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Hintergrund Mit dem Modellprojekt GERDA („Geschutzter e-Rezept-Dienst der Apotheken“) wurde von der Landesapothekerkammer (LAK) und dem Landesapothekerverband (LAV) in Baden-Wurttemberg die Moglichkeit geschaffen, Rezepte im Rahmen von Online-Sprechstunden uber das von der Kassenarztlichen Vereinigung Baden-Wurttemberg betriebene telemedizinische Portal „docdirekt“, zu verordnen. Vor diesem Hintergrund war das Ziel der Studie, Barrieren und fordernde Faktoren aufseiten der Apotheken fur die Beteiligung an einer Versorgung, die eine elektronische Verordnung von Rezepten beinhaltet, zu explorieren und zu priorisieren. Auf Basis dieser Determinanten wurden Empfehlungen zur Optimierung einer erfolgreichen Implementierung ahnlicher Versorgungsangebote abgeleitet. Methode Es wurde ein Mixed-Methods-Design gewahlt, um die Determinanten zu explorieren und zu priorisieren. Im ersten Schritt wurden Determinanten fur die Beteiligung an einem System, welches die elektronische Verordnung von Rezepten ermoglicht mithilfe von Einzelinterviews mit an docdirekt beteiligten Telearzten, niedergelassenen Hausarzten und Apothekern exploriert. Anschliesend wurden diese Determinanten in einem zweiten Schritt durch eine quantitative Befragung von Apothekern priorisiert. Ergebnisse Von den 523 an der Umfrage teilgenommenen Apothekern war mehr als die Halfte bereit sich an einem E-Rezept-System zu beteiligen, 8,5% schliesen eine zukunftige Beteiligung aus. Insgesamt konnten 18 Determinanten fur die Beteiligung an einem System, welches die elektronische Verordnung von Rezepten ermoglicht, exploriert werden. Der Schutz der freien Apothekenwahl wurde als wichtigster Aspekt fur eine Beteiligung identifiziert. Gefolgt von der Moglichkeit einer Korrekturfunktion bei E-Rezepten (um z. B. Retaxierungen oder Medikationsfehlern zu vermeiden), der Integration des E-Rezepts in die bestehende Apotheken-EDV sowie dem gesetzlichen Ausschluss von direkten Vertragen mit Versandapotheken. Zeitersparnisse und eine ggf. hohere Vergutung wurden dagegen als weniger relevant bewertet. Schlussfolgerung Insgesamt gab uber die Halfte der befragten Apotheken an, sich an einem E-Rezept-System beteiligen zu wollen. Fur die ab Januar 2022 geplante flachendeckende Einfuhrung von E-Rezepte kann der Einbezug der identifizierten fordernden Faktoren vonseiten der Politik, Softwareentwickler und Verbande eine wichtige Rolle bei der Implementierung spielen. Background The GERDA (“Protected e-prescription service for pharmacies”) project of the Chamber of Pharmacists (LAK) and Pharmacists Association (LAV) of the federal state of Baden-Wuerttemberg provided the opportunity to prescribe medications within the telemedical portal “docdirekt” that is operated by the Association of Statutory Health Insurance Physicians of Baden-Wuerttemberg. Against this background, the aim of the study was to explore and prioritize barriers and enablers among pharmacists to participate in a medical supply system that includes electronic prescriptions (e-prescriptions). Based on these determinants, recommendations for optimizing the successful implementation of similar care offers were derived. Method A mixed methods design was chosen to explore and prioritize the determinants. In the first step, determinants for participation in an electronic prescribing system were explored by means of individual interviews of docdirekt tele-physicians, primary care physicians and pharmacists. In a second step, these determinants were prioritized through a quantitative survey of pharmacists. Results Out of the 523 pharmacists that answered the questionnaire, more than half were willing to participate in an e-prescription system, while 8.5% excluded future participation. A total of 18 determinants for the e-prescription system participation could be explored. The protection of the free pharmacy choice for the patients was identified as the most important determinant, followed by the option of a correction function for e-prescriptions (e. g. to avoid retaxing or medication errors), the integration of the e-prescription into the existing pharmacy IT system and the statutory exclusion of direct contracts with online pharmacies. Time savings and possibly higher remunerations were rated as less relevant. Conclusion More than half of the pharmacies surveyed stated that they wanted to participate in an e-prescription system. Widespread introduction of e-prescriptions in planned for January 2022. Successful implementation of this move will be facilitated if the identified determinants are taken into consideration by politics, software developers and associations.

Objective: The purpose of this study was to determine the opinions of pharmacists, who are important users of e-prescribing practices in Turkey, on the function of a prescription application. Method: A questionnaire was developed to determine the opinions of pharmacists on Turkish e prescribing practices, using a stratified and systematic random sampling method. A total of 378 pharmacists responded to the questionnaire. Results: The average level of satisfaction of e-prescription reported by pharmacists was 4.4 +/- 0.8. Although 52.4% of the participating pharmacists reported no problems using the e-prescription application, 47.6% reported encountering problems. The majority of the problems associated with e-prescription practices were caused by the physicians who entered the e-prescription into the system. The most common problem (17.4%) reported was the inability to read the e-prescription code as written by physicians. The primary contribution of the e-prescribing practice reported by pharmacists was the acceleration of prescription procedures. Conclusion: E-prescription practice is advantageous to pharmacies across many aspects, improving drug delivery to patients, and most pharmacists reported thatthe e-prescription practice washighly satisfying. The development of electronic and information technologies increases access toinformation resources and diversity, resulting inchanges in the expectations and utilisation levels of users; therefore, continuous improvements are required to improve the performance of the e-prescribing system. (c) 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved. WOS:000631985400014 2-s2.0-85099500347

Aim: This study aims to describe the prescribing pattern of medications by dermatology outpatient department in a public hospital in Alkharj. Methodology: This is a retrospective study that included collecting data from outpatient electronic prescriptions in a public hospital in Alkharj. All of the outpatients who received prescriptions written by the dermatology department between 1st of January till 30th of June 2018 were included in the study. The data were collected and analyzed using Microsoft Excel. Results: A total of 328 patients received outpatient prescriptions written by dermatology department. Most of them were females (62.80%) and aged less than 40 years (67.38%). The most prescribed drug in the present study was Hydrocortisone (14.33%) followed by White Soft Paraffin (8.84), Fusidic acid (8.54%) and Cetirizine (8.23%). Most of the medications were prescribed as ointment (28.66%) followed by creams (28.04%). Conclusion: Females were found to be more predominant with dermatological diseases when compared to males. The most commonly prescribed drugs were hydrocortisone, white soft paraffin, fusidic acid and cetirizine. It is important to evaluate prescribing pattern of the drugs periodically to improve the quality of prescriptions.

Objectives: The number of electronic prescriptions (ePrescriptions) grows steadily in Belgium as in other European countries. In the future, Belgium wants to dematerialize the ePrescription flow, removing all paper trails. A quality check of the digital content and implementation of national ePrescription guidelines in the field was conducted, comparing the content at both prescription and pharmacy side. Methods: An explanatory mixed-methods design was applied. In a first phase, potential problems (warning flags) were identified by consulting stakeholders. Secondly, the warning flags were validated to problems (errors) in a random set of ePrescriptions collected in April 2019. In a third phase, explanatory interviews were held with various stakeholders in order to find explanations and to identify the initiators of these errors. Results: In the first phase, 15 warning flags were identified to evaluate the quality of an ePrescription. In the second phase, a random selection of 11,798 ePrescriptions was validated. The most prevalent errors found, were the digital construction of the messages (18.88%), combined with lots of necessarily deemed substitutions by the pharmacist (3.39%) not following what was prescribed originally. In the third phase, stakeholders indicated that software of the prescriber and the use of inconsistent databases between prescriber and pharmacy can often be seen as the cause and initiator of these problems. Conclusions: Use of authentic medication databases and well-designed software systems have the potential to solve ePrescription problems. Focus should go to prevention instead of detection.

Aim: This study aimed to describe the prescribing pattern of methyldopa in a public hospital in Alkharj. Methodology: This is a retrospective study that was conducted to know the prescribing pattern of methyldopa. The data were collected from the outpatient electronic prescriptions in a public hospital in Alkharj in 2017 and 2018. Results: Only 27 patients in the outpatient setting received methyldopa in 2017 and 23 patients in 2018. all of the patients who received methyldopa were females. Most of the prescribers were residents (82.61%) and only 17.39% were consultants. About 82.61 % of the prescriptions were written by obstetrics and gynecology department. Conclusion: The prescribing of methyldopa is infrequent in the outpatient setting. Although it is generally safe, it may cause numerous side-effects as well as it can interact with other medications, so it is important to monitor its prescribing trends to ensure that it is prescribed appropriately.

The Medicare Improvements for Patients and Providers Act passed by Congress in 2008 has changed prescribing practices in the United States. Electronic prescriptions (e-prescriptions) have now become the most widely used form of prescriptions. The government in fact financially discourages the use of the older more traditional paper prescriptions.Many emergency medicine physicians fear that this blanket policy is not in the best interests of their unique patient population. It is the belief of many of these physicians that emergency patients are more likely to fill paper prescriptions than e-prescriptions. This theory is predicated on the knowledge that many emergency patients are less established in the system and their visits are frequently rushed, chaotic, and unplanned. For these reasons, the e-prescription system is not ideal for them and the theorized consequence is that many e-prescriptions go unfilled, leaving patients to go untreated.A retrospective analysis was conducted at the emergency department of the University of California, Irvine Medical Center to identify insured adult patients who were given a non-controlled substance prescription in either the paper or electronic form. Pharmacy claim data to insurances was used to determine whether these prescriptions were filled. 405 encounters were included, 218 of which included e-prescriptions and 187 of which included paper prescriptions. Our findings showed that paper prescriptions are filled at the same rate as electronic prescriptions (58.3% versus 57.8% p=1). These results were surprising as they contradicted what many physicians believe is the situation. More studies are needed in order to be able to broaden these results to the entire emergency medicine patient population, but these results may begin to alter prescription practices in emergency medicine.

Aim: This study aims to determine the prescribing patterns of vitamin D supplements in a public hospital in Al-Kharj. Methodology: This cross-sectional drug utilization study was conducted at a public hospital in Al-Kharj that included a review of the outpatient electronic prescriptions in 2018. Therefore, inclusion criteria included the outpatient prescriptions that contain Vitamin D supplement in 2018. The data were collected using Microsoft Excel® and the descriptive data were represented as numbers and percentages. Results: In 2018, 311 patients were prescribed Alfacalcidol. Most of the patients who received Alfacalcidol were females (76.21%), aging 40-69 (58.85%). The majority of Alfacalcidol drugs were prescribed by Internal Medicine department (56.91%). In 2018, 127 patients were received Cholecalciferol. Most of the patient were females (79.53%), in the age level between 30-39 (21.26%) followed by patients less than 10 years (18.90%). The majority of Cholecalciferol drugs were prescribed by Internal Medicine department (30.71%). Conclusion: Vitamin D supplements were used frequently with other medicines for chronic conditions. More studies are needed to know the effect of Vitamin D supplements in the prevention or treatment of chronic diseases. Moreover, in order to use vitamin D supplements correctly, it is important to know the prescribing trends of these supplements.

Aim: The study was conducted to demonstrate the pattern of ciprofloxacin prescribing at outpatient Setting in Al-kharj. Methodology: A retrospective study was conducted to demonstrate the pattern of ciprofloxacin prescribing. The Information was collected from electronic prescriptions in a public hospital in Al-Kharj city. The data was processed using Microsoft Excel and the descriptive data was represented as frequencies and percentages. Results: There were 611 ciprofloxacin prescriptions in 2018. Ciprofloxacin is the 5th most commonly prescribing antibiotics in the outpatient setting in 2018. The majority of the patients were in the age level between 20-39 (53.51%). Out of 773 prescriptions, 162 were excluded (eye or ear drops). There were 608 tablets (99.51%). Conclusion: Ciprofloxacin is one of the common prescribed antibiotics in the outpatient settings. If it is prescribed inappropriately it will lead to increase bacterial resistance rate, increase adverse effects and increase the cost of the treatment. It should be prescribed appropriately and the patients should be monitored frequently during its use.

BackgroundFree-text directions generated by prescribers in electronic prescriptions can be difficult for patients to understand due to their variability, complexity and ambiguity. Pharmacy staff are responsible for transcribing these directions so that patients can take their medication as prescribed. However, little is known about the quality of these transcribed directions received by patients.MethodsA retrospective observational analysis of 529 990 e-prescription directions processed at a mail-order pharmacy in the USA. We measured pharmacy staff editing of directions using string edit distance and execution time using the Keystroke-Level Model. Using the New Dale-Chall (NDC) readability formula, we calculated NDC cloze scores of the patient directions before and after transcription. We also evaluated the quality of directions (eg, included a dose, dose unit, frequency of administration) before and after transcription with a random sample of 966 patient directions.ResultsPharmacy staff edited 83.8% of all e-prescription directions received with a median edit distance of 18 per e-prescription. We estimated a median of 6.64 s of transcribing each e-prescription. The median NDC score increased by 68.6% after transcription (26.12 vs 44.03, pConclusionPharmacy staff put significant effort into transcribing e-prescription directions. Manual transcription removed the majority of quality issues; however, pharmacy staff still miss or introduce following their manual transcription processes. The development of tools and techniques such as a comprehensive set of structured direction components or machine learning–based natural language processing techniques may help produce clear directions.

Ukraine has launched a government program «Affordable Medicines» for patients with cardiovascular disease, type 2 diabetes and bronchial asthma in 2017, which reimburses essential medicines for outpatients. Since April 2019, electronic prescriptions for the «Affordable Medicines» program have been introduced. The purpose of this study was to analyze and compare the development of a government drug reimbursement program, including the dynamics of the number of prescription and dispensed electronic prescriptions for medicinal products in the «Affordable Medicines» program in 2019, both in Ukraine and at the level of Lviv city and Lviv region. For research and analysis, we have obtained statistics from the National Health Service of Ukraine (NHSU) on the number of e-prescriptions for medicines in the Affordable Medicines program and pharmacy facilities involved in the program over certain periods from April to December 2019 across Ukraine and at the level of Lviv city and Lviv region. We used informative, comparative research methods and a method of retrospective analysis of the dynamics of prescribed and dispensed e-prescriptions for medicines. The results of the study showed that Lviv region is consistently among the leaders of e-dispensing medicines. E-prescriptions are most commonly prescribed for patients aged over 65 years old with cardiovascular disease. Differences in e-appointments of pharmacies by INN at the level of Lviv city and Lviv region are revealed in comparison with the average data of Ukraine. E-prescribing has been shown to increase access to medication for patients, as at the end of 2019 through the «Affordable Medicines» program, 1.77 million patients were enrolled and 10.86 million e-prescriptions were written out, of which 9.23 million (84.94%) were released from pharmacies. Lviv region has actively implemented e-prescriptions and according to the NHSU 43% of the pharmacies in the region are connected to this system and they issue e-prescriptions, that is higher than the average data in Ukraine of 35%. The positive dynamics of the growth of e-prescriptions written and released of essential drugs from 29% to 85% indicates the effective implementation of the e-prescription in Ukraine and confirms the effective implementation of the drug reimbursement program. Considering the benefits of electronic prescriptions, reducing the number of errors, time, monitoring appointments, it is promising to expand the list of drugs, including. those that are purchased for budgetary or accounting purposes to optimize pharmaceutical assistance to the public.

Background Rational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs. Purpose To identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged >65 years. Methods This cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria. Results PIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs. Conclusion PPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients.

Türk ilaç sektörü bir yönü ile gelir elde etme, diğer bir yönü ile sağlık harcamalarındaki ilaç harcamalarını kontrol etme amacıyla son dönemde yerli üretime odaklanmıştır. Türk ilaç sektörünün “yerli” üretim odaklı stratejisi üretim ile birlikte maliyette uygunluk ve erişilebilirlik olarak sıralanmaktadır. Sektör, teknoloji ve üretim kapasitesi ile ivme yakalasa da yabancı firmalar ile rekabet alanında istenilen hedefe ulaşamamıştır. Bunun nedenleri ilaç fiyatlarında sabit kur düzenlemesi, araştırma-geliştirme faaliyetlerine odaklanılmaması ve üretim merkezi sayısının azlığıdır. Bu çalışmanın amacı 2011-2018 yılları arasındaki ilaç politikalarının yerli üretim, akılcı ilaç kullanımı, elektronik reçete ve ilaç takip sistemi kapsamında değerlendirmektir. Bu çalışmada yerli-ithal ilaç satışları, sağlık harcamalarında ilaç harcama oranları, insan kaynağı olarak eczacı dağılımı, geri ödeme kapsamı ve kapsam dışı ilaç dağılımı, akılcı ilaç kullanımının mevcut durumu, ilaç takip sistemi ve elektronik ilaç uygulamasına yönelik değerlendirmeler yapılacaktır. Çalışma kapsamında Sağlık Bakanlığı istatistik yıllıklarından elde edilen ikincil verilerin değerlendirilmesini kapsayan bir derleme sunulmuştur. Araştırmada ayrıca konu ile ilgili literatür taramasındaki yayınlar ve ilaç sektörü araştırma raporlarından da yararlanılmıştır. Son yıllarda yerli ürün üretimi ve tüketimi desteklense de ithal ilaç gruplarındaki fiyat baskısı ilaç sektöründe istenilen düzeyde etkiyi sağlamamıştır. Benzer durum etkin olmayan akılcı ilaç politikalarının uygulama alanlarında da görülebilir. Dünyada stratejik öneme sahip ilaç sektörünün katma değer yaratabilmesi ve ülke ekonomisine katkı sağlayabilmesi için ilaç sektörünün sürdürülebilirliğine ve sektörler arası entegrasyonu sağlayan sağlık politikalarına ihtiyaç vardır., The Turkish drug industry has recently focused on domestic production for both generating revenue and controlling drug expenditures among health expenditures. The “domestic” production-oriented strategy of the Turkish drug industry is explained as affordability and accessibility along with production. Although the sector has gained momentum with its technology and production capacity, it has not reached the desired level in the field of competition with foreign companies. The reasons for this are fixed exchange rate regulation in drug prices, inability to focus on research and development and having very few production centers. The aim of this study is to evaluate the drug policies between 2011 and 2018 within the scope of domestic production, rational drug use, electronic prescription and drug tracking system. In this context, certain evaluations will be made regarding domestic-imported drug sales, drug expenditure rates in health expenditures, pharmacist distribution in terms of human resources, reimbursement coverage and uncovered drug distribution, current state of rational drug use, drug tracking system and electronic drug implementation. Within the scope of the study, a compilation covering the evaluation of secondary data obtained from the statistical annuals of the Ministry of Health was presented. In the research, publications in the literature review and pharmaceutical industry research reports were also used. Although domestic product production and consumption have been supported in recent years, price pressures in imported drug groups have not achieved the desired effect in the drug sector. Similar inefficiency can be seen in the application areas of rational drug policies. In order for the strategically important drug sector to create added value and contribute to the national economy, health policies that enable inter-sector integration are needed.

Background An increase in the incidence of syphilis was reported in Greenland from 2011 to 2014, and notification rates kept rising in the following years in spite of focused efforts. In order to better understand the syphilis epidemic, this study was conducted to describe the syphilis epidemic in Greenland from 2015 to 2019. Methods Syphilis cases and their characteristics were identified through reviews of electronic medical records and laboratory results in three different datasets; notifications to the National Board of Health, electronic prescriptions for benzathine penicillin, and the national laboratory database. Annual incidences were calculated stratified by gender, age, and region. Results The incidence of syphilis in Greenland increased from 107.4 to 246.8 cases per 100,000 inhabitants from 2015 to 2019. The incidence increased in both genders and in nearly all regions although with large regional differences. Especially the age group 15-29 years showed a substantial increase in incidence in 2018 and 2019. More females than males were infected (245 female cases vs. 178 male cases). Conclusions The burden of syphilis in Greenland is high, primarily among the age group 15-29 years. A higher incidence among females than among males were found, suggesting mainly heterosexual transmission, as seen for other STIs in Greenland.

Background: One of the most important steps of the health transformation program involves the application of electronic prescriptions (e-prescriptions) in health services. Information technologies are highly important in generating e-prescriptions, which can be described as a document produced by authorized personnel electronically, containing written information and instructions regarding a patient’s medication and its usage. E-prescribing has become increasingly applied in recent years as a contributing application to prescribers and patients. The aim of this study was to determine the level of satisfaction of family physicians providing primary care in Turkey regarding the application of e-prescriptions, and reveal the related positive effects and problems encountered in the first months of implementation of e-prescribing. Methods: A questionnaire with eight questions was sent to e-mails of all family physicians working in Turkey in May 2013. A total of 1564 family physicians filled in the questionnaire form and sent it back by e-mail. The responses to open-ended questions were evaluated by content analysis. Results: It was observed that the most frequently indicated advantages of the application of e-prescriptions were speeding up the prescription process and saving time (36.6%). The most commonly reported problems regarding the application of e-prescriptions were found to be system-induced problems (26.5%) and internet problems (19.9%). In addition, the mean score of satisfaction of the family physicians who did not report problems with the application of e-prescriptions was higher than that of those who reported having problems with it. In the study, 77.8% of the family physicians were satisfied with the application of e-prescriptions. Conclusion: Although some problems were reported regarding the application of e-prescriptions in the first months of the application, family physicians participated in the study were found to be satisfied with the application of e-prescriptions, and identified positive effects on their work and processes. © 2019 The Author(s). 2-s2.0-85058557719 PubMed: 30709101

With the development of the internet, applications have become complicated, and the relevant technology has diversified. Compared with medical applications, the significance of information technology has been expanding to include clinical auxiliary functions of medical information. This includes electronic medical records, electronic prescriptions, medical information systems, etc. Although research on the data processing structure and format of various related systems is becoming mature, the integration is insufficient. An integrated medical information system with security policy and privacy protection, which combines e-patient records, e-prescriptions, modified smart cards, and fingerprint identification systems, and applies proxy signature and group signature, is proposed in this study. This system effectively applies and saves medical resources&mdash, satisfying the mobility of medical records, presenting the function, and security of medicine collection, and avoiding medical conflicts and profiteering to further acquire the maximum effectiveness with the least resources. In this way, this medical information system may be developed into a comprehensive function that eliminates the transmission of manual documents and maintains the safety of patient medical information. It can improve the quality of medical care and indispensable infrastructure for medical management.

Background Pharmacists in community and hospital pharmacies assess prescriptions to prevent prescription errors and adverse drug events. There are, however, few reports on prevalence of clinical important pharmaceutical interventions for patients located within primary care. Objective To study documented pharmaceutical interventions on prescriptions in Norwegian pharmacies for patients located in primary care. Setting Data were collected in 11 community pharmacies during a 3 months period in 2016, and the outpatient department of four hospital pharmacies in Norway during a 6 months period of 2018. Method Retrospective analysis of electronically documented pharmaceutical interventions on prescriptions for patients located in primary care. Main outcome measure The number and classification of pharmaceutical interventions in relation to the total number of prescriptions. Results An intervention was documented in 124,178 (45.1%) of the 275,339 prescriptions dispensed during the study period. Interventions of potential clinical importance were performed and documented in 0.8% (2262) of the prescriptions. Conclusion A substantial number of pharmaceutical interventions are performed on prescriptions in Norwegian pharmacies after introduction of electronic prescriptions. A potentially clinical important intervention is performed in one of every 125 prescriptions (0.8%). This result indicates that pharmacists at Norwegian pharmacies prevent more than 400,000 prescription errors of potential clinical importance each year.

Background and importance The antimicrobial stewardship programmes are essential to achieve proper use of antibiotics, especially in units of special complexity, such as the intensive care unit (ICU). Aim and objectives To show the antibiotic pressure in the ICU and the groups of antibiotics with greatest deviation in their consumption (2017); to describe the activities carried out by the ICU antimicrobial stewardship team (ICU-AST) from 2018 to June 2019; and to show the results obtained in 2018 and in the first and second quarters of 2019. Material and methods • This was a prospective intervention study from January 2018 (when 2017 ICU antibiotic pressure data were obtained) to June 2019. • The ICU-AST comprised an intensive care doctor, microbiologist and hospital pharmacist, all with experience in AST. • The activities and interventions of the ICU-AST were agreed in the commission of infections after analysis of the data obtained. To measure antibiotic pressure, the rate DDD/1000 bed days was used. All antibiotic pressure data were obtained by the hospital pharmacist who analysed consumption in the ICU from electronic prescriptions data. • All actions carried out by the group were recorded in a database (Excel) where all variables were coded (date, training activity, information feedback and modification in prescriptions). Results Data were adjusted so that changes in DDD (2019) did not generate interference. Antibiotic pressure in the ICU (2017): 2295.85 DDD/1000 bed days. Groups of antibiotics with greatest deviation: carbapenems 333.03 DDD/1000 bed days and antifungals 210.95 DDD/1000 bed days. Activities carried out by ICU-AST: in 2018, the interventions (n=943) performed to reduce antibiotic pressure and carbapenem and antifungal consumption were adequacy of prescriptions to the internal guidelines (33.54%), de-escalation of treatments (27.32%), proposition of short course treatments (19.36%), broad spectrum restriction (10.57%) and other (9.21%). Four training sessions on antibiotic prescriptions were conducted (2018) and antibiotic pressure data were shown quarterly (2018–June 2019). All antibiotic treatments were reviewed 48–72 hours after initial administration by the ICU-AST. No additional economic resources were needed as the ICU-AST was formed by professionals who already worked in the centre. The results obtained were Antibiotic pressure: 2018: 2078.88 DDD/1000 bed days 1st quarter 2019: 1760.55 DDD/1000 bed days 2nd quarter 2019: 1830.95 DDD/1000 bed days Carbapenems: 2018: 329.43 DDD/1000 bed days 1st quarter 2019: 211.34 DDD/1000 bed days 2nd quarter 2019: 232.29 DDD/1000 bed days Antifungals: 2018: 132.26 DDD/1000 bed days 1st quarter 2019: 120.22 DDD/1000 bed days 2nd quarter 2019: 108.67 DDD/1000 bed days Conclusion and relevance In 2017, antibiotic pressure in the ICU was high. Two groups of antibiotics had excessive consumption: carbapenems and antifungals. The ICU-AST carried out training sessions, feedback of antibiotic pressure data and intervened directly, modifying the antibiotics treatment. This intervention achieved a decrease in global antibiotic pressure in the ICU. In addition, the ICU-AST achieved a reduction in antibiotic pressure in the groups with greater deviation: carbapenems and antifungals. A limitation of the study was that mortality was not measured, although no significant change is expected as the mortality commission did not report any significant change during the study period. References and/or acknowledgements No conflict of interest.

Background and importance Prescription in the emergency department (ED) is compromised by multiple causes which could lead to a higher risk of medication errors. Aim and objectives To compare and analyse pharmaceutical interventions (PIs) performed in frail patients (FP) with those performed in the rest of the patients (ROP). Material and methods A prospective interventional study (January 2019–June 2019) was conducted in a tertiary hospital. A medical reconciliation was made daily using electronic prescriptions (EP) of patients own drugs and ED treatment of all patients admitted. FP (defined by their primary care physician) were also personally interviewed. Electronic medical history was consulted to evaluate current treatment and to collect demographic data. PIs were performed electronically in ROP and discussed personally with the clinician in charge of FP. PIs were categorised. The rate of medical acceptance was evaluated. Drugs were classified as high risk drugs (HRD), potentially inappropriate drugs in the elderly (PID) and other. Results We included 418 patients: 61 in the FP group (mean age 78.8 years (SD=10.4), 55.7% men) and 357 in the ROP group (mean age 76.4 years (SD=13.5), 50.0% men). In the FP group, 188 PIs were registered (mean interventions/patient 3.1 (DE 2.3)): 43.6% were medical reconciliation errors, 16.5% were to discontinue a prescription (DP), 11.2% were omission of a drug in the acute treatment (ODAT) and 12.7% were other reasons. A total of 22.3% of the interventions were made in HRD (85.7% accepted) and 12.2% in PID (73.9% accepted). In the ROP group, 370 PIs were registered (mean interventions/patient 1.25 (DE 0.6)): 29.5% were incorrect dose, 18.1% were medical reconciliation errors, 14.7% were exchange of a drug was proposed, 7.8% were adjustment to renal function, 5.4% were DP, 5.1% were ODAT and 19.4% were other. A total of 19.5% of interventions were done in HRD (75.0% accepted) and 11.4% in PID (40.5% accepted). The approval rates for FP and ROP were 80.9% and 69%, respectively. Results were presented to the hospital’s security commission. Six security measurements were accepted and implemented, two related to HRD (insulin and anticoagulants). Conclusion and relevance The high rates of acceptance of the PIs showed that the integration of the pharmacist in the multidisciplinary ED team improved the safety of the prescriptions, especially when the pharmacist was physically present. References and/or acknowledgements No conflict of interest.

Background and importance Hospital discharge has been described as the care transition in which a major number of incorrect prescriptions occur. Discharge medication reconciliation aims to prevent discrepancies when comparing the inhospital with the discharge electronic prescription. Aim and objectives To assess the incidence of unjustified discrepancies during a medication reconciliation programme by pharmacists in complex chronic patients (CCP) at hospital discharge. Material and methods This was a cross sectional study where we assessed unjustified discrepancies between the inhospital prescriptions (which are summarised in the discharge report) and the electronic prescriptions for all CCP from April 2019 to May 2019. Data were obtained from the discharge report prescriptions and the electronic prescriptions. Unjustified discrepancies were assessed according to the medical records. CCP were defined as patients with chronic diseases and comorbidities due to socioeconomic, cultural and environmental situations interfering with the decision and the need to implement specific plans. Discrepancies were classified according to: (i) incomplete prescription, (ii) omission, (iii) incorrect dose, (iv) incorrect drug selection, (v) duplicity, (vi) incorrect timing and (vii) incorrect administration route. Results We analysed the discharge prescriptions of 97 patients. Mean age was 81.7±9.7 years and 50 (51.6%) were women. Seventy-seven (79.4%) patients were admitted to medical wards and 20 (20.6%) to surgical wards. A total of 272 discrepancies were found in 77 (79.4%) patients with a mean of 2.8±2.8 discrepancies per patient: 114 (41.9%) discrepancies were related to incomplete prescription, 70 (25.7%) to omission, 67 (24.6%) to incorrect dose, 10 (3.7%) to incorrect drug selection, 7 (2.6%) to duplicities, 3 (1.1%) to incorrect timing and 1 (0.4%) to incorrect administration route. Conclusion and relevance We found that about 80% of patients presented at least one unjustified discrepancy. Medication reconciliation is a major component of safe patient care in any environment. Therefore, education of healthcare professionals and implementation of tools such as electronic reconciliation software could be useful to improve safety. References and/or acknowledgements No conflict of interest.

Objectives To investigate (1) what Finnish pharmacy customers have learned about the implemented electronic prescriptions (e-prescriptions), (2) from whom or where have they learned about them, (3) whether they are satisfied with the information received and if not, (4) what more information they would like. Methods We surveyed 1288 (44%) pharmacy customers aged ≥18 years collecting medicines for themselves with e-prescriptions in 18 pharmacies across Finland in 2015. Descriptive analysis, chi-square and Fisher's exact tests were used in the analysis. Key findings Nearly all respondents had received information about e-prescriptions (97%). A physician (67%) and a pharmacy (53%) were the most common information sources. The vast majority of the respondents had learned about how to purchase medicines with an e-prescription (86%). Most of them had also received information about the benefits of e-prescriptions (59%) and how they can view their e-prescriptions on a computer (58%). The majority of pharmacy customers felt they had received sufficient information on e-prescriptions (83%). Those dissatisfied with the information received asked for more information about how e-prescriptions are protected against misuse (47%) and who can view their e-prescriptions (44%). Conclusions Most Finnish pharmacy customers have learned how to use e-prescriptions, what their benefits are and how to view e-prescriptions on a computer. The information is generally obtained from physicians and pharmacies. Information needs concern data protection and data security. Customers are mainly satisfied with the information received. However, their knowledge only partly meets the national requirements on the information they should be provided with.

Background To analyse trends in the rates of consumption of benzodiazepine (BZD) anxiolytics, BZD hypnotics and non-BZD hypnotics and the association with contextual factors. Methods Descriptive time series study. Units of analysis were monthly dose per inhabitant per day (DID) and dose per medical card per day(DCD) of benzodiazepine(BZD anxiolytics(BZD-A), BZD hypnotics(BZD-H) and non-BZD hypnotics(Non-BZD-H) between January 2006-December 2015. We analysed 6 primary healthcare districts(PHD) and used defined daily doses (DDDs) to calculate the monthly DIDs(overall and by ATC group). Trends and monthly percentage change (MPC) were analysed through joinpoint regression. Results The annual DID increased by 26% overall, the trend was different across ATC groups. Consumption in BZD-A and BZD-H increased (27.1%,61.9%), consumption in Non-BZD-H decreased by 35%. There was high variability in DCD across the PHD, with an overall increase of 10.2%(5.7%-22.9%). By ATC, DCD increased by 10.4% in BZD-A(4.2%-22.2%) and by 44.2% in BZD-H(33.2%-76.5%). The overall DCD in the Non-BZD-H decreased by 42.1%(19.7%-50.8%). We found an initial upward trend in consumption of BZD-A until April/2008(monthly percentage change –MPC- +0.5%), followed by a slightly slower increase (+0.1%). No changes in trend were detected in BZD-H. In Non-BZD-H, we observed an upward trend until February/2013(+0.1%), followed by a sharp decrease until August/2013(−6.3%), and finally a slight decrease(−0.3%). Conclusions BZD consumption has increased in the last decade, with variability across areas. The changes in trends do not coincide with the financial crisis, introduction of prescriptions by active ingredient, electronic prescriptions or copayment. The only decrease in the Non-BZD-H may be linked to an intervention.

Pacientes submetidos a operações do trato gastrointestinal são complexos e frequentemente recebem medicamentos via sondas enterais (SE). O objetivo desse estudo foi analisar o perfil e fatores associados às limitações da administração via SE de medicamentos prescritos para pacientes submetidos a operações do trato gastrointestinal e parede abdominal. Para tal, analisou-se todas as prescrições eletrônicas de pacientes sob uso de nutrição enteral (NE) em pós-operatório em um hospital universitário geral (01/05 a 05/12/2017). Medicamentos prescritos para administração via SE foram identificados e realizou-se uma revisão da literatura acerca de limitações para sua administração por esta via. Determinou-se a prevalência dessas limitações e fatores associados por meio de análises uni (qui-quadrado de Pearson) e multivariada (regressão logística - nível de significância estatística de 5%). Foram analisadas 341 prescrições de 40 pacientes. Identificou-se 725 medicamentos prescritos via SE (44 medicamentos diferentes). Na revisão, recuperou-se 33 artigos para construção de uma base de dados, que permitiu a identificação de 188 limitações quanto à administração via SE entre os medicamentos prescritos, e uma prevalência de pelo menos uma limitação de 57,5% (n=23), que mostrou-se associada positivamente à idade igual ou superior a 60 anos (OR 4,67; IC95% 1,07-20,40). Devido à escassez de referências voltadas para administração de medicamentos via SE, esse estudo configura uma importante ferramenta para o cuidado farmacoterapêutico ao paciente sob uso de NE. O número de limitações identificado foi reduzido, mas sua associação com idade avançada e a gravidade da população estudada reforçam a importância da priorização de seu manejo.

Introduction Primary nonadherence to medication occurs when a patient does not fill a prescription and often leads to suboptimal patient outcomes, lost productivity, and increased net costs. Pilot introduction of electronic prescriptions (e‑prescriptions) in Poland took place in 2018, enabling nationwide assessment of primary nonadherence. Objectives To determine the prevalence and drivers of primary nonadherence in Poland. Methods This retrospective analysis included data from all e‑prescriptions issued in Poland in 2018. Primary nonadherence was defined as not filling a prescription within 1 month from the date of issuing. Results Out of all 119 880 e‑prescriptions issued in Poland in 2018, 94 913 were filled, thus the primary nonadherence rate reached 20.8%. Although no differences in primary nonadherence were observed between sexes, age was found to have a significant effect, with older groups showing lower rates of primary nonadherence. In addition, slightly lower rates of primary nonadherence (17.0%) were found for e‑prescriptions issued for selected drugs of key importance (n = 47 492). Multivariable analysis performed within this subset showed that those aged ≥75 years had the lowest odds for nonadherence (odds ratio, 0.55; 95% CI, 0.48-0.64). Differences in primary nonadherence rates were observed across therapeutic areas (lowest value in antibiotics, 14.3%), drug classes (lowest value in sulfonylureas, 13.2%), and individual drugs. Primary nonadherence rates were lower for drugs covered by the "Leki 75+" program, which makes them free of charge for those aged 75 years or older. Conclusions A high percentage of prescriptions issued in Poland are never filled. E‑prescriptions allow the identification and analysis of drivers of this phenomenon. Our findings may help designing national health and medicine policies.

Background: Electronic prescription (E-prescribing) automates the manual prescription process which enables physicians, pharmacies and payers to gain access to information that contributes to patient safety, controlling costs, and gaining business intelligence. E-Prescribing eliminates handwriting errors/illegibility and gives both physician and pharmacist access to a patient‘s prescription history to reduce the chance of the wrong drug being dispensed. According to the FDA, more than 95,000 prescription drug errors have occurred since 2000, mainly due to mistakes when reading a handwritten prescription and dispensing a similar-sounding, but different drug. Subjects and Methods: A systematic review was conduct by searching published articles from 2014 to 2019 from database including Proquest, Cochrane, Pubmed, and Scopus. The keywords were “electronic prescription”, “e-prescription”, “e-prescribing”, “patient safety”, and “hospital’. Inclusion criteria were full text articles and English. Exclusion criterias were non-systematic review, literature review or narrative review, inaccessible, and not focused on patient safety. A total of 10.852 abstracts were obtained by searched database. After review process, 7 were finally retained in this review. Results: Seven articles stated that e-prescriptions increased patient safety in hospital. E-prescribing had several advantages including (1) eliminates errors in handwriting and dispensing; (2) provide access patient prescription history; and (3) avaibility of patient‘s documented allergies to prevent negative reaction. Conclusions: The e-prescription increases patient safety in hospital. E-prescribing has several advantages including (1) eliminates errors in handwriting and dispensing; (2) provide access patient prescription history; and (3) avaibility of patient‘s documented allergies to prevent negative reaction. Keywords: electronic prescription, e-prescription, e-prescribing, patient safety, hospital.

Telehealth is an emerging sector in Singapore. During the Coronavirus Disease 2019 pandemic, telehealth enabled patients to access medical and medication-related services while supporting social distancing efforts. In this article, we provided an overview of the roles of community pharmacists in telehealth in Singapore. In collaboration with various telehealth providers, Watsons Singapore offered medication-related services including reviewing electronic prescriptions and optimizing medication regimens, for both local and international patients. While there were challenges to resolve, these collaborations allowed community pharmacists to continue to utilize their specialized skills in medication management and optimization in the new digital telehealth workflows.

SummaryAfter implementation of a system-wide EMR within our university system, e-prescribing is now commonplace.The authors conducted a study to assess whether optimization of computerized provider order entry (CPOE) can reduce errors in these electronically transmitted prescriptions and would require less frequent interventions from pharmacists, in particular the need for them to “call to clarify” (CTC) details of particular prescriptions. Secondary analysis based on cost assumptions was preformed to presume cost differences before and after optimization changes.In order to generate complete, error-free prescriptions, optimization changes were implemented in the form of in line validation messages. These messages were generated if (1) an order did not specify a provider or pharmacy; (2) the DEA requirements were not met; (3) character limits were exceeded in patient sig or demographics or (4) administration instructions had breaks or had both discrete and free text elements. Retrospectively, prescriptions were randomly selected from a nine month period before and after implementing changes. These prescriptions were analyzed by a pharmacist and a nurse to identify types of errors that would require a CTC to a prescribing provider. Errors were compared statistically to determine effectiveness of changes pre and post optimization.A total of 602 prescriptions were analyzed; 301 before changes and 301 after changes. Of these prescriptions, 20.27% had errors before changes and 12.96% had errors after changes. The decline in the error rate was considered statistically significant for pImplementing optimization changes to the CPOE resulted in a reduction in error rate requiring pharmacist CTC. This study identifies effective optimization changes for electronic prescribing that can reduce prescribing errors and may result in cost saving.

The National Diabetes Inpatient Audit is a yearly audit aimed at providing a snapshot view on various aspects of diabetes care across hospitals in England. Results are provided for each hospital and are shown in comparison to other hospitals. Since 2011, our 450-bedded hospital has been in the first quartile with regards to medication errors, prescription errors, medicine management errors and insulin errors. In the 2016 audit, we had 11.6% medication errors whereas across England, there were 44.6% medication errors. Our service is exemplary on many fronts. Foundation year doctors get formal training in diabetes care. Information Technology is key in providing the fail-proof electronic prescribing software, access to General Practitioner’s Health records, safe insulin prescribing e-module, and up-to-date online clinical guidelines. We have Pharmacists and Pharmacist Technicians who check electronic prescriptions on a daily basis. We also benefit from the service of a Diabetes Specialist Pharmacist. We provide a twice-weekly specialist diabetes ward round across the whole hospital and patients are usually identified from the Electronic Patients Record software. The Diabetes Specialist Nurses are additionally available for one-to-one education Monday to Friday 0900 to 1700. Finally, we run a comprehensive diabetes education day for nurses and other allied health care professionals twice a year. Disclosure M. Parsad: None. K.D. Lambert: None. D. Ardern: None. A.C. Mezzullo: None.

Lääkemääräys on laadittava sähköisesti 1.1.2017 alkaen. Laissa määriteltyjen poikkeustapausten perusteella laaditussa kirjallisessa ja puhelinlääkemääräyksessä on perusteltava, miksi sitä ei ole annettu sähköisesti. Valtakunnallisen toiminnallisen muutoksen myötä on mahdollista selvittää ensimmäisen kerran lääkemääräysten kokonaismäärä Suomessa. Tutkimusaineistona ovat reseptikeskukseen tallennetut potilastietojärjestelmissä ja Kelaimessa laaditut sähköiset lääkemääräykset sekä apteekeissa tallennetut (sähköistetyt) kirjalliset, puhelin- ja erityislupavalmisteiden lääkemääräykset tutkimusjaksolla 1.1.–30.11.2017. Reseptikeskukseen tallennettiin tutkimusjaksolla 29,477 (100 %) milj. sähköistä lääkemääräystä, joista 96,6 % oli laadittu potilastietojärjestelmissä ja 1,0 % Kelaimella. Apteekeissa sähköistettiin 0,375 (1,3 %) milj. lääkemääräystä, joista 0,246 (0,8 %) milj. oli kirjallisia ja 0,122 (0,4 %) milj. puhelinlääkemääräyksiä. Apteekeissa sähköistetyistä lääkemääräyksistä yli puolet oli kirjallisia lääkemääräyksiä, jotka oli laadittu teknisen häiriön perusteella. Tutkimuksessa selvitettiin ensimmäisen kerran Suomessa lääkemääräysten kokonaismäärää vuoden 2017 yhdentoista kuukauden tietojen perusteella. Valtakunnallisessa seurannassa ilmeni päivittäin teknisiä häiriöitä, joiden perusteella laadittiin kirjallisia ja puhelinlääkemääräyksiä., Electronic prescription is mandatory in Finland since 1 January, 2017. A physician or a dentist can issue a written or a telephone prescription under exceptional circumstances, and the reason for issuing must be given. Because of the administrative nationwide change it was the first time possible to find out prescription volume in Finland. Written and telephone prescriptions were typed in to the national Prescription Centre at the 815 pharmacies. Electronic prescriptions were sent to the Prescription Centre (ePrescription Service) from electronic patient data systems, or Kelain web prescription service. Data from the Prescription Centre were extracted from 1 January till 30 November, 2017. There were 29.477 Million (100%) new electronic prescriptions, of which 96.6% were from electronic patient data systems and 1.0% from Kelain web service. Altogether 0.375 Million (1.3%) prescriptions were typed in at the pharmacies, of which 0.246 Million (0.8%) were written and 0.122 Million (0.4%) telephone prescriptions. Approximately half of the prescriptions typed in at the pharmacies were written prescriptions that were issued because of a technical failure. In this study we report the first time prescription volume in Finland. All the prescriptions in the national Prescription Centre are electronic, and only 1.3% of the prescriptions were typed in at the pharmacies in the first eleven months since the electronic prescription became mandatory 1 January, 2017. Written prescriptions were issued because a technical failure occurred in local or areal data or software systems.

Background There is a major risk in the development of antibiotic resistance in Europe, with a particular rise in antibiotic resistance to piperacillin-tazobactam. Countries such as Lithuania, Bulgaria or Italy already suffer from this increase in resistance to antibiotics (European Centre for Disease Prevention and Control, 2015). 1 As elsewhere in France, the overuse of piperacillin-tazobactam in our university hospital has represented a warning signal, for the Anti-Infective Committee in particular (+107.8%). 2 Purpose The aim of this study is to evaluate the use of piperacillin-tazobactam within a university hospital. Material and methods During 2 months, all electronic prescriptions of piperacillin-tazobactam and manual prescriptions for units which do not benefit from electronic prescriptions were analysed in order to evaluate their compliance and their relevance with clinical and biological data registered in patient records. Results Ninety-one prescriptions were studied, the majority from the clinical haematology department 17.6% (n=16), digestive surgery unit 13.2% (n=12) and pneumology unit 10.98% (n=10). Medication was, in most cases, prescribed by medical residents 94.5% (n=86). Indications included nosocomial pneumonia 39.5% (n=36), febrile neutropaenia 22% (n=20) and digestive infections 17.6% (n=16). Isolated germs were mainly staphylococci ( aureus, epidermidis ) 25.3% (n=23), Escherichia coli 11% (n=10) and Pseudomonas aeruginosa 11% (n=10). Microbiological documentation was not always available 75.8% (n=69), nor was information on the performance of an antibiogram 60.2% (n=56). The mean dose was 12.7 g/day (eight; 16 g/day) and the mean duration of piperacillin-tazobactam treatment was 12 days (2 days; 55 days). Conclusion This work highlights abidance by dose, treatment duration and indications. However, it also reveals insufficient microbiological documentation, few antibiograms and a lack of antibiotic therapy reassessment. The results of this study have been presented to the Anti-Infective Committee and hospital prescribers in order to improve the proper use of this antibiotic. References and/or Acknowledgements 1. European Centre for Disease Prevention and Control 2015. 2. National network of prevention infections associated with care 2015. No conflict of interest

Background NICE guidelines (NG31, 2015) advise that suitable anticipatory medicines (AMs) are prescribed as early as possible for people likely to need symptom control in the last days of life. To date, there has been limited evaluation of this practice. This study aimed to characterise anticipatory prescribing (AP) at a district general hospital in relation to three main areas: patient population, outcomes, and prescribing and administration patterns. Methods A retrospective review of electronic prescriptions and clinical records was undertaken in April 2017. All patients who were prescribed AMs using the hospital electronic AP protocol from 1 st July to 31 st Sept 2016 were identified. Demographic, clinical and outcome data were collected for all identified patients (n=118). Prescribing and administration patterns were reviewed for a representative subsample (n=50). Results 118 patients were prescribed AMs (mean age: 81.2±10.3 years, 63 men). 38 (32.3%) had malignant disease and 49 (41.5%) had inpatient palliative team involvement. 66% (n=78) died in hospital, representing 49.7% of all inpatient deaths in that 3 month period. Median time from AM prescription to inpatient death was 1 day (IQR: 0–3). 34% (n=40) of those prescribed AMs as an inpatient were discharged. Of these, 33 (82.5%) had died within 6 months, a median of 8 days (IQR: 4–26) after discharge; AMs were omitted from the discharge prescription in 30%. For the 50-patient subsample, AMs were administered in 54% of cases, usually within a few hours of death. Conclusions There appeared to be an appropriate rate of AP but prescribing patterns suggest a reactive rather than anticipatory approach, with some lack of continuity between inpatient and discharge prescriptions. More education and research are needed to support earlier identification of those in need of AP and smoother transitions between the inpatient and community setting.

Importance Electronic prescribing promises to improve the safety and clarity of prescriptions. However, it also can introduce miscommunication between prescribers and pharmacists. There are situations where information that is meant to be sent to pharmacists is not sent to them, which has the potential for dangerous errors. Objective To examine how frequently prescribers or administrative personnel put information intended for pharmacists in a field not sent to pharmacists, classify the type of information included, and assess the potential harm associated with these missed messages. Design, Setting, Participants Medication record data from our legacy electronic health record were requested for ambulatory care patients seen at an academic medical center from January 1, 2000, to May 31, 2015 (20 123 881 records). From this database, 6 060 272 medication orders met our inclusion criteria. We analyzed a random sample of 10 000 medication orders with internal comments. Main Outcomes and Measures Reviewers classified internal comments for intent. Comments intended for pharmacists were also sorted into descriptive categories and analyzed for the potential for patient harm. Results We found that 11.7% of the prescriptions in our sample contained comments that were intended to be sent to pharmacists. Many comments contained information about the dose, route, or duration of the prescription (38.0%). Approximately a third of the comments intended for pharmacists contained information that had the potential for significant or severe harm if not communicated. Conclusion We found undelivered comments that were clearly intended for pharmacists and contained important information for either pharmacists or patients. This poses a legitimate safety concern, as a portion of comments contained information that could have prevented severe or significant harm.

Fatema Aljasmi,1 Fatema Almalood,1 Ahmed Al Ansari2 1Department of Primary Health Care, 2Department of Training and Education, Bahrain Defence Force Hospital, West Riffa, Kingdom of Bahrain Background: One of the important activities that physicians – particularly general ­practitioners – perform is prescribing. It occurs in most health care facilities and especially in primary health care (PHC) settings.Objectives: This study aims to determine what types of prescribing errors are made in PHC at Bahrain Defence Force (BDF) Hospital, and how common they are.Methods: This was a retrospective study of data from PHC at BDF Hospital. The data consisted of 379 prescriptions randomly selected from the pharmacy between March and May 2013, and errors in the prescriptions were classified into five types: major omission, minor omission, commission, integration, and skill-related errors.Results: Of the total prescriptions, 54.4% (N=206) were given to male patients and 45.6% (N=173) to female patients; 24.8% were given to patients under the age of 10 years. On average, there were 2.6 drugs per prescription. In the prescriptions, 8.7% of drugs were prescribed by their generic names, and 28% (N=106) of prescriptions included an antibiotic. Out of the 379 prescriptions, 228 had an error, and 44.3% (N=439) of the 992 prescribed drugs contained errors. The proportions of errors were as follows: 9.9% (N=38) were minor omission errors; 73.6% (N=323) were major omission errors; 9.3% (N=41) were commission errors; and 17.1% (N=75) were skill-related errors.Conclusion: This study provides awareness of the presence of prescription errors and frequency of the different types of errors that exist in this hospital. Understanding the different types of errors could help future studies explore the causes of specific errors and develop interventions to reduce them. Further research should be conducted to understand the causes of these errors and demonstrate whether the introduction of electronic prescriptions has an effect on patient outcomes. Keywords: medical errors, general practice, prescribing errors, omission errors, commission errors, rational drug use