Incorporating medication indications into the prescribing process

Kron, Kevin; Myers, Sara; Volk, Lynn A.; Nathan, A W; Neri, Pamela M.; Salazar, Alejandra; Amato, Mary G.; Wright, Adam; Karmiy, Sam; McCord, Sarah; Seoane‐Vazquez, Enrique; Eguale, Tewodros; Rodríguez-Monguió, Rosa; Bates, David W.; Schiff, Gordon D.

doi:10.2146/ajhp170346

Cited by 34 publications

(52 citation statements)

References 19 publications

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“…In contrast, in prior research, pharmacists saw RFU as a tool to assess medication safety, and physicians saw it as a tool to support interprofessional communication (i.e., to decrease the number of clarifying calls from the pharmacy), and to provide transparency around why a drug is prescribed [10]. Of note, no singular terminology or definition about what a clinical indication is or what information it needs to carry exists [21]. Indications listed on medication bottles should facilitate use by patients for decision making, as well as being of utility for clinicians to facilitate information transfer.…”

Section: Discussionmentioning

confidence: 99%

How do I keep myself safe? Patient perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis

Whaley

Bancsi

et al. 2020

J of Pharm Policy and Pract

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Background Medications are crucial for maintaining patient wellness and improving health in modern medicine, but their use comes with risks. Helping patients to understand why they are taking medications is important for patient-centered care and facilitates patient adherence to prescribed medications. One strategy involves enhancing communication between patients, physicians, and pharmacists through the sharing of reason for use (RFU) information or the indication for medications. Methods Semi-structured interviews were conducted with 20 patients in Ontario, Canada, to gain perspectives on how patients currently store their medication information and benefits and disadvantages of adding RFU to prescriptions and medication labels. An interview guide was used by the two interviewers, and the interviews were recorded, transcribed, and thematically coded. Results The analysis yielded three main themes: patient decision making with RFU, RFU in modern, patient-centered care, and logistical aspects of communicating RFU. The patients that were interviewed expressed the value of having RFU when deciding if a medication was effective or to stop taking the medication. Patients felt comfortable with RFU being added to prescriptions and acknowledged the value in adding RFU to medication labels, helping patients and others identify and distinguish medications. Patients generally expressed interest in having RFU written in lay language and identified strengths and weaknesses of having access to RFU via a website or app. Conclusions Patients rated the importance of knowing RFU very highly, identified the value in sharing RFU with pharmacists on prescriptions, and in having RFU on medication labels. These results can be used to inform policy on the addition of RFU on prescriptions and medication labels and support improved communication between patients, pharmacists, and physicians about RFU.

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Section: Discussionmentioning

confidence: 99%

How do I keep myself safe? Patient perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis

Whaley

Bancsi

et al. 2020

J of Pharm Policy and Pract

View full text Add to dashboard Cite

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“…Interviews with clinicians following the usability tests confirmed several features and concerns we had collected in earlier design phases of this project. 8 These issues and suggestions centered around integration with the rest of the EHR and the quality and reliability of back-end knowledge required for the drug or regimen choice recommendations. Differentiating an indication from a billing diagnosis is a related issue that requires further conceptual and design considerations.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a Prototype for Indications-Based Prescribing With 2 Commercial Prescribing Systems

et al. 2019

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Key Points Question Is a redesigned electronic prescribing workflow to better support the incorporation of the indication in the outpatient prescribing process associated with reduced errors and improved clinician experience? Findings This quality improvement study compared an indications-based electronic prescribing prototype with that of 2 leading electronic health record vendors and found that the usability of the prototype system substantially outperformed both vendors’ prescribing systems in terms of efficiency, error rate, and satisfaction. Meaning Reengineering prescribing to start with the drug indication allowed indications to be captured in an easy and useful way and may be associated with saved time and effort, reduced errors, and increased clinician satisfaction.

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“…CancelRx is an important tool with the potential to decrease errors in medication prescribing and dispensing by facilitating cancellation of erroneous orders immediately upon recognition and communication of changes in medication regimens from prescribers to pharmacies. This function may be complementary with other health information technology (IT) tools to reduce prescribing errors, such as indications-based prescribing 34,35 or to facilitate communication between pharmacies and prescribers, such as RxChange, which allows pharmacists to request changes of e-prescriptions from prescribers. 36 However, how e-cancellation interacts with these and other functions of e-prescribing within the EHR has yet to be fully determined.…”

Section: Discussionmentioning

confidence: 99%

Understanding CancelRx: Results of End-to-End Functional Testing, Proactive Risk Assessment, and Pilot Implementation

et al. 2019

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Background CancelRx allows prescribers to send electronic cancellation messages to pharmacies when medications are discontinued. Little is known about its functionality and impact on clinical workflows. Objectives To understand CancelRx functionality, its potential impact on workflows and medication safety risks, and to develop mitigating strategies for risks introduced by implementation. Methods We conducted direct observations and semi-structured interviews to develop CancelRx use cases and assessed CancelRx in an end-to-end test environment, proactive risk assessment, and pilot implementation from April 16 to July 15, 2018. Results E-cancellations were sent upon discontinuation of e-prescriptions written within the electronic health record (EHR), but not other medications (e.g., printed prescriptions) and could be initiated by nonprescribers. In our proactive risk assessment, CancelRx implementation eliminated five of seven failure modes in outpatient prescribing to Johns Hopkins pharmacies, but introduced new risks, including (1) failure to act if an e-cancellation was not sent or was unsuccessful; (2) failure to cancel all prescriptions for a medication; (3) errors in manual matching; and (4) erroneous medication cancellations. We identified potential mitigation strategies for these risks. During pilot implementation, 92.4% (428/463) of e-cancellations had confirmed approval by the receiving pharmacy, while 4.5% (21/463) were denied, and 3.0% (14/463) had no e-cancellation response. Among e-cancellations received by the pilot pharmacy, 1.7% (7/408) required manual matching by pharmacy staff. Based on performance in testing, 73.4% (340/463) of completed e-cancellations would be expected to generate an in-basket message, including 21 (6.2%) denials and 319/340 (93.8%) approvals with a note from the pharmacy. Conclusion CancelRx is an important functionality with the potential to decrease adverse events due to medication errors. However, changes in implementation in our EHR and pharmacy software and enhancements in the CancelRx standard are needed to maximize safety and usability. Further studies are needed to evaluate the impact of e-cancellation on medication safety.

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Incorporating medication indications into the prescribing process

Cited by 34 publications

References 19 publications

How do I keep myself safe? Patient perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis

How do I keep myself safe? Patient perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis

Comparison of a Prototype for Indications-Based Prescribing With 2 Commercial Prescribing Systems

Understanding CancelRx: Results of End-to-End Functional Testing, Proactive Risk Assessment, and Pilot Implementation

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