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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.

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.

One of the major problems in cardiology practice is poor adherence to antihypertensive medication. This study aimed to evaluate medication adherence, we also aim to investigate the predictors of intentional and unintentional non-adherence. We issued a survey containing questions about patient demographics, blood pressure control, pharmaceutical care, and adherence level to medication. Retrospective analysis of the prescription database of the National Health Service of the Republic of Latvia was performed. The prevalence of non-adherence was 45.9%. The lowest adherence rate (38.2%) was found among patients taking medication for 2–4.9 years. Even though 84.7% of respondents had a blood pressure monitor at home, only 25.3% of them reported measuring blood pressure regularly. There were differences between the groups of adherent patients in terms of the patients’ net income (p = 0.004), medication co-payments (p = 0.007), and whether the pharmacist offered to reduce the costs of drug therapy (p = 0.002). Roughly half of the prescriptions (50.4%) containing perindopril were purchased by patients from pharmacies. The medication adherence level and blood pressure control at home were assessed as low. Intentionally non-adherent respondents discontinued their medication because of fear of getting used to medicines. The pharmacists’ behaviour in terms of offering to reduce the costs of medications used was influenced by socio-economic factors.

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

Introduction: The cost of treatment of pulmonary embolism for Greece has been studied from the data of the Pulmonary Embolism Practice of the Larissa University General Hospital (LUGH) and the National Institute of Health Services (NIHS). Purpose: To estimate the cost of Pulmonary Embolism which Greece is charged in monetary units per year. Methodology: Taking into account the treatment modalities of the randomized patients of the LUGH Pulmonary Embolism Practice, the cost of the NIHS was calculated from 101,426 electronic prescriptions for Pulmonary Disease and the cost of the Pulmonary Disease was estimated for the years 2013 - 2017. Results: The study of clinic patients showed that in 2013 the total charge for the treatment of Pulmonary Embolism was 312.382,61 € while in 2017 it was 1.369.118, 23 €. Newer oral anticoagulants (DOACs) account for 92.69% of online prescriptions and adjusting the rate to 101,426 electronic prescriptions it is estimated that 94,410 electronic prescriptions are charged by the state with € 4,046,086.79 while 2,474 electronic prescriptions which are therapeutic methods with Low Molecular Heparines cost 103,692.75€. The total burden for Greece for the years 2013 - 2017 for Pulmonary Embolism is € 4,149,779.54. Conclusions: The cost of medication has a significant impact on health costs and the increase in burden per year confirms the best diagnostic tools for the treatment of Pulmonary Embolism.

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.

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.

Background Nonurgent cases presented to the emergency department (ED) would usually be discharged with over-the-counter (OTC) medication. In a computerised government-funded hospital in Malaysia, standard amounts of medication are dispensed in a prepacked form. Objectives To investigate the number of ED revisits among patients who receive prepacked OTC medication. Methods Past electronic prescriptions were generated and reviewed individually. All prescriptions containing OTC medicines were followed up for 2 weeks. Key findings There were 401 OTC prescriptions analysed. Only 47 (12%) revisited the ED. Eight patients (2%) revisited possibly due to insufficient medication. Conclusion The current practice of dispensing prepacked medication may be continued and may be suitable for pharmacies handling prescriptions for OTC medication.

Overuse of Short-Acting Beta-Antagonist(SABA) has been associated with poor outcomes and inadequate medical care. The Portuguese Electronic Medical Prescription(PEM) records all electronic prescriptions in the country. We aim to describe SABA overuse in Portuguese patients using the PEM database. This is a retrospective population-based analysis of anonymized PEM data from a random sample of 103647 patients. We selected patients to whom SABA was prescribed at least once, between July and December 2016. We estimated the number of doses based on the prescribed medication, defining overuser as a patient who consumes more than one canister (200 doses of 100 µg) of Salbutamol or equivalent per month. Patients characterization, prescription of concomitant medication and prescriber were also analysed. SABA was prescribed and dispensed to 2644 per 100,000(10^5) Portuguese patients. From these, 49/10^5 (1.9%) were SABA overusers, consuming a mean of more than 13 SABA inhalations per day per patient. Compared to non-overusers, SABA overusers were mostly male (68.6%[95%CI 55.0-79.7] vs 49.5%[47.6-51.4]) and above 40 years of age (94.1%[84.1-98.0] vs. 40.5%[38.6-42.4]). SABA prescribers were mostly from primary care (61.0%[54.9-66.9] vs 33.0%[31.4-34.7] for overusers and non-overusers, respectively). About 27% (14/10^5) of the overusers did not use any other respiratory medication and 33.3% used antibiotics, 7.8% used systemic corticosteroids and 5.9% used both. This is the first analysis of prescription of SABA medication from the official Portuguese prescription database. SABA overuse was frequent and more ¼ did not use any additional respiratory medication. These results suggest there is a need for initiatives to reduce SABA use in Portugal.

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.

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.

Background Prescription opioids (POs) are well recognised for their role in pain management. However over recent years, use of POs has become an increasingly complex public health issue, with the emergence of increasing quantities of POs being misused and abused. Pharmacists represent the ‘gatekeepers’ of medicines, which can be a challenging role, relating in particular to POs. Objective This study aimed to gain insight into the challenges Australian community pharmacists experience in the dispensation of POs. Setting Sydney Australia. Method Twenty-five pharmacists were recruited from suburbs in and around Sydney, Australia. Pharmacists were interviewed using an in-depth, semi-structured protocol. All interviews were audio-recorded, transcribed and thematically analysed. Main outcome measure Identification of issues/factors that may influence the dispensing of POs. Results Pharmacists were reportedly confronted with several issues in the dispensing of POs, particularly in relation to the patient and prescriber. Pharmacists reported some individuals becoming increasingly more “creative” in the methods used to obtain POs, rendering detection of potential abuse/misuse increasingly difficult. Poor professional relationships with prescribers-an apparent power dynamic between the two professions, and limited engagement with patients were issues also identified. The majority of participants suggested that an electronic monitoring database would help in the identification of PO abuse/misuse. Conclusion Education is required to emphasise the importance of inter-professional collaboration between pharmacists and prescribers, as is empathy in the pharmacist-patient relationship. Prescription drug monitoring programs and prescribers sending electronic prescriptions directly to the pharmacist were perceived as helpful initiatives to undertake.

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

Objective To validate electronic prescriptions (e-prescriptions) as a method for measuring treatment adherence in patients with hypertension. Methods This prospective study initially included 120 patients treated for hypertension in primary care centers. Adherence was measured using the gold standard, the medication event monitoring system (MEMS), versus the index test, the e-prescription program, at baseline and at 6, 12, 18 and 24 months. We calculated the adherence rate using the MEMS and the medication possession ratio (MPR) for the e-prescriptions. We considered patients adherent if they had an adherence rate of 80% to 100%. To validate the e-prescription, we obtained measures of diagnostic accuracy, the Kappa concordance index, and the area under the ROC curve (AUC). Results We included 102 patients. Overall adherence was 77.4% by MEMS (95%CI: 66.8-88) and 80.4% (95%CI: 70.3-90.5) by MPR. At 24 months, sensitivity was 87% and specificity, 93.7%. The AUC was 0.903 (95%CI: 0.817-0.989). Conclusion Measures of treatment adherence were not significantly different between e-prescription and gold standard at most visits, and the e-prescription showed good discriminatory diagnostic capacity. Practice implications If patients are included in an e-prescription program for at least 2 years, e-prescription is an inexpensive method to measure adherence in hypertension.

Patients undergoing hematopoietic stem cell transplantation (HSCT) are at risk of developing potential drug–drug interactions (PDDIs). The aim of this study was to assess the prevalence of PDDIs that occur in HSCT patients on the day of hematopoietic stem cell infusion. We performed a cross-sectional study based on the evaluation of prescriptions to HSCT patients on the day of infusion (day 0). The PDDIs were analyzed using the DRUG-REAX® system and classified according to the severity level, available scientific evidence, time of onset, and potential clinical impact. Forty patients undergoing HSCT were included in this study; 33 patients (82.5 %) were exposed to at least one major and one contraindicated PDDI in a concomitant manner. All patients exposed to PDDIs had an increased risk of cardiotoxicity. Most cases of PDDIs were classified as being of major severity (80.9 %), with time of onset not specified (61.9 %), and with good or excellent scientific evidence (52.4 %). HSCT patients have a high prevalence of clinically significant PDDIs. The management of PDDIs requires an approach that includes biochemical tests, installation of cardiac monitors, periodic electrocardiograms, implementation of electronic prescriptions with a PDDI alert system, and availability of the PDDI databases.

Background In July 2015, the electronic software CATO was introduced for chemotherapy prescribing. Before CATO implementation, chemotherapy prescriptions were handwritten on a designated form. Purpose To determine the impact of electronic prescribing by comparing the rate of prescribing errors and omissions using handwritten versus electronic prescriptions, and to compare the clinical significance of errors and omissions for both prescribing methods. Material and methods A data collection form was designed based on chemotherapy prescription requirements detailed by the National Cancer Control Programme (NCCP) in Ireland. Omissions and errors were defined as the absence or incorrect recording of these requirements. Data collection was completed by 4 pharmacists. Pharmacists categorised prescription errors/omissions as potentially clinically significant or not. This was not graded for this analysis. A pilot (n=30) was completed by all data collectors to ensure consistent data collection. Only parenteral oncology/haematology prescriptions were included. Data were collected in two phases. Phase 1 was a retrospective review of handwritten chemotherapy prescriptions identified by random systematic sampling. Phase 2 was a prospective analysis of electronic prescriptions. A sample size with 60% population proportion was chosen. Results 153 handwritten prescriptions and 153 electronic prescriptions were analysed. 53% reduction in prescribing errors was found (p Conclusion Introduction of CATO prescribing has significantly reduced prescribing errors. Potentially clinically significant errors and omissions have also greatly reduced. These data, although subjective, suggest that the quality and safety of chemotherapy prescribing has greatly improved. Continued auditing of prescribing errors and omissions is imperative to further improve these results. No conflict of interest

Background A 10-fold error occurred in our hospital when multiple vials were used to prepare a single dose of an injectable medicine. We aimed to prevent future similar errors and proposed and tested a ‘1 vial rule’. Purpose To compare paediatric injectable drug doses with available products; to identify doses which could be administered using a single ampoule or vial; and to determine the feasibility of a ‘1 vial rule’. Material and methods This study did not require ethics approval. Electronic prescriptions were screened on 1 day in January 2015. Each prescribed dose of injectable medicines was recorded. The number of vials needed to prepare the dose was calculated. For each dose we determined whether a single vial could be used. For all options, we calculated the excess drug in the vial. We determined the extent to which a ‘1 vial rule’ could apply. Results 169 prescriptions for 48 different injectable medicines were observed. 70% (119/169) of doses could be administered using the smallest vial available. 50 doses needed multiple vials, including 20 doses requiring 3 or more vials. Using larger vial sizes, 95% (160/69) of doses could be administered using a single vial. For 32/50 of doses, the excess drug available was unchanged. For 8/50 prescriptions, only 1 vial size of the drug was available. For 10 prescriptions for 6 drugs using larger vials resulted in greater excess of drug being available than with smaller vials, increasing the potential for overdose. Conclusion Most injectable doses prescribed could be administered using a single vial if the vial size nearest the dose was used. A ‘1 vial’ rule applies to 95% of paediatric injectable doses. Using more than 1 vial alerts staff that correct doses may be exceeded, prompting staff to double check prescriptions and dose or volume calculations. The rule has been successfully accepted and promoted across our paediatric unit as an error prevention strategy. References and/or acknowledgements Chappell K, Newman C. Potential tenfold drug overdoses on a neonatal unit. Arch Dis Child Fetal Neonatal Ed2004;89:F483–4. doi: 10.1136/adc.2003.041608

Background Medicines prescription is the centrepiece in the triad of care (patient–prescriber–pharmacy). The electronic prescription has long been considered an effective means to reduce transcription errors as well as securing the flow of drugs at the hospital level. However, the experience of the Massachusetts General Hospital of Boston team found an error rate comparable between manual and electronic prescriptions (11.7%)1 What about the time saving that electronic prescribing can provide compared with manual prescribing? Purpose The objective of this work was to evaluate the impact of electronic prescription of medicine on time saving of the pharmaceutical team compared with manual prescription in our hospital. Material and methods We analysed the prescriptions received and processed in our hospital pharmacy over a period of 1 month according to good dispensing practices. We calculated the time between receipt of prescriptions and dispensation of medicines by the pharmaceutical team for both prescription modalities (electronic and manual). Results 384 (58%) manual prescriptions and 276 (42%) electronic prescriptions were analysed, prepared and dispensed by the pharmacy team in our hospital. The average length of preparation of manual prescriptions was 25±10 min and the average length of preparation of electronic prescriptions was 15 min±5. The difference was statistically significant (p Conclusion Our team found a considerable gain in time (10 min by prescription or 170 min per day) between prescription of medicines by physicians and their dispensation by the hospital pharmacy despite the high number of drugs dispensed in the case of electronic prescriptions. This time saved would allow the pharmaceutical team to focus on other activities, more precisely the pharmacological analysis of prescriptions and hospital preparations. References and/or acknowledgements 1. Nanji KC, Rothschild JM, Salzberg C, et al. Errors associated with outpatient computerised prescribing systems. J Am Med Inform Assoc2011;18:767–73. No conflict of interest

Objective To explore the impact of electronic prescriptions (ePrescriptions) on the dispensing process in Finnish community pharmacies. Methods A survey of a random sample of dispensers (B.Sc. in Pharmacy) (n = 1004) and pharmacists (M.Sc. in Pharmacy) (n = 228) was conducted in 2014. Key findings Altogether, 778 questionnaires were analysed, giving response rates of 64% (n = 635) for dispensers and 65% (n = 143) for pharmacists. According to the respondents, prescription renewal (75%), transferring prescription data into the pharmacy data system (75%), receiving a prescription (73%), checking prescription information (62%) and making dispensing entries concerning the prescription (58%) have become easier with ePrescriptions. However, correcting dispensing entries afterwards (78%), correcting one's own processing errors made during dispensing (77%), correcting errors on the prescription caused by the physician (73%) and cancellation of medicine dispensing (64%) have been hindered. Technical problems in using ePrescriptions were most often experienced less than once a month. Conclusions Some parts of the dispensing process have become easier, whereas making corrections to the prescription has been hindered with ePrescriptions. Thus, the ePrescription system needs further development to ensure the easy and efficient use of ePrescriptions in the future., final draft, peerReviewed

A pediatric compounded non-sterile products repository (pCNP) to optimize the effectiveness and safety of “off-label” use of compounded pharmacotherapy through complete transmission of electronic prescriptions across the continuum of care is described. The advent of electronic prescribing has the potential to refocus and resolve long-standing issues of prescription therapy for pediatric patients related to formulation, indication, dosing, and outcomes follow-up, among others. This white paper describes the architecture and function of the pCNP repository. Further, it calls on professional societies, health information technology (HIT) and pharmaceutical industries, universities, and government to create a safer pediatric pharmacotherapy system across the continuum of care. This system would include pCNPs within the existing federal and corporate database structures for medical language, and integrates advanced system safety features as requirements for prescribing, compounding, and dispensing non-mass produced prescription therapies for children.

Objective The objectives of this cross-sectional study were to estimate the prevalence of unintended discrepancies between three sources of prescription information and to describe the types of electronic prescribing system vulnerabilities identified. Methods Staff from community pharmacies identified approximately 200 new prescriptions written at three participating ambulatory care clinics (2 adult, 1 paediatric). Unintended discrepancies were identified by comparing three sources of prescription information: (1) the prescriber's note as documented in the patient's chart; (2) the electronic prescription (e-prescription) entered into the clinic's electronic prescribing software; (3) the medication that was ultimately dispensed by the pharmacy as indicated on the prescription label. The discrepancy rate was calculated by dividing the number of discrepancies identified by the number of prescriptions evaluated. Results A total of 602 prescriptions written by 33 prescribers were evaluated from the 3 ambulatory care clinics. The discrepancy rate between the prescriber's note and the e-prescription was 1.7%, 0.6% and 3.9% for the three clinics. The discrepancy rate between the e-prescription (clinic) and the prescription label (pharmacy) was 4.2%, 0.9% and 1.5%. Differences between directions for administration was the most common type of discrepancy identified. Conclusions Discrepancy rates between the prescriber's note and the e-prescription were similar to the discrepancy rates between the e-prescription and pharmacy label. To reduce outpatient medication errors, a better understanding is needed of the sources of discrepancies that occur within the prescriber's clinic, and those that occur between the clinic and pharmacy.

Handwritten recycled paper prescription for parenteral nutrition (PN) may become a concentrated source of viable contaminants, including pathogens. This study examined the effect of using fresh printouts of electronic prescriptions on these contaminants.Cellulose sponge stick swabs with neutralizing buffer were used to sample the surfaces of PN prescriptions (n = 32 handwritten recycled; n = 32 printed electronic) on arrival to the pharmacy or following printing and PN prescriptions and bags packaged together during delivery (n = 38 handwritten recycled; n = 34 printed electronic) on arrival to hospital wards. Different media plates and standard microbiological procedures identified the type and number of contaminants.Staphylococcus aureus, fungi, and mold were infrequent contaminants. nonspecific aerobes more frequently contaminated handwritten recycled than printed electronic prescriptions (into pharmacy, 94% vs 44%, fisher exact test P .001; onto wards, 76% vs 50%, p = .028), with greater numbers of colony-forming units (CFU) (into pharmacy, median 130 [interquartile range (IQR), 65260] VS 0 [075], Mann-Whitney U test, P .001; onto wards, median 120 [15320] vs 10 [040], P = .001). packaging with handwritten recycled prescriptions led to more frequent nonspecific aerobic bag surface contamination (63% vs 41%, fisher exact test P = .097), with greater numbers of CFU (median 40 [IQR, 080] VS 0 [040], Mann-Whitney U test, P = .036).The use of printed electronic PN prescriptions can reduce microbial loads for contamination of surfaces that compromises aseptic techniques.

Manuscript. Published version available at http://dx.doi.org/10.1111/aogs.13002 Introduction: Knowledge about global use patterns of contraceptive implants is limited. This study aims to describe implant use patterns from a user and prescriber perspective. Material and methods: In a cross-sectional design, we estimated the annual number of users by calculating doses sold per 1000 women-years in the Norwegian Prescription Database for the years 2006-2012. For each contraceptive method, we calculated on an annual basis a proportion of defined daily doses (DDDs) of all hormonal contraceptives in five years age groups. Data were analyzed in SPSS version 22, with chi-square test, t-test, and survival analysis. Results: Sales from pharmacies for contraceptive implants more than doubled over the study years and was consistently higher in the younger age groups. The collection rate was 9.3 per 1000 women in 2012, when implant sales amounted to 2.4% of all daily doses of hormonal contraceptives sold. General practitioners and doctors with no specialty were the major prescribers to starters of contraceptive implants, whereas gynecologists prescribed nearly 12% of the volume, a higher proportion to women > 35 years of age than younger women. The cumulative proportions of continued users at 6-, 12-, 24-, and 36-months were 96.1%, 78.6%, 51.9%, and 34.9%, significantly lower for users who had doctors with no specialty as prescribers. At end of first expiration period, 21% of starters continued using implants. Conclusion: Implants play a minor role in the overall use of hormonal contraception in Norway. One in five starters continue as long-term users.

Objectives The purpose was to explore pharmacists’ opinions regarding the impacts of electronic prescriptions (ePrescriptions) on medication safety in Finnish community pharmacies. Further objectives were to explore how often and what kinds of ambiguities or errors pharmacists have perceived in ePrescriptions. Method A survey of randomly selected dispensers (n = 1004) and pharmacists (n = 228) was conducted in 2014. Results Altogether 778 questionnaires were returned, yielding response rates of 64% (n = 635) for dispensers and 65% (n = 143) for pharmacists. The respondents felt that ePrescriptions improve medication safety in many areas: they lower the number of prescription forgeries, reduce the risk of dispensing errors, promote better management of the patient’s overall medication, facilitate monitoring of duplicative therapy and drug interactions, and lessen the risk of incorrect interpretation of prescriptions. Many respondents (32%) reported that they had weekly found ambiguities or errors in ePrescriptions that required clarification during the dispensing process. Of the respondents, 18.6% had found such ambiguities or errors daily or almost daily. The three most common ambiguities or errors in ePrescriptions were incorrect total amount of medication (79.0%), missing notation of exceptional dosage instructions or exceptional purpose of use (SIC!) (69.0%), and unclear or incorrect dosage instructions (65.4%). Incorrect strength (14.9%) and incorrect pharmaceutical form (14.2%) were also commonly experienced problems. Conclusions According to Finnish community pharmacists, the introduction of ePrescriptions has promoted medication safety in many areas. However, ambiguities and errors are common in ePrescriptions. Some of these can delay dispensing of the medicine, whereas others can cause serious risks to medication safety., final draft, peerReviewed

Background Clinical decision support systems (CDSS) reduce prescription errors, but their effectiveness is reduced by high alert rates, “alert fatigue”, and indiscriminate rejection. Objectives To compare acceptance rates of alerts generated by the SafeRx ® prescription CDSS among different alert types and departments in a tertiary care hospital, identify factors associated with alert acceptance, and determine whether alert overrides were justified. Methods In a retrospective study, we compared acceptance rates of all prescription alerts generated in 2013 in 18 departments of Israel’s largest tertiary care center. In a prospective study in 2 internal medicine departments, we collected data on factors potentially associated with alert override, and an expert panel evaluated the justification for each overridden alert. We used multivariate analyses to examine the association between patient and physician-related factors and alert acceptance. Results In the retrospective study, of 390,841 prescriptions, 37.1% triggered at least one alert, 5.3% of which were accepted. Acceptance rates ranged from 7.9% for excessive dose alerts to 4.0% for duplicate drug and major drug-drug interactions alerts (p Conclusions The vast majority of SafeRx ® alerts are overridden, and overriding is justified in most cases. Minimizing the number of alerts is essential to reduce the likelihood of developing “alert fatigue”. Our findings may inform a rational, department-specific approach for alert silencing.

Home parenteral nutrition (HPN) is increasingly prescribed for pediatric patients with complex medical conditions. Commercial vendors are widely available to compound HPN. The aim of this study was to determine the frequency of discrepancies between written HPN prescriptions and commercially compounded solutions, as well as to record the associated severity of harm from discrepancies.From January to April 2013, 2 clinical pharmacists independently and prospectively reconciled HPN compounding records with electronic prescriptions (gold standard) during all routine ambulatory encounters to a multidisciplinary HPN program. Types, severity, and causes of discrepancies were recorded.Sixty-one unique patients were identified for inclusion during 117 visits. HPN solutions were compounded at 13 unique vendors across 14 states. Of all 100 compounding records, 46 (46%) contained at least 1 discrepancy, with a total of 60 discrepancies identified, affecting 34 of 61 (56%) patients. There was at least 1 discrepancy in solutions originating from 10 of 13 (77%) home infusion companies. Discrepancies were classified as Medication Error Reporting and Prevention levels C (n = 37) and D (n = 23; ie, all reaching patient but not causing harm).We found an alarmingly high rate of preparation discrepancies in a cohort of pediatric patients receiving HPN. Routine reconciliation of HPN compounds with intended prescriptions may be critical for ambulatory patients receiving this high-risk therapy. While home infusion commercial vendors provide an indispensable function, discrepancies and errors with potential for harm may be more common than previously appreciated.

Objective To detect, quantify, and compare the medication error produced with manual versus electronically assisted prescription systems. Methods A descriptive, observational, prospective study in two traumatology hospitalisation units; one with manual prescriptions and the other with electronically assisted prescriptions. Prescription errors were determined. Results We analysed 1536 lines of treatment (393 treatment forms) from 164 patients. With manual prescriptions, we detected errors in 19.54% of cases, compared to 9.4% in electronically assisted prescriptions. Omission errors were significantly lower with electronically assisted prescriptions, especially with drugs that act upon the central nervous system. Conclusions Prescription error has decreased by 53% since computerising the prescription process. This is particularly useful for omission errors, as prescription is more complete. The decrease in error regarding drugs that act on the central nervous system stands out.

Background Increased electronic prescribing (eRx) rates have the potential to prevent errors, increase patient safety, and curtail fraud. US Federal meaningful use guidelines require at least a 40% electronic prescribing rate. Objective We evaluated eRx rates among primary care providers in New York City in order to determine trends as well as identify any obstacles to increased eRx rates required by meaningful use guidelines. Methods The datawe analysed included automatic electronic data transmissions from providers enrolled in the Primary Care Information Project (PCIP) from 1 January 2009 to 1 July 2010 and follow-up telephone calls to a subset of these providers to identify potential barriers to increased eRx usage. Results Over the course of the study, these providers increased the eRx rate from 12.9 to 27.5%, with an average rate of 24.1%. Conversations with providers identified their perceived barriers to increased eRx use as primarily patient preference for paper prescriptions and a belief that many pharmacies do not accept eRx. Conclusions The data gathered from our providers indicate that there is an increasing trend in the eRx rate to 27.5% by July 2010, but still short of the 40% meaningful use level. However, obstacles to increased rates remain primarily providers' belief that many patients prefer paper prescriptions and many pharmacies are not yet prepared to accept electronic prescriptions.

In brief Inhaled corticosteroids increase the risk of oral candidiasis in people with chronic obstructive pulmonary disease Low-dose aspirin is ineffective as primary cardiovascular prevention in type 2 diabetes Electronic prescriptions reduce the risk of nonadherence compared to paper scrips Prescriptions for oral anti-osteoporosis drugs in the UK have plateaued in men and decreased among women in recent years, while gaps in care remain

We read with great interest the study by Martinez-Lopez-de-Castro et al (in July 2018),1 which analysed the factors leading to a greater satisfaction among patients visiting the outpatient hospital pharmacy. We strongly agree with their findings that the information provided, resolution of doubts, pharmacist’s personal treatment of the patient and time devoted to the patient are important in meeting patient preferences and expectations. We are from a district general hospital in China with 1800 beds. With electronic prescriptions and an automatic drug delivery machine, which were introduced in 2014, considerable time and manpower is saved. However, a neutral third-party investigation report shows that the patient satisfaction of the outpatient hospital pharmacy did not exhibit a consistent upward trend. We sought to explore a method to improve the quality of pharmaceutical care by setting up full-time clinical pharmacists to resolve any doubts the patients raised during the treatment, showing the patients how …

Many e-prescribing systems allow for both structured and free-text fields in prescriptions, making possible internal discrepancies. This study reviewed 2914 electronic prescriptions that contained free-text fields. Internal discrepancies were found in 16.1% of the prescriptions. Most (83.8%) of the discrepancies could potentially lead to adverse events and many (16.8%) to severe adverse events, involving a hospital admission or death. Discrepancies in doses, routes or complex regimens were most likely to have a potential for a severe event (p=0.0001). Discrepancies between structured and free-text fields in electronic prescriptions are common and can cause patient harm. Improvements in electronic medical record design are necessary to minimize the risk of discrepancies and resulting adverse events.

Electronically transmitted prescriptions (ETPs) became common after 1995 in Sweden; however, it is accompanied by a substantial increase in the number of prescriptions not picked up at pharmacies.To investigate the "no pick-up" rates of ETPs at pharmacies across type of drug and patient age and gender and the reasons patients' report for no pick-up.A cross-sectional study examining no pick-up of ETPs transmitted during 3 months in 2002, and a mail survey of patients to determine the reasons for failure to pick-up in the county of Sörmland, Sweden, with a population of 261,000, and 21 pharmacies. Chi-square tests were used for calculations of frequency differences among groups.The overall no pick-up rate of ETPs was 2.5%; men had consistently higher rates than women. The highest rates were seen for adolescents and young adults. Rates were higher than average for antibiotics. About 60% of the answers indicated that prescriptions not picked up were duplicate prescriptions or not needed. "Unintentional nonadherence" was reported by one-fifth of patients.No pick-up rate in general was low (2.5%), but there were differences across patient age and gender, the rates being higher among adolescents and young adults. Duplicate prescriptions may explain a significant share of the abandoned prescriptions.

The adoption of electronic prescribing is on the rise, as it reduces medication errors compared to handwritten orders. The inadvertent dispensing of discontinued medications is a type of medication error that is less well described, but one that can lead to adverse events. Software for electronic prescriptions transmits orders for refills or new prescriptions, but not discontinuations, to the pharmacy. Medications that have been stopped are displayed only at the prescribing facility's electronic medical record (EMR). This report describes five cases in which the pharmacy dispensed electronically discontinued medications, two of which contributed to adverse outcomes.