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1.
Farm Hosp ; 44(7): 57-60, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32533673

RESUMO

On the 20th of March 2020, triggered by the public health emergency declared,  the Health Authorities in Madrid reported a legal instruction (Orden 371/2020)  indicating the organization of a provisional hospital to admit patients with  COVID-19 at the Trade Fair Institution (IFEMA). Several pharmacists working in  the Pharmacy and Medical Devices Department of the Madrid Regional Health  Service were called to manage the Pharmacy Department of the  abovementioned hospital. Required permissions to set up a PD were here  authorized urgently. Tackling human and material resources, and computer  systems for drug purchase and electronic prescription, were some of the initial  issues that hindered the pharmaceutical provision required for patients from the  very day one. Once the purchase was assured, mainly by direct purchase from suppliers, drug dispensing up to 1,250 hospitalized patients (25 nursing units) and 8 ICU patients was taken on. Dispensing was carried out  through either drug stocks in the nursing units or individual patient dispensing  for certain drugs. Moreover, safety issues related to prescription were  considered, and as the electronic prescription was implemented we attained  100% prescriptions review and validation. The constitution of a multidisciplinary  Pharmacy and Therapeutics Committee let agree to a pharmacotherapy guide,  pres cription protocols, therapeutic equivalences, interactions, and drug  dispensing circuits. The Pharmacy Department strategy was to ensure a very  quick response to basic tasks keeping the aim to offer a pharmaceutical care of  the highest quality whenever possible. Working under a health emergency  situation, with many uncertainties and continuous pressure was a plight.  However, the spirit of collaboration in and out of the Pharmacy Department was  aligned with the whole hospital motivation to offer the highest quality of  healthcare. These were possibly the keys to allow caring for almost 4,000  patients during the 42 days that the hospital lasted.


Assuntos
Infecções por Coronavirus , Assistência à Saúde/organização & administração , Hospitais Urbanos/organização & administração , Modelos Teóricos , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Betacoronavirus , Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/métodos , Prescrição Eletrônica/normas , Fiscalização e Controle de Instalações/legislação & jurisprudência , Previsões , Planejamento de Instituições de Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitalização , Hospitais Urbanos/legislação & jurisprudência , Humanos , Comunicação Interdisciplinar , Segurança do Paciente , Serviço de Farmácia Hospitalar/legislação & jurisprudência , Comitê de Farmácia e Terapêutica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Espanha
2.
Farm. hosp ; 44(supl.1): 57-60, 2020.
Artigo em Espanhol | IBECS | ID: ibc-190480

RESUMO

El día 20 de marzo de 2020 la Consejería de Sanidad publicó una Orden (371/2020) para la apertura de un centro hospitalario provisional para atender a pacientes COVID-19 en la Institución Ferial de Madrid (IFEMA), por razón de emergencia sanitaria. Se dispuso un equipo de farmacéuticos de la Subdirección General de Farmacia y Productos Sanitarios para la apertura de un Servicio de Farmacia, que obtuvo la autorización correspondiente por el órgano competente, con carácter de urgencia. La gestión de recursos humanos, materiales y de herramientas informáticas para la adquisición y prescripción electrónica fueron unas de las primeras dificultades que se solaparon con el primer reto de garantizar la prestación farmacéutica a los pacientes que atendía el hospital desde el mismo día uno. Asegurada la adquisición, fundamentalmente mediante la compra directa a proveedores, se planteó la dispensación para un máximo de 1.250 pacientes de hospitalización (25 controles de enfermería) y una Unidad de Cuidados Intensivos de 8 pacientes; se establecieron botiquines en las unidades de enfermería y circuitos individualizados de dispensación para determinados medicamentos. A su vez, desde el primer momento se trabajó en la seguridad en la prescripción, llegando a la revisión y validación del 100% de los tratamientos, una vez instaurada la prescripción electrónica. La creación de una omisión de Farmacia y Terapéutica multidisciplinar permitió consensuar la guía farmacoterapéutica, protocolos de prescripción, equivalencias terapéuticas, interacciones y circuitos de dispensación de medicamentos. La estrategia del Servicio de Farmacia se basó en asegurar una res-puesta rápida en las funciones básicas, sin perder la visión de incorporar una atención farmacéutica de la máxima calidad posible a medida que iba siendo factible. A pesar de un escenario adverso, de incertidumbre y presión continuas por la emergencia sanitaria, se ha mantenido un espíritu de colaboración y contribución dentro y fuera del Servicio de Farmacia, alineado con un objetivo común de trabajo en equipo para brindar una atención sanitaria rápida y de la mayor calidad posible. Posiblemente éstas han sido las claves del éxito que han permitido atender a casi 4.000 pacientes en los 42 días de vida del hospital


On the 20th of March 2020, triggered by the public health emergency declared, the Health Authorities in Madrid reported a legal instruction (Orden 371/2020) indicating the organization of a provisional hospital to admit patients with COVID-19 at the Trade Fair Institution (IFEMA).Several pharmacists working in the Pharmacy and Medical Devices Department of the Madrid Regional Health Service were called to manage the Pharmacy Department of the abovementioned hospital. Required permissions to set up a PD were here authorized urgently. Tackling human and material resources, and computer systems for drug purchase and electronic prescription, were some of the initial issues that hindered the pharmaceutical provision required for patients from the very day one. Once the purchase was assured, mainly by direct purchase from suppliers, drug dispensing up to 1,250 hospitalized patients (25 nursing units) and 8 ICU patients was taken on. Dispensing was carried out through either drug stocks in the nursing units or individual patient dispensing for certain drugs. Moreover, safety issues related to prescription were considered, and as the electronic prescription was implemented we attained 100% prescriptions review and validation. The constitution of a multidisciplinary Pharmacy and Therapeutics Committee let agree to a pharmacotherapy guide, prescription protocols, therapeutic equivalences, interactions, and drug dispensing circuits. The Pharmacy Department strategy was to ensure a very quick response to basic tasks keeping the aim to offer a pharmaceutical care of the highest quality whenever possible. Working under a health emergency situation, with many uncertainties and continuous pressure was a plight. However, the spirit of collaboration in and out of the Pharmacy Department was aligned with the whole hospital motivation to offer the highest quality of healthcare. These were possibly the keys to allow caring for almost 4,000 patients during the 42 days that the hospital lasted


Assuntos
Humanos , Infecções por Coronavirus , Assistência à Saúde/organização & administração , Hospitais Urbanos/organização & administração , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Betacoronavirus , Assistência à Saúde/legislação & jurisprudência , Prescrição Eletrônica/normas , Fiscalização e Controle de Instalações/legislação & jurisprudência , Serviço de Farmácia Hospitalar/legislação & jurisprudência , Pneumonia Viral , Espanha , Garantia da Qualidade dos Cuidados de Saúde , Comitê de Farmácia e Terapêutica/organização & administração , Segurança do Paciente
3.
Rev Assoc Med Bras (1992) ; 65(11): 1349-1355, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31800895

RESUMO

OBJECTIVE: To assess the frequency and severity of prescriptions errors with potentially dangerous drugs (heparin and potassium chloride for injection concentrate) before and after the introduction of a computerized provider order entry (CPOE) system. METHODS: This is a retrospective study that compared errors in manual/pre-typed prescriptions in 2007 (Stage 1) with CPOE prescriptions in 2014 (Stage 2) (Total = 1,028 prescriptions), in two high-complexity hospitals of Belo Horizonte, Brasil. RESULTS: An increase of 25% in the frequency of errors in Hospital 1 was observed after the intervention (p<0.001). In contrast, a decreased error frequency of 85% was observed in Hospital 2 (p<0.001). Regarding potassium chloride, the error rate remained unchanged in Hospital 1 (p>0.05). In Hospital 2, a significant decrease was recorded in Stage 2 (p<0.001). A reduced error severity with heparin (p<0.001) was noted, while potassium chloride-related prescription severity remain unchanged (p> 0.05). CONCLUSIONS: The frequency and severity of medication errors after the introduction of CPOE was affected differently in the two hospitals, which shows a need for thorough observation when the prescription system is modified. Control of new potential errors introduced and their causes for the adoption of measures to prevent these events must be in place during and after the implementation of this technology.


Assuntos
Prescrição Eletrônica/estatística & dados numéricos , Heparina/administração & dosagem , Sistemas de Registro de Ordens Médicas , Erros de Medicação/estatística & dados numéricos , Cloreto de Potássio/administração & dosagem , Brasil , Prescrição Eletrônica/normas , Heparina/efeitos adversos , Humanos , Cloreto de Potássio/efeitos adversos , Estudos Retrospectivos
4.
J Med Syst ; 43(11): 327, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646400

RESUMO

Belgium is in a transition phase from paper-based prescriptions to electronic prescriptions (ePrescriptions) during which both the paper and electronic format are valid. Since patients still get a paper proof of the ePrescription, sometimes pharmacists use the ePrescription as paper-based prescription. When the government demands a complete dematerialization, i.e. no more paper-based prescriptions, this will no longer be possible. Therefore, we questioned the frequency and reasons for treating an ePrescription as paper-based. The logged interactions in the national database were used to identify possible reasons. The tarification service Koninklijk Limburgs Apothekers Verbond (KLAV) provided prescriptions of June 2018. KLAV supports tarification for community pharmacies all over Belgium, thereby providing a representative sample for the Belgian community pharmacies. A two-stage cluster random sampling technique was applied to retrieve a subset of 10,000 prescriptions. In this subset we identified 4961 ePrescriptions (49.61%) of which 226 (4.56%, in total 2.26%) were treated as paper-based. Reasons observed for this incorrect handling are (1) non-compliance of the community pharmacist; (2) errors in software or handling of the community pharmacist; (3) errors at the prescriber side or patient tries to fraud; (4) incorrectly revoking the ePrescription; and (5) errors in software of prescriber. The main reasons for treating ePrescriptions as paper-based are non-compliance of the community pharmacist (n = 124, 54.87%) by ignoring its digital nature, and errors in software or handling of the community pharmacist (n = 85, 37.61%). Future research is necessary to investigate user opinions and to measure the impact of introducing ePrescribing in the daily routine.


Assuntos
Atitude do Pessoal de Saúde , Prescrição Eletrônica/normas , Farmacêuticos/psicologia , Bélgica , Prescrições de Medicamentos/normas , Fraude/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Erros de Medicação/estatística & dados numéricos , Farmácias/normas , Guias de Prática Clínica como Assunto/normas
5.
Farm. comunitarios (Internet) ; 11(2): 14-21, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186874

RESUMO

Introducción: la e-receta finalizó su implantación en la Comunidad Valenciana (CV) en septiembre de 2013, observándose que el paciente no retiraba parte de los medicamentos que tenía prescritos, por lo que se diseña un estudio para estudiar las diversas incidencias que pudieran ser la causa. Objetivos: analizar y cuantificar las incidencias detectadas en la dispensación de las e-receta prescritas a los pacientes en farmacia comunitaria de la CV. Métodos: estudio observacional, transversal, prospectivo multicéntrico de base poblacional de las incidencias detectadas en las dispensaciones de las e-receta. Población diana: pacientes mayores de 18 años o cuidadores. Resultados: se registraron 22.983 solicitudes de medicamentos o productos sanitarios (MPS) correspondientes a 6.621 pacientes. De los MPS disponibles para ser dispensados se rechazaron un 12,0 %. Las discrepancias entre lo que el médico prescribió y el paciente entendió supusieron el 19,0 % de los rechazos. Las distintas razones relacionadas con el inccumplimiento fueron el 32,3 % de los medicamentos rechazados (MR). En aquellos medicamentos en los que el paciente debía pagar una aportación el rechazo fue ligeramente mayor (12,2 %) que en el caso de los que no. Conclusiones: La dispensación de MPS prescritos a través de la e-receta permite identificar problemas relacionados con medicamentos (PRM) que inciden sobre la falta de adherencia y las discrepancias con lo prescrito en la receta electrónica


Introduction: The e-receipt finished its implantation in the Valencian Community (CV) in September 2013, observing that the patient did not withdraw part of the medicines prescribed, so a study is designed to find out the various incidents that could be the cause. Objectives: To analyze and quantify the incidences detected in the dispensation of the e-recipes prescribed to patients in community pharmacy (FC) de la CV. Methods: Observational, cross-sectional, prospective multicenter population-based study of the incidences detected in the dispensations of the e-recipes. The target population: patients over 18 years of age, or caregivers. Results: 22,983 requests for medicines or health products (HP) were recorded for 6,621 patients. Of the medicines or HP available for dispensing, 12.0% were rejected. • Discrepancies between what the doctor prescribed and what the patient understood accounted for 19.0% of refusals. • The different reasons related to non-compliance were 32.3% of medicines or health products (HP). In those medicines where the patient had to pay a contribution, the rejection was slightly higher (12.2%) than in the case of those who did not. Conclusions: The dispensing of prescribed medicines/HP through the e-prescription makes it possible to identify drug related problem DRPs that affect the lack of adherence and discrepancies with what is prescribed in the electronic prescription


Assuntos
Humanos , Adulto , Prescrição Eletrônica/normas , Farmácia/organização & administração , Cooperação do Paciente , Farmacêuticos/organização & administração , Prescrições de Medicamentos/normas , Prescrição Eletrônica/estatística & dados numéricos , Estudos Transversais , Estudos Prospectivos , Amostras de Medicamentos
6.
Int J Clin Pharm ; 41(3): 672-676, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30997622

RESUMO

Background Handling of unavailable prescriptions, i.e. prescriptions missing on the online server, is considered troublesome and time-consuming by community pharmacy staff and may result in both patient dissatisfaction and non-compliance. Objective To describe the occurrence and reasons for unavailable prescriptions at Danish community pharmacies as well as the types of drugs involved. Method An online 11-item questionnaire was developed and distributed to 24 community pharmacies across Denmark which each collected data on unavailable prescriptions handled within a 3-week period. Results Out of 194,358 prescriptions dispensed during the study period, a total of 2765 (1.4%) unavailable prescriptions were registered. Of these, 51.1% (n = 1412) occurred when a patient expected a new prescription after having consulted a physician, most often the patient's general practitioner (75.6%; n = 1067). Of all unavailable prescriptions, 68.1% (n = 1882) concerned prescriptions on regular drugs for treatment of a chronic condition, with the patient not having any medication left in 27.9% (n = 526) of these cases. Unavailable prescriptions most frequently concerned cardiovascular drugs (15.8%; n = 437) followed by nervous system drugs (14.4%; n = 399). Conclusion Unavailable prescriptions occur in approximately 1% of all dispensing at Danish community pharmacies. Miscommunication between the patient and general practitioner seems to be the primary source of unavailable prescriptions.


Assuntos
Serviços Comunitários de Farmácia/normas , Prescrições de Medicamentos/normas , Prescrição Eletrônica/normas , Satisfação do Paciente , Inquéritos e Questionários , Dinamarca/epidemiologia , Feminino , Humanos , Masculino
8.
Int J Comput Assist Radiol Surg ; 14(5): 861-871, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887422

RESUMO

PURPOSE: For the parallel external fixator, there are some defects, such as uneven distraction rate, unbearable pain and uncontrollable movement trajectory in practical clinical applications. In order to solve the problems, a new deformity correction algorithm, which is used to calculate the elongation of the six struts, is developed. Meanwhile, the corresponding computer software for getting the electronic prescription is developed. METHODS: First, the trajectory of the moving bone is planned by Cartesian coordinate path control. Next, the prescription is obtained from the trajectory by the inverse pose solution algorithm. Finally, the genetic algorithm is utilized to optimize the achieved prescription. From the year of 2015 to 2018, twenty-three patients with complicated tibia deformity are treated by using parallel external fixator and the developed computer software. All patients have standing, patella-forward, full-length post-operative AP and lateral radiographs of the lower limbs with the complete proximal ring for getting the deformity parameters and frame parameters. These parameters are input into the computer software to calculate a daily prescription schedule for strut adjustment. Radiographs are taken regularly to determine the effects of recovery during the correction process. RESULTS: The mean time of follow-up is 18 months (range 11-40 months). All patients reach the requirements for deformity correction, and their symptoms and appearance are improved significantly. No cases of wound infections or complications occur, and no severe pain came as well during the correction process. CONCLUSIONS: By using the computer-aided parallel external fixator for the correction of lower limb deformities, satisfactory outcomes can be achieved. Hence, this method greatly improved the treatment of these patients in a clinical application.


Assuntos
Algoritmos , Prescrição Eletrônica/normas , Fixadores Externos , Fêmur/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Procedimentos Ortopédicos/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Fêmur/anormalidades , Fêmur/diagnóstico por imagem , Seguimentos , Humanos , Desigualdade de Membros Inferiores/diagnóstico , Masculino , Pessoa de Meia-Idade , Radiografia , Software , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Int J Med Inform ; 123: 49-53, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30654903

RESUMO

INTRODUCTION: Outpatient Electronic Prescription Systems (OEPSs) are widely used in some European states, such as Denmark, Sweden and the Netherlands. The Czech OEPS (known as eRecept) was introduced in 2011, but with limited functions and voluntary usage it was not much accepted until 2018, when its usage was made compulsory not only for pharmacies, but for physicians as well. METHODS: Using data from the Czech State Institute for Drug Control (Státní ústav pro kontrolu léciv or SÚKL in Czech) and from other sources, the system was described and data about its performance since 2013 have been obtained. RESULTS: The usage of the system was very low between 2013 and 2016, whilst moderate growth was seen in 2017. By 2018, the system has been widely adopted, although some twenty per cent of Czech physicians still do not use the system at all. DISCUSSION: A sudden rise in usage can be explained as the result of making the system compulsory starting in January 2018. Still, new features of the system are eagerly awaited and should be introduced to expand its benefits. CONCLUSION: The Czech Republic has joined the EU countries widely using the OEPS.


Assuntos
Prescrição Eletrônica/normas , Erros de Medicação/prevenção & controle , Pacientes Ambulatoriais/estatística & dados numéricos , República Tcheca , Humanos
10.
Int J Clin Pharm ; 41(1): 228-236, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30446896

RESUMO

Background The computerization of prescriptions with a computerized physician order entry contributes to securing the error-free drug supply, but is not risk-free. Objective: To determine the impact of a computerized physician order entry system on prescribing errors immediately after its implementation and 1 year later. Setting The Cardiology and Diabetology Departments at Toulouse University Hospital, France. Method The prescriptions were analysed by pharmacists over three 30-day periods for 3 consecutive years (N: computerization period, N - 1, N + 1). For each identified error, the prescriber was informed by a pharmaceutical intervention. The pharmaceutical interventions were counted and arranged according to the classification by the French Society of Clinical Pharmacy. Their average numbers and clinical impacts were compared for each period using t-tests and Kruskal-Wallis tests. Main outcome measure The average numbers of pharmaceutical interventions. Results In total, 12.1 pharmaceutical interventions per 100 patient days were done during the N - 1 period, 14.1 during N and 9.6 during N + 1. Among those, 3.6 (N) and 2.1 (N + 1) were related to the computerization itself, and 10.5 (N) and 7.5 (N + 1) were not. The average number of computerization-related pharmaceutical interventions significantly decreased from N to N + 1 (p = 0.04). The average number of classic interventions decreased from N - 1 to N + 1 (p = 0.02). The clinical impacts of the computerization related errors were similar to those of other errors. Conclusion The implementation of the computerized physician order entry induced the appearance of specific computerized-related errors, but the number of classic errors decreased. The entry-system related errors were not more severe than other errors, and the number decreased after 1 year.


Assuntos
Prescrições de Medicamentos/normas , Prescrição Eletrônica/normas , Sistemas de Registro de Ordens Médicas/normas , Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/normas , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Farmacêuticos/normas , Médicos/normas , Estudos Retrospectivos
11.
Arch Dis Child ; 104(6): 596-599, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30154183

RESUMO

Medication-related errors are among the most common medical errors, and studies have shown that the paediatric population is particularly vulnerable. Errors can occur during any step in the medication process. This review article seeks to highlight new advancements in the field of paediatric medication safety at each stage of the medication process, from ordering and transcribing to medication dispensing and administration. We will focus on interventions that are increasingly widely used, such as computerised provider order entry with clinical decision support, barcoding technologies and safe medication administration through technologies pumps (SMART pumps), as well as innovative mobile application devices and workflow management systems that are being piloted at single institutions. By highlighting what is new in paediatric medication safety, as well as the gaps that remain, we hope to continue to foster focus on this critically important area in order to create the safest possible environment for children.


Assuntos
Erros de Medicação/prevenção & controle , Sistemas de Medicação/normas , Pediatria/normas , Criança , Sistemas de Apoio a Decisões Clínicas , Prescrições de Medicamentos/normas , Prescrição Eletrônica/normas , Humanos , Sistemas de Registro de Ordens Médicas , Erros de Medicação/estatística & dados numéricos , Sistemas de Medicação/organização & administração , Aplicativos Móveis , Segurança do Paciente , Pediatria/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Serviço de Farmácia Hospitalar/normas , Melhoria de Qualidade
12.
J Oncol Pharm Pract ; 25(7): 1687-1691, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30400751

RESUMO

BACKGROUND: Dose banding parenteral chemotherapy has the potential to optimise aseptic unit capacity and reduce drug expenditure without compromising the service provided. METHODS: Dose banding tables from NHS England were implemented into the electronic chemotherapy prescribing system. Compliance to the dose bands was analysed and submitted quarterly. Analysis of drug expenditure, drug use and cost per milligram data was also collected. RESULTS: Expenditure on the 17 drugs identified in the 2016/17 dose standardisation CQUIN reduced by approximately £100,000 per month over the CQUIN despite an increase in the number of prescribed doses of these drugs. At the beginning of the year, the percentage of work compounded in house was 60%, which was reduced to 51% of total workload at the end of the year due to outsourcing commonly prescribed doses from commercial pharmaceutical aseptic manufacturers. CONCLUSION: Dose banding parenteral chemotherapy is an efficient cost-saving strategy which also can help to increase the capacity of the aseptic unit.


Assuntos
Antineoplásicos/normas , Análise Custo-Benefício/métodos , Prescrição Eletrônica/normas , Infusões Parenterais/normas , Serviço Hospitalar de Oncologia/normas , Centros de Atenção Terciária/normas , Antineoplásicos/administração & dosagem , Antineoplásicos/economia , Relação Dose-Resposta a Droga , Prescrição Eletrônica/economia , Humanos , Infusões Parenterais/economia , Serviço Hospitalar de Oncologia/economia , Centros de Atenção Terciária/economia
13.
Health Aff (Millwood) ; 37(11): 1877-1883, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30395495

RESUMO

While electronic prescribing has been shown to reduce medication errors and improve prescribing safety, it is vulnerable to error-prone processes. We review six intersecting areas in which changes to electronic prescribing systems, particularly in the outpatient setting, could transform medication ordering quality and safety. We recommend incorporating medication indications into electronic prescribing, establishing a single shared online medication list, implementing the transmission of electronic cancellation orders to pharmacies (CancelRx) to ensure that drugs are safely and reliably discontinued, implementing standardized structured and codified prescription instructions, reengineering clinical decision support, and redesigning electronic prescribing to facilitate the ordering of nondrug alternatives.


Assuntos
Prescrições de Medicamentos , Prescrição Eletrônica/normas , Sistemas de Registro de Ordens Médicas/normas , Erros de Medicação/prevenção & controle , Humanos , Pacientes Ambulatoriais , Farmácias
14.
J Patient Saf ; 14(4): 241-245, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30451716

RESUMO

OBJECTIVES: Compared with blank prescriptions, electronic prescribing (e-prescribing) is safer and more formulary-compliant, satisfying, and efficient. Owing to cost, fewer publicly funded organizations use e-prescribing but may afford preformatted prescription forms. We investigated whether preformatted prescription forms confer similar benefits as e-prescribing. METHODS: Two preformatted prescription forms containing medications' name, strength, dose, route, frequency, number of refills, and restrictions were released in an adult medicine clinic, which previously used blank forms. Pharmacy data were evaluated for changes in prescribing safety and formulary compliance. Surveys assessed changes in prescribing satisfaction and perceived efficiency. RESULTS: Preformatted prescription forms yielded safer, more formulary-compliant prescribing than blank forms. Among medications preformatted on forms, a smaller percentage of pharmacy interventions were for prescribing errors compared with the same medications prescribed previously using blank forms (54% vs. 31%, P = 0.014). Among medications preformatted on forms, a smaller percentage of pharmacy interventions were for formulary noncompliance compared with the same medications prescribed previously using blank forms (21% vs. 4%, P = 0.002).Nearly all respondents felt preformatted forms helped with legibility and choosing the correct dose and proper strength. Fifty percent of respondents indicated the forms improved medication selection.Preformatted forms were perceived as more satisfying and efficient. Ninety-three percent of respondents stated they would use the forms on their next patient. CONCLUSIONS: Preformatted prescription forms achieved the major objectives of e-prescribing: safer, more formulary-compliant, satisfying, and efficient prescribing. They can serve as a transitional phase to e-prescribing for resource-constrained organizations such as publicly funded clinics.


Assuntos
Prescrições de Medicamentos/normas , Prescrição Eletrônica/normas , Assistência Farmacêutica/normas , Adulto , Humanos
15.
Int J Med Inform ; 119: 88-93, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30342691

RESUMO

CONTEXT: Despite widespread efforts to improve the quality and safety of healthcare through use of hospital information systems (HIS), many healthcare organizations face challenges in implementation and effective use of these applications, in particular when systems have been developed internationally (mainly in the US). Suppliers of these technologies also find it challenging to produce systems that work effectively across a range of geographical, cultural and institutional boundaries. In this paper, we seek to understand the strategies used by suppliers and adopters of HIS to overcome the challenges involved in the development and adoption of generic overseas systems. METHODS: We conducted a qualitative study, by interviewing 176 individuals (eight organizations), observing two user groups, and running a supplier focus group. We used inductive thematic analysis to assess emerging strategies in developing and implementing overseas packaged HIS in English settings. FINDINGS: The health sector in England has entered a period of potentially transformative change with many international HIS suppliers entering the market. This has provoked call for the 'Anglicization' of generic systems. This endeavor, has resulted in emergence of more or less aligned supplier and user strategies to overcome the difficulties in the process. This includes a continuous process of identification and classification of requests (by suppliers), and unification and voicing of needs (by adopters). CONCLUSIONS: The complexity of health service provision, drives calls for customization of technologies in this sector. Consequent tensions between 'standardization' and 'localization' are requiring suppliers of generic solutions to develop more sophisticated strategies as they pursue international growth of their market.


Assuntos
Comportamento de Escolha , Coleta de Dados/métodos , Prescrição Eletrônica/normas , Sistemas de Informação Hospitalar/normas , Pesquisa Qualitativa , Inglaterra , Humanos
16.
J Clin Psychopharmacol ; 38(5): 447-453, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30113352

RESUMO

BACKGROUND: Patients with severe mental illness are at risk of medical complications, including cardiovascular disease, metabolic syndrome, and diabetes. Given this vulnerability, combined with metabolic risks of antipsychotics, physical health monitoring is critical. Inpatient admission is an opportunity to screen for medical comorbidities. Our objective was to improve the rates of physical health monitoring on an inpatient psychiatry unit through implementation of an electronic standardized order set. METHODS: Using a clinical audit tool, we completed a baseline retrospective audit (96 eligible charts) of patients aged 18 to 100 years, discharged between January and March 2012, prescribed an antipsychotic for 3 or more days. We then developed and implemented a standard electronic admission order set and provided training to inpatient clinical staff. We completed a second chart audit of patients discharged between January and March 2016 (190 eligible charts) to measure improvement in physical health monitoring and intervention rates for abnormal results. RESULTS: In the 2012 audit, thyroid-stimulating hormone (TSH), blood pressure, blood glucose, fasting lipids, electrocardiogram (ECG), and height/weight were measured in 71%, 92%, 31%, 36%, 51%, and 75% of patients, respectively. In the 2016 audit, TSH, blood pressure, blood glucose, fasting lipids, ECG, and height/weight were measured in 86%, 96%, 96%, 64%, 87%, and 71% of patients, respectively. There were statistically significant improvements (P < 0.05) in monitoring rates for blood glucose, lipids, ECG, and TSH. Intervention rates for abnormal blood glucose and/or lipids (feedback to family doctor and/or patient, consultation to hospitalist, endocrinology, and/or dietician) did not change between 2012 and 2016. CONCLUSIONS: Electronic standardized order set can be used as a tool to improve screening for physical health comorbidity in patients with severe mental illness receiving antipsychotic medications.


Assuntos
Prescrição Eletrônica/normas , Nível de Saúde , Pacientes Internados/psicologia , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , Monitorização Fisiológica/normas , Adulto , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Eletrocardiografia/efeitos dos fármacos , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Saúde Mental , Pessoa de Meia-Idade , Monitorização Fisiológica/tendências , Estudos Retrospectivos
17.
Br J Nurs ; 27(15): 869-875, 2018 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-30089040

RESUMO

The wearing of compression garments is an essential aspect of the management of lymphoedema. Patients however, do not always receive the requested garment on an NHS prescription from their general practitioner (GP). Through an audit cycle over 3 years, necessary changes in clinical practice were identified and introduced. The aim was to improve the number of patients obtaining the correct garment on an NHS prescription. The audit standard was not met in any of the audits and the conclusion made is that compression garments are difficult to find on NHS electronic prescribing systems leading to a delay in patients receiving their prescription and a risk of error due to the wide range of options available. Further work is necessary to ensure that electronic prescribing systems address the problem of product recognition for compression garments so that the process of obtaining compression garments is smooth, accurate and timely for patients and their GPs.


Assuntos
Bandagens Compressivas , Prescrição Eletrônica/normas , Linfedema/terapia , Auditoria Clínica , Vestuário , Humanos
18.
J Gen Intern Med ; 33(12): 2070-2077, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30076573

RESUMO

BACKGROUND: Oral anticoagulants reduce the risk of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation at elevated stroke risk are not treated with oral anticoagulants. OBJECTIVE: To test whether electronic notifications sent to primary care physicians increase the proportion of ambulatory patients prescribed oral anticoagulants. DESIGN: Randomized controlled trial conducted from February to May 2017 within 18 practices in an academic primary care network. PARTICIPANTS: Primary care physicians (n = 175) and their patients with atrial fibrillation, at elevated stroke risk, and not prescribed oral anticoagulants. INTERVENTION: Patients of each physician were randomized to the notification or usual care arm. Physicians received baseline email notifications and up to three reminders with patient information, educational material and primary care guidelines for anticoagulation management, and surveys in the notification arm. MAIN MEASURES: The primary outcome was the proportion of patients prescribed oral anticoagulants at 3 months in the notification (n = 972) vs. usual care (n = 1364) arms, compared using logistic regression with clustering by physician. Secondary measures included survey-based physician assessment of reasons why patients were not prescribed oral anticoagulants and how primary care physicians might be influenced by the notification. KEY RESULTS: Over 3 months, a small proportion of patients were newly prescribed oral anticoagulants with no significant difference in the notification (3.9%, 95% CI 2.8-5.3%) and usual care (3.2%, 95% CI 2.4-4.2%) arms (p = 0.37). The most common, non-exclusive reasons why patients were not on oral anticoagulants included atrial fibrillation was transient (30%) or paroxysmal (12%), patient/family declined (22%), high bleeding risk (20%), fall risk (19%), and frailty (10%). For 95% of patients, physicians stated they would not change their management after reviewing the alert. CONCLUSIONS: Electronic physician notification did not increase anticoagulation in patients with atrial fibrillation at elevated stroke risk. Primary care physicians did not prescribe anticoagulants because they perceived the bleeding risk was too high or stroke risk was too low. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02950285.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Prescrição Eletrônica/normas , Fidelidade a Diretrizes/normas , Sistemas de Registro de Ordens Médicas/normas , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Masculino
20.
Pharmacoepidemiol Drug Saf ; 27(10): 1101-1111, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29687504

RESUMO

PURPOSE: To assess the accuracy of using diagnostic codes from administrative data to infer treatment indications for antidepressants prescribed in primary care. METHODS: Validation study of administrative diagnostic codes for 13 plausible indications for antidepressants compared with physician-documented treatment indications from an indication-based electronic prescribing system in Quebec, Canada. The analysis included all antidepressant prescriptions written by primary care physicians between January 1, 2003 and December 31, 2012 using the electronic prescribing system. Patient prescribed antidepressants were linked to physician claims and hospitalization data to obtain all diagnoses recorded in the past year. RESULTS: Diagnostic codes had poor sensitivity for all treatment indications, ranging from a high of only 31.2% (95% CI, 26.8%-35.9%) for anxiety/stress disorders to as low as 1.3% (95% CI, 0.0%-5.2%) for sexual dysfunction. Sensitivity was notably worse among older patients and patients with more chronic comorbidities. Physician claims data were a better source of diagnostic codes for antidepressant treatment indications than hospitalization data. CONCLUSIONS: Administrative diagnostic codes are poor proxies for antidepressant treatment indications. Future work should determine whether the use of other variables in administrative data besides diagnostic codes can improve the ability to predict antidepressant treatment indications.


Assuntos
Antidepressivos/uso terapêutico , Análise de Dados , Depressão/classificação , Depressão/tratamento farmacológico , Prescrição Eletrônica/normas , Classificação Internacional de Doenças/normas , Adulto , Idoso , Depressão/epidemiologia , Prescrição Eletrônica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia , Reprodutibilidade dos Testes
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