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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.

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

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

After a two-year pilot, including the ICT (Information and Communication Technology) developments and small scale tests, the Recip-e project for ambulatory electronic prescriptions is currently in national roll-out phase. Along with the operational secure data-flow, an important number of parameters are captured and taken along; these parameters are processed and archived, enabling us to make a first evaluation regarding the approach taken in Belgium, both from a technical point of view and from a methodologic point of view, regarding the technical developments and the involvement of all stakeholders.

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

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

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.

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

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

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

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.

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

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

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.

This is the peer reviewed version of the following article: Roksvaag, I. & Skjeldestad, F.E. (2018). Decreasing trends in number of depot medroxyprogesterone acetate starters in Norway - a cross-sectional study. Acta Obstetricia et Gynecologica Scandinavica, 97(2), 151-157, which has been published in final form at https://doi.org/10.1111/aogs.13262. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Introduction - In this study, we examined changes in depot medroxyprogesterone acetate (DMPA) prescriptions over a time‐period when new professions started prescribing, and when the method gained some negative media attention. Material and methods - The Norwegian Prescription Database provided data on hormonal contraception from 2006 through 2012. We estimated the annual number of DMPA users by calculating doses sold per day/1000 women and calculated, for each contraceptive method on annual basis, a proportion of defined daily doses of all hormonal contraceptives in five‐year age groups at reproductive age. All analyses were done in SPSS, version 22, with Chi‐square test, t‐test, and survival analysis with p < 0.05 as significance level. Results - There were minor differences in overall DMPA use during the study years. The take‐out rate was equivalent to 11–12/1000 women aged 15–49 years. DMPA sales amounted to nearly 4% of all daily doses of hormonal contraceptives sold. General practitioners and physicians without a specialty were the major prescribers. The number of starters decreased by nearly 40% during the study years and was consistent across age groups. The average use duration among starters was 17.7 (95% CI 17.5–17.9) months (range 0–90). There were minor changes in the relative proportion of long‐term users beyond 24 months during the study years. Conclusions - DMPA plays a minor role in the overall use of hormonal contraception in Norway, even among teenagers. The number of starters is decreasing, indicating a more restrictive attitude toward first use, especially among general practitioners.

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 The development of electronic prescriptions secures patient medication care in hospital. However, software can also lead to medication errors, for example when the drug data sheet is misconfigured. 1 Purpose To correct configuration errors related to prescription and distribution parameters in prescription software, in order to obtain a more accurate drug database, improve drug information and decrease the number of prescription errors. Material and methods 3 pharmacists and 2 pharmacy residents developed a monthly checklist to consolidate the key data regarding drugs which were available in our hospital. Between June and October 2016, all of the data sheets corresponding to these drugs were extracted monthly and then analysed. Configuration errors were identified, quantified and corrected in prescription software (Orbisv8.4, AGFA). Results During the initial set up, 25 checkboxes and 15 path fields were available on 7 tabs. Using data mining, the main parameters of prescription (5 path fields) and distribution (5 path fields) were first studied. On average, 2073 data sheets per month were extracted. Regarding prescription parameters, 1641 of 2125 data sheets (77.2%) included at least 1 error in June. This rate decreased to 13.4% in October (270/2021). The rates of data sheets with at least 1 errors were, respectively, in June and October: 72.3% (1536/2125) and 9.6% (194/2021) for the pharmacotherapeutic groups, 8.4% (179/2125) and 3.4% (69/2021) for the pharmaceutical forms, 4.8% (102/2125) and 0.89% (18/2021) for administration routes, and 3.8% (80/2125) and 0.15% (3/2021) for prescription units. In June and October, 84.1% (1787/2125) and 2.28% (46/2021) of data sheets, respectively, included at least 1 error of distribution: respectively, 74.4% (1581/2125) and 0.30% (6/2021) for the minimum unit of distribution, 18.7% (397/2125) and 0.0% for the global order mode, 4.1% (87/2125) and 2.1% (42/2021) for the packaging, 3.8% (80/2125) and 0.15% (3/2021) for the distribution unit, and 2.4%(50/2125) and 0.0% for the restocking. Conclusion Updating data have led to a more accurate drug database for prescription software. Enlargement of the method to other criteria (drug status, colour of the wording according to the class, etc) will improve drug information. This work should also decrease the number of medication errors in our hospital. References and/or acknowledgements 1. Charpiat B, et al. Opportunities for medication errors and pharmacist’s interventions in the context of computerised prescription order entry. Ann Pharm Fr2012. 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.

Over the last decade, there have been significant advances in information technology (IT) within the medical environment to improve safety and quality in clinical care. One such intervention is remote access to electronic health records (RA-EHR), defined as accessing healthcare records away from the hospital setting. More National Health Service (NHS) trusts enable RA-EHR to clinicians including access to live patient observations, electronic prescriptions, radiology and pathology databases, clinic letters and emails. Studies have shown senior clinicians accessing clinical information remotely had contacted junior teams to make changes in clinical management, postulating that it may serve to improve patient safety.1 2 However, there is potential for clinicians to invest more of their personal time to clinical commitments, leading to burnout and stress.3 4 To …

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.

This study investigated whether the adoption of electronic prescriptions (e-prescriptions) had increased in the 27 member countries of the European Union (EU) in the beginning of this decade. Our previous study in 2002 concerning the old union with 15 countries had discovered that e-prescriptions were rare in daily practice and that there was only slight interest for their future use. Since the internal market with free movement of people, goods, services, and capital is a central issue in the Union, we took a cross-border view of the use of the e-prescriptions.A semiopen questionnaire on the use of e-prescriptions, chosen systems, the process itself, investments, and the acceptance of non-national European prescriptions was e-mailed to community pharmacy associations of the 27 EU member countries that were members of or otherwise identified by the Pharmaceutical Group of the EU.Five countries were using e-prescriptions as a part of their daily practice, but only Denmark and Sweden reported nationwide use. These countries were the same that used e-prescriptions nationally already in 2002. Pilots presented in 2002 had not yet advanced into daily practice. Some new pilots/projects were prepared in the old and new member countries. E-prescription models and systems used were divergent between the countries and sometimes even within a country.Nationwide use of e-prescriptions was not more common than in 2002. Several countries had piloted or were piloting projects on e-prescriptions. Interoperability of different systems is a challenge to which EU-funded projects might offer a solution.

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