmacia comunitaria, comparando los resultados con los obtenido en estudios similares. Métodos: Se invitó a 34 pacientes (62% mujeres, edad media 61,47 años), que acudieron a retirar un IBP para uso propio, a cumplimentar un cuestionario estructurado con 10 preguntas relacionadas con el uso de estos medicamentos. Resultados: La primera prescripción del IBP fue realizada por el médico de atención primaria en 65% y por el especialista en el 32%. Omeprazol fue el IBP más prescrito (88%). El 91% de los pacientes llevaba tomando el fármaco más de un año y el 35% más de 10 años. Un 47% de los pacientes habían interrumpido el tratamiento en alguna ocasión; presentando el 63% molestias gástricas sugestivas de rebote ácido tras la interrupción. Los motivos para el uso de IBP fueron: patología digestiva diagnosticada (21%) o no diagnosticada (21%), toma de AINEs (21%) y de otros medicamentos (37%). Se demostró una falta de conocimiento generalizada sobre los objetivos del uso de IBP y la forma de utilizarlos. Conclusiones: Los IBP, se utilizan de forma excesiva, tanto por las indicaciones como por la duración del tratamiento. Este uso no racional puede desencadenar problemas de salud

Introduction: Proton pump inhibitors (PPI) are one of the drugs most frequently dispensed by pharmacies. They are used to decrease the symptoms derived of an excessive gastric acid secretion. Objectives: To analyse the usage of PPIs in a community pharmacy, comparing the results with those reported in similar studies. Methods: 34 patients (62% women, average age 61.47 years), who came to remove a PPI for own use, were invited to complete a questionnaire with 10 questions related to the usage of PPI. Results: The primary care physician provided the first prescription of PPIs in 65% of patients, while in 32% the prescription was done by a specialist. Omeprazole was the most prescribed PPIs (88%). Most patients (91%) had been taking the drug over a year and 35% over 10 years. Discontinuation of treatment was reported by 47% of the patients, with 63% showing gastric discomfort suggestive of acid rebound. Prescription of PPIs was related to diagnosed (21%) or undiagnosed (21%) digestive diseases, intake of NSAIDs (21%) or other medications (37%). A general lack of knowledge about the objectives of PPI usage and how to use them were also demonstrated. Conclusions: This study shows the overuse of PPI regarding both, the indications and the duration of therapy. The improper usage of PPI may trigger negative consequences for patients

Development of the management for parenteral nutrition traceability in a standard hospital / Desarrollo de la gestión de la trazabilidad de la nutrición parenteral en un hospital tipo

Objective: to develop the traceability control and the hazard analysis in the processes of parenteral nutrients (PN). Method: a standardized graphical notation was generated, describing in detail each of the stages in the overall process. The presence of hazards was analysed by sequencing decisions. The existence of Control Points (CP) or Critical Control Points (CCP) was estimated by Criticality Index (CI) for each hazard taking into account the probability of occurrence and the severity of the damage. The threshold for the IC was set in 6. Results: a specific flow chart for the management and traceability of PN was obtained, defining each of the stages in CPs (validation and transcription of the prescription and administration) or CCPs (preparation, storage and infusion pump –flow and filter-). Stages regarding the delivery, the recovery and the recycle of the packing material of PNs are not considered CPs and, therefore, they were not included in the dashboard. Conclusions: PN must be dealt with in the frame of a standardized management system in order to improve patient safety, clinical relevance, maximize resource efficiency and minimize procedural issues. The proposed system provides a global management model whose steps are fully defined, allowing monitoring and verification of PN. It would be convenient to make use of a software application to support the monitoring of the traceability management and to store the historical records in order to evaluate the system (AU)

Objetivo: desarrollar el control de la trazabilidad y el análisis de riesgos en el proceso de mezcla de nutrientes parenterales (NP). Método: se diseñó la notación gráfica normalizada, caracterizando cada una de las etapas dentro del proceso global. Se analizó la presencia de riesgos mediante la secuenciación de decisiones. La existencia de Puntos de Control (PC) o de Puntos Críticos de Control (PCC) se calculó mediante el Índice de Criticidad (IC) para cada uno de los riesgos, teniendo en cuenta la probabilidad del suceso y la gravedad de los daños. El punto de corte del IC se estableció en 6. Resultados: se obtuvo el diagrama de flujo específico para la gestión y trazabilidad de la NP, caracterizándose cada una de las etapas en PC (validación y transcripción de la prescripción y administración) o PCC (preparación, conservación y bomba de infusión -flujo y filtro-). Las etapas de entrega de la NP y de recuperación y reciclado del material de envasado no se consideraron PC y, en consecuencia, no fueron incluidos en el cuadro de gestión. Conclusiones: la NP debe integrarse en un sistema normalizado de gestión con el fin de mejorar la seguridad del paciente y la pertinencia clínica, maximizar la eficiencia de los recursos y minimizar los incidentes procesales. El sistema propuesto permite establecer una gestión global cuyas etapas quedan totalmente caracterizadas, permitiendo su control y verificación. Sería deseable disponer de una aplicación informática que facilitara el seguimiento de la gestión de la trazabilidad y tener un histórico de los registros que permita evaluar el sistema (AU)

Modelling the Medication Management System for Resource Limited Settings: A Formal Representation of the Prescribing and Dispensing Phases.

We propose a conceptual data model for relational databases targeting the prescribing and dispensing phases of the medication management system. The model was developed using recommendations from existing standards and guidelines, with necessary modifications made to suit adoption in resource-limited settings. We present the model as an entity-relationship diagram with 10 entities, 12 relationships and 48 attributes. It is our hope that this work will help mitigate barriers in the implementation of electronic prescribing and dispensing standards in the developing world.

User Preferences for Improving the Estonian National e-Prescription Service.

National e-Prescription services are becoming more common in Europe. While enhancing communication between levels of health care, few solutions have demonstrated enhanced quality of care and patient safety benefits. The article presents the results of a project to map the user needs the Estonian national e-prescription service. A survey was conducted among primary care physicians (PCPs) to inquire about their needs in the medication management process. The results showed that PCPs lacked a medication management tool to support patient care across different care settings. A mockup for the national service was developed based on the survey results. The medication management tool features a visual presentation of a patient's medication list and includes decision support functions for allergies and potential interactions. This mockup will be used to further investigate the needs of PCPs as well as other care providers in the medication management process.