Integrating patient-centric indications into the prescribing process: Experience at a tertiary academic medical center

Abstract

Purpose To describe the development of and implementation of a patient-centric clinical indications library (CIL) into the prescribing process and determine the operational and humanistic outcomes (from prescriber, pharmacist, and patient perspectives) of including indications on outpatient prescription labels. Methods A descriptive retrospective data analysis was conducted. Multiple stakeholder groups were engaged to develop and integrate the CIL into the prescription package. After CIL integration, prescribers, pharmacists, and patients were surveyed. A focus group discussion consisting of Veterans and caregivers was held. Results Following implementation of the CIL, the proportion of prescriptions associated with an indication increased from 88% to 96%. Surveyed clinicians responded that indications helped them better understand a patient’s profile (61.1% of prescribers and 100% of pharmacists). Among surveyed pharmacists, 61.5% and 53.8%, respectively, believed that indications helped them catch instances of wrong medications and wrong doses ordered. Veterans surveyed found that indications on their prescription labels helped them know what their medications were for (91.0% of respondents) and why it is important to take their medications (70.7%). In focus group discussions, Veterans and family members and/or caregivers expressed a preference to see indications that describe how a medication works (eg, “to lower blood sugar” vs “for diabetes”) because they felt that type of phrasing is measurable, action oriented (which was appealing due to Veterans’ military background), provides surreptitious education, and tells the users what to expect. Conclusion Engaging multidisciplinary stakeholder groups, optimizing the electronic health record system, and authorizing pharmacists to add known indications to prescriptions increased the number of prescriptions with indications, decreased the perceived time spent on order entry and verification, and enabled better understanding of each medication’s purpose by providers and patients.

Documenting the indication for antimicrobial prescribing: a scoping review

“…The results of this scoping review are consistent with findings in studies that evaluated medications in general which have shown that documenting indication results in similar improvements in prescribing outcomes 137–139. Similar barriers have also been identified: alert fatigue and prescribers overriding mandatory fields;140 time pressure141 and ambiguity in medication indications 142.…”

Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis

“…Interventions to encourage or mandate indication documentation fell into two non-mutually exclusive groups: interventions encouraging indication documentation via selection from a list or free-text entry (n=14),30–43 or via use of indication-based order sentences (n=10) 11 18 20 32 40 41 44–47…”

“…Interventions based on indication-based order sentences explicitly linked an indication with the medication, along with the dose, frequency, route and so on 11 18 20 32 40 41 44–47. When the medication was ordered, the indication was therefore automatically documented.…”

“…Further research investigating the impact of electronic prescribingbased indication documentation from the perspective of nursing staff is therefore required. Only two studies included patient participation/feedback (37,46); further research into patients and carers' perspectives on indication documentation within electronic prescribing systems may be required. Lastly, effectiveness research conducted in this field should aim to use randomised designs, or at least controlled beforeand-after/interrupted-time-series methods to strengthen the evidence; only 5 of 21 studies in the present review employed these stronger designs.…”

Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience

“…As it is well understood that older patients struggle to swallow large SODF, a simple patient-centric approach could focus on the manufacturing of reduced dosage form sizes in order to enhance swallowing experience and patient compliance [26,[128][129][130][131][132][133]. Following this concept, and for a given pharmaceutical drug product, a wide range of SODF presentations should be available on the market to meet the heterogeneous needs of the older patient population [134][135][136][137]. Examples may include not only minitablets [138][139][140][141] and multiparticulate systems [142][143][144][145][146], which are patient centric for supporting a better swallowing experience and flexible dosing [147,148], but also chewable tablets [149] and buccal films [150][151][152].…”