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in its writing, inclusion of information, improper prescription, and even incorrect prescription. The impact of these errors can lead to several factors that can be detrimental, ranging from the inaccuracy of drugs given to certain individuals, errors in measuring the dose given, or incompatibility of drugs with certain patients so that it can result in disability or death. This study aims to determine the completeness of outpatient prescriptions according to prescribing SOP compliance served in the internal disease polyclinic of MM Indramayu Hospital. This study used a descriptive method which was carried out retrospectively using activity data for the period January - December 2020. Sampling was carried out using the Slovin formula and obtained 380 recipes. Based on the data collection and analysis carried out in this evaluation, it can be seen that the administrative completeness of prescriptions that meet the requirements are (74.73%), while the administrative completeness of prescriptions that do not meet the requirements are (25.26%). Administrative documents that meet the criteria are Signature, Incryptio, Invocation, Patient Name and Age (100%), while other administrations are Praescriptio/Ordonatio (28.68%), Subscriptio (45.26%), and Address (75.78%). From this evaluation, it can be concluded that many outpatient prescriptions meet the completeness aspect of the prescription SOP at MM Indramayu Hospital. However, improvements in prescribing need to be done so that there are no prescriptions that do not meet the requirements. This can be done by reviewing doctors to be more thorough and clear in prescription writing, communication between pharmacists and doctors or medical audits of prescription writing

Objective: To evaluate written prescriptions according to a checklist based on WHO guidelines (prescription audit). To compare prescriptions of senior and junior physicians and to provide data and recommendations. Study Design: Cross-sectional, analytic study. Place and Duration of Study: Pak Emirates Military Hospital, and Combined Military Hospital, Rawalpindi Pakistan, from March to Aug 2018. Methodology: A total of 205 prescriptions using convenient sampling technique were analyzed according to a checklist based on WHO guidelines for standard prescription writing. Data was analyzed using SPSS-22. Results: Out of total 205 prescriptions, 83 (40%) prescriptions belong to senior and 122 (60%) to junior physicians. Fifty (25%) prescriptions lacked patient name, 49 (24%) lacked age. Gender was mentioned in only 117 (57%) prescriptions. Date, diagnosis and dosage of drug were written in 170 (83%), 172 (84%) and 177 (86%) respectively while dosage form and route of administration were mentioned in 144 (70%) and 102 (50%) respectively. Generic name was written in only 75 (37%) prescriptions. Name and stamp of the doctor were available on 135 (66%) and 125 (61%) prescriptions respectively. A statistically significant association was observed between senior and junior physicians in terms of error in name of patient and dosage form (p=0.002& 0.005 respectively). Conclusions: Prescriptions were mainly deficient in the generic names of drugs. Route of administration was missing in half of the prescriptions. None of the parameters was totally accurate. Prescriptions from junior physicians had more errors.

Incomplete prescribing can be one of the causes of medication errors in patients. This incident can be avoided by screening prescriptions by pharmacists at pharmacies which include administrative and pharmaceutical studies. The purpose of this study was to determine the administrative and pharmaceutical prescription completeness in June-December 2018 at CS Farma Pharmacy. The research method was descriptive nonexperimental with retrospective data collection. Samples were collected by simple random sampling technique and obtained 385 pieces of recipes that have met the inclusion criteria. The result shows that the completeness of administrative prescriptions consisted of: patient name 99,22%, patient age 88,05%, sex 9,09%, body weight 0%, doctor's name 3,64%, doctor's SIP 0% , prescription date 97,92%, doctor's address 100%, doctor's telephone number 0,26% and doctor's initial 6,23%. Pharmaceutical aspects consisted of: dosage form 69,61%, dosage strength 57,66%, drug stability 100% and incompatibility 100%. It can be concluded that the prescription in CS Farma Pharmacy on June-December 2018 was not complete administratively and pharmaceutically yet, based on Permenkes No.73 In 2016.

Expedited partner therapy (EPT) is an effective strategy for partner management of sexually transmitted infections. Some states, including Wisconsin, allow EPT prescriptions to be filled without a patient name. This study determined the refusal rates of nameless EPT prescriptions in Milwaukee pharmacies.In this cross-sectional study, 3 trained research assistants of different age, sex, and race posed as "patients" and visited 50 pharmacy locations from one pharmacy chain in Milwaukee County, WI, to fill nameless EPT prescriptions. A χ test was used to compare demographics of patients, pharmacists, and pharmacies. Multiple logistic regression was used to identify factors associated with prescription refusal.Twenty-nine (58%) of 50 nameless EPT prescriptions were refused. Univariate analysis showed that prescriptions were more likely to be refused if the pharmacy was in the suburbs (77%) compared with Milwaukee city (43%; P = 0.01), if the pharmacist was older than the patient (82%) compared with being younger (46%) or within the same age group (33%; P = 0.01 for both), and if the patient was white (78%) compared with nonwhite (47%; P = 0.03). Multivariable regression revealed significantly higher refusals for pharmacies located in the suburbs compared with the city (odds ratio, 5.3; 95% confidence interval, 1.4-20.3; P = 0.03) and in patients who were white compared with nonwhite (odds ratio: 4.8; 95% confidence interval, 1.2-19.8; P = 0.01).More than half of nameless EPT prescriptions were refused in Milwaukee county pharmacies, more frequently at suburban pharmacies and for white patients. Increased pharmacist education regarding EPT is essential to help combat the sexually transmitted infection crisis.

SETTING Regional tuberculosis (TB) centres of the Yangon and Mandalay Regions of Myanmar, which account for 65% of all notified rifampicin-resistant tuberculosis (RR-TB) cases countrywide. OBJECTIVE To determine 1) initial loss to follow-up (LTFU), 2) treatment delay, and 3) factors associated with initial LTFU and treatment delay among RR-TB patients residing in the Yangon and Mandalay regions diagnosed using Xpert® during January-August 2016. DESIGN This was a retrospective cohort study. Each diagnosed patient was tracked in the drug-resistant TB treatment registers of the Yangon and Mandalay regional treatment centres for January-December 2016 using patient name, age, sex, township and date of diagnosis. If the diagnosed patient was not found in the treatment register by 31 December 2016, he/she was considered 'initial LTFU'. RESULTS Of the 1037 RR-TB patients diagnosed, 310 (30%) experienced initial LTFU, which was significantly higher among patients aged 55 years and among those diagnosed in the Mandalay Region. A treatment delay of >1 month was observed in 440 (70%) patients (median delay 41 days). Delay was uniformly high across patient subgroups, and was not associated with any factor. CONCLUSION Initial LTFU and treatment delays among RR-TB patients were high. Future studies using qualitative research methods are needed to ascertain the reasons for this observation.

BACKGROUNDMislabeled samples are a serious problem in most clinical laboratories. Published error rates range from 0.39/1000 to as high as 1.12%. Standardization of bar codes and label formats has not yet achieved the needed improvement. The mislabel rate in our laboratory, although low compared with published rates, prompted us to seek a solution to achieve zero errors.METHODSTo reduce or eliminate our mislabeled samples, we invented an automated device using 4 cameras to photograph the outside of a sample tube. The system uses optical character recognition (OCR) to look for discrepancies between the patient name in our laboratory information system (LIS) vs the patient name on the customer label. All discrepancies detected by the system's software then require human inspection. The system was installed on our automated track and validated with production samples.RESULTSWe obtained 1 009 830 images during the validation period, and every image was reviewed. OCR passed approximately 75% of the samples, and no mislabeled samples were passed. The 25% failed by the system included 121 samples actually mislabeled by patient name and 148 samples with spelling discrepancies between the patient name on the customer label and the patient name in our LIS. Only 71 of the 121 mislabeled samples detected by OCR were found through our normal quality assurance process.CONCLUSIONSWe have invented an automated camera system that uses OCR technology to identify potential mislabeled samples. We have validated this system using samples transported on our automated track. Full implementation of this technology offers the possibility of zero mislabeled samples in the preanalytic stage.

Introduction: Hospital admission within 72 hours of emergency discharge is a widely accepted measure of emergency department quality of care. Patients returning for unplanned admission may reveal opportunities for improved emergency or followup care. Calgary emergency physicians, however, are rarely notified of these readmissions. Aggregate site measures provide a high level view of readmissions for managers, but dont allow for timely, individual reflection on practice and learning opportunities. These aggregations may also not correctly account for variation in planned readmissions and other workflow nuances. There was a process in place at one facility to compile and communicate readmission details to each physician, but it was manual, provided limited visit detail, and was done weeks or months following discharge. Methods: A new, realtime 72 hour readmission notification recently implemented within the Calgary Zone provides direct and automated email alerts to all emergency physicians and residents involved in the care of a patient that has been readmitted. This alert is sent within hours of a readmission occurring and contains meaningful visit detail (discharge diagnosis, readmit diagnosis, patient name, etc) to help support practice reflection. An average of 15 alerts per day are generated and have been sent since implementation in April, 2017. Although an old technology, the use of email is a central component of the solution because it allows physicians to receive notifications at home and outside the hospital network where they routinely perform administrative tasks. A secondary notification is sent to personal email accounts (Gmail, Hotmail, etc) to indicate an unplanned admission has occurred, but without visit detail or identifiable information. It also allowed implementation with no new hardware or software cost. Results: A simple thumbs up/down rating system is used to adjust the sensitivity of the alert over time. More than 66% of those providing feedback have indicated the alert is helpful for practice reflection (i.e., thumbs up). And of those that indicated it was not helpful, comments were often entered indicating satisfaction with the alert generally, or suggestions for improvement. For example, consulted admitting physicians are often responsible for discharge decisions and should be added as recipients of the alert. Conclusion: Many physicians have indicated appreciation in knowing about return patients, and that they will reflect on their care, further review the chart, or contact the admitting physician for further discussion. Most are accepting of some ‘expected’ or ‘false positive’ alerts that aren’t helpful for practice reflection. Further tuning and expansion of the alert to specialist and consult services is needed to ensure all physicians involved in a discharge decision are adequately notified.

In the prescription service flow, pharmacists are required to do prescription screening which includes administrative screening, pharmaceutical suitability and clinical considerations. The administrative and pharmacetic aspects of the prescription were chosen because it was the initial screening when the recipe was served at the pharmacy because it included all the information in the recipe relating to the clarity of the drug writing, the validity of the recipe, and the clarity of the information in the recipe. This research was conducted to find out how the administrative and pharmacetic prescriptions at the Kumbum Pos Pengumben Pharmacy in the period of August to December 2018 fulfilled the prescription completeness according to Minister of Health Regulation No. 73 of 2016. Administrative and pharmacy checks were carried out on 288 prescription sheets by filling in the tables Data collection (Checklist) in accordance with the completeness aspects reviewed. From the results of the study showed the incidence of incomplete prescriptions at the Post-Pengumben K-24 Pharmacy namely 99% body weight, 36% sex, 28% patient age, 1% patient name, 6% doctor name, 28% SIP, as many as 1%, telephone number as much as 15%, initial as much as 53%, prescription date as much as 2%, preparation as much as 25%, dosage strength 24%, drug stability 1%, and 0% compatibility. The complete prescription at the K-24 Pharmacy Station Post has not fulfilled the administrative and pharmaceutical requirements in accordance with Permenkes No. 73 of 2016.

Our software has two modules include in it extraction of data & EHR system with cloud . Now a days there is a busy schedules of doctors so they have no time to read the huge amount of articles ,they discussed the disease related problems either in conference or in the seminar only . So we provide a great extraction approach for this problem to give huge information of articles to the system, the machine learning process is done on the article. It only give the information to the doctors which is they want & related and useful to their work .The second approach includes in our system is that we proposed the EHR(Electronic Health Record) system. Which includes the details information of the patient ex: patient name ,id, address ,photo etc . This data also available on cloud. This information is easily accessible and it requires the less time to be searched the data about disease & treatment. Using the EHR system we can access the medical history of the patient from any location . It reduces the time require for the lab tests , previous treatments, allergies of patient.

Objective To understand the factors that influence success in scrubbing personal names from narrative text. Materials and methods We developed a scrubber, the NLM Name Scrubber (NLM-NS), to redact personal names from narrative clinical reports, hand tagged words in a set of gold standard narrative reports as personal names or not, and measured the scrubbing success of NLM-NS and that of four other scrubbing/name recognition tools (MIST, MITdeid, LingPipe, and ANNIE/GATE) against the gold standard reports. We ran three comparisons which used increasingly larger name lists. Results The test reports contained more than 1 million words, of which 2388 were patient and 20 160 were provider name tokens. NLM-NS failed to scrub only 2 of the 2388 instances of patient name tokens. Its sensitivity was 0.999 on both patient and provider name tokens and missed fewer instances of patient name tokens in all comparisons with other scrubbers. MIST produced the best all token specificity and F-measure for name instances in our most relevant study (study 2), with values of 0.997 and 0.938, respectively. In that same comparison, NLM-NS was second best, with values of 0.986 and 0.748, respectively, and MITdeid was a close third, with values of 0.985 and 0.796 respectively. With the addition of the Clinical Center name list to their native name lists, Ling Pipe, MITdeid, MIST, and ANNIE/GATE all improved substantially. MITdeid and Ling Pipe gained the most—reaching patient name sensitivity of 0.995 (F-measure=0.705) and 0.989 (F-measure=0.386), respectively. Discussion The privacy risk due to two name tokens missed by NLM-NS was statistically negligible, since neither individual could be distinguished among more than 150 000 people listed in the US Social Security Registry. Conclusions The nature and size of name lists have substantial influences on scrubbing success. The use of very large name lists with frequency statistics accounts for much of NLM-NS scrubbing success.

Elimination of medical errors is important for pathologists. Errors occurring in surgical pathology involve specimen defects, specimen labeling, processing, diagnosis, and reporting defects. Errors occur during prelaboratory, laboratory, and postlaboratory phases. We reviewed our experience with mislabeled specimens in the laboratory for an 18-month period. The percentage of error was calculated on a per case, block, and slide basis. Errors were characterized by site and as incorrect patient or site. The study involved 75 labeling errors (0.25% of cases) that were detected. Of the 75 errors, 55 (73%) involved patient name, and 18 (24%) involved site. The majority of mislabelings (52 [69%]) occurred in the gross room. Although infrequent, labeling errors involved misidentification of patient or specimen source. Of the errors, 73% (55/75) of errors resulted in slides assigned to an incorrect patient. Most errors occurred in the gross room. Newer technologies such as bar coding and radio frequency chip methods may reduce the frequency of specimen labeling errors.

Background: The laboratory request form (LRF) is a communication link between laboratories, requesting physicians and users of laboratory services. Inadequate information or errors arising from the process of filling out LRFs can significantly impact the quality of laboratory results and, ultimately, patient outcomes.Objective: We assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency.Methods: LRFs submitted to the Department of Haematology (DH) and Blood Transfusion Services (BTS) of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage.Results: Of the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8%) and signature of laboratory receiver (63.5%). None of the DH and only 9.4% of BTS LRFs met all quality indicator indices.Conclusion: The level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices.

Purpose: To identify and quantify possible errors in handwritten outpatient prescriptions in relation to adherence to standard guidelines on the layout and content of prescriptions. Method: A sample of 200 handwritten outpatient prescriptions were collected from two pharmacies located in a sub-urban (Aluthgama) and an urban (Kandy) area in Sri Lanka. Data were extracted using a pilot-tested questionnaire and the legibility of the prescription was assessed by three independent investigators. The results from the suburban area were compared with those from the urban area. Results: Based on the layout of the prescription, the presence of patient information was unsatisfactory. Patient name and age were present in less than half of the prescriptions. However, prescriber information except registration number was present in more than 75 % of the prescriptions. Date of consultation was present in > 81.5 % of the prescriptions. Non-standard abbreviations were used in 36.5 % of the prescriptions while incomplete units were observed in 51 % of the prescriptions. Nearly half of the prescriptions from both urban and suburban locations were illegible. Occurrence of prescriber details was a significantly different between Aluthgama and Kandy. Conclusion: Prescription errors are common in outpatient settings of Aluthgama and Kandy areas in Sri Lanka. Standardized prescription writing process in relation to layout, use of abbreviations, and units and legibility, is proposed as a potential solution to overcome this problem. Keywords: Medication error, Prescriptions, Standardized prescription writing, Prescriber information, Non-standard abbreviation

Aim To evaluate the usefulness of dose-banding in reducing prescribing errors in a paediatric A & E department Method Dose banding is a process where the dose is determined within defined ranges or bands, based on the age or weight of the child depending on the medication. Dose bands are often used in prescribing cytotoxic agents through an agreement between pharmacists and clinicians. A previous audit conducted in paediatric AE 19% of all errors were dosing errors. The intention of this study was to apply dose-banding to selected medications prescribed in the paediatric AE this was achieved by asking nursing staff to photocopy every prescription issued, morning and night, during this time period. All prescriptions were screened retrospectively for prescribing errors using a streamlined version of a validated data collection tool. Prescriptions written under Patient Group Directions (PGDs) were exempted from dose-banding, but were included in the analysis. Results A total of 590 medication orders (MOs) from 428 prescriptions were screened for different types of prescribing errors over two consecutive weeks. Of these, 450 (76.3%) were doctor MOs and 140 (23.7%) were PGD MOs. A total of 225 (38.1%) MOs contained a prescribing error, giving an overall prescribing error rate of 37.9%. Allergy status was missing in 36 (6.1%), date of birth (DOB) was missing in 98 (16.6%) and the patient name was missing in 88 (14.9%) MOs. Dosing errors occurred in 38 (6.4%) MOs. Of the 450 MOs written by doctors, 194 followed the dose banding schedule and none of these resulted in an incorrect dose; 114 MOs were not written according to the dose bands – and 22 of these had an incorrect dose; 142 MOs were written for drugs that were not included in the dose-banding schedule, and 2 of these had an incorrect dose. Of the 140 MOs from PGDs, 14 had an incorrect dose. Conclusion Overall the dose-error rate for MOs written by doctors was 24 out of 256 (9.4%) for non-dose banded drugs versus 0% for dose-banded drugs. The error rate for PGD MOs was 10%. The results suggest that dose-banding may be a useful strategy to help reduce prescribing errors in paediatrics.

It is important that all images in a picture archiving and communication system (PACS) environment should be stored in the correct location, e.g., in the proper patient's folder. However, if patient information, such as identification number or patient name, has been entered incorrectly, the image may be stored in the wrong place. We are developing an automated patient recognition method for chest radiographs based on a template-matching technique to prevent such filing errors. To further improve the performance of our method, we investigated the usefulness of a new automated patient-recognition method based on a template-matching technique by using edge-enhanced and smoothed images. We found that the relationship between the correlation values obtained with and without the edge-enhancement technique tended to provide different criteria for identifying correct or incorrect patients. When we combined the two methods to distinguish the images by a rule-based method, 67.1% of wrongly identified patients in our database could be identified as wrongly identified, without any false warnings for correctly identified patients. We consider that this automated method for patient recognition based on edge-enhanced images would be useful in preventing "wrong" images from being stored in a PACS environment.

Background and Aims Errors are common in paediatric inpatient prescribing. This audit cycle assessed the impact of new strategies aimed at reducing prescribing errors. Methods Drug charts from short-stay admissions in January 2010 were assessed retrospectively. Two gold standards were used; local hospital prescribing guidelines and the British National Formulary for Children (BNFC) 2009. From these results, a number of strategies were implemented to improve practice: prescribing training for new doctors was enhanced; a mandatory prescribing competency assessment was introduced; awareness was raised through local and regional presentations; increasing the availability of BNFC in clinical areas; daily pharmacy endorsements of drug charts and provision of Doctors’ name stamps; and recommendations for a drug chart re-design. We then re-audited using identical methods in July 2010. Results A total of 106 charts were assessed. Changes in documentation were found as follows: Improvements: reason for non-administration (+26%), allergy status (+20%), at least one medication pharmacy-endorsed (+16%), date of birth (+5%), dose in mg/kg where applicable (+5%), frequency for all medications (+2%), ‘micrograms’ written in full (+1%). No change: patient name (100%), no unofficial abbreviations (100%), weight (96%), signature when administered (96%). Worsening: appropriate decimals (–6%), doctor’s name stamp (–6%), start date (–5%), total dose (–2%), administration route (–1%). Conclusions This audit revealed significant improvements in paediatric prescribing following implementation of our recommendations. However, key areas were identified for further improvement. Current work includes continued development of training, a dedicated prescribing area on the ward, regular monitoring of drug charts and continuing re-audit.