Potential Medication Errors in Electronic Prescribing in A Primary Health Care

An effort to reduce medication errors is to use drugs prescription electronically[1,2,4]. However, there needs to be an evaluation of this system, because this system is not free from errors in medication. This study aimed to find out the description of prescribing flow, to examine electronic prescription completeness, and find out the potential medication errors that occur in the prescribing phase of electronic prescription using prescribing indicators[1,5,9,10]. This study used observational method by taking general practice outpatient prescription data of March 2018 in a company health service located in Bandung and analyzed descriptively[6,7,8]. Electronic prescription of medicines at this health care was made and inputted by doctors. When an error occured on a computer system, the doctor would prescribe it manually so that the patient can still be served. Incompleteness of the most common recipe was on administrative requirements where all prescriptions did not listed the doctor's practice permit, patient's gender, patient's weight, telephone number of the place of practice, and patient's contact number. Medication errors had the most potential for the occurrence of prescription writing with two or more drugs interacting and this error was classified as category D according to The National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP). &nbsp

The causes of prescribing errors in English general practices: a qualitative study

Background: Few detailed studies exist of the underlying causes of prescribing errors in the UK. Aim: To examine the causes of prescribing and monitoring errors in general practice and provide recommendations for how they may be overcome. Design and setting: Qualitative interview and focus group study with purposive sampling of English general practices. Method: General practice staff from 15 general practices across three PCTs in England participated in a combination of semi-structured interviews (n = 34) and six focus groups (n = 46). Thematic analysis informed by Reason’s Accident Causation Model was used. Results: Seven categories of high-level error-producing conditions were identified: the prescriber, the patient, the team, the working environment, the task, the computer system, and the primary–secondary care interface. These were broken down to reveal various error-producing conditions: the prescriber’s therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health; the patient’s characteristics and the complexity of the individual clinical case; the importance of feeling comfortable within the practice team was highlighted, as well as the safety implications of GPs signing prescriptions generated by nurses when they had not seen the patient for themselves; the working environment with its extensive workload, time pressures, and interruptions; and computer-related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts were all highlighted as possible causes of prescribing errors and were often interconnected. Conclusion: Complex underlying causes of prescribing and monitoring errors in general practices were highlighted, several of which are amenable to intervention

Whole Networks versus Inter-organizational Systems: Exploring Common Ground for US E-prescribing

Healthcare networks driven by technology, such as e-prescribing, play an increasing role in care coordination. These networks are a mix of public and private entities whose governance and performance have only recently been studied. Given the critical role these networks play, their structure and governance need to be better understood to achieve expected network performance. The inter-organizational information system literature has begun shifting its focus beyond enterprises to inter-organizational transactions (e.g., supply chain). At the same time, the public administration literature has grasped upon the governance of whole networks but has not embraced the implications of technology. This study seeks to describe the ambulatory e-prescribing network in the United States by drawing upon both literatures. One of the key challenges identified is the necessity of multi-level analysis and performance measures

Analysis of Patient Safety Incidents in Primary Care Reported in an Electronic Registry Application

Incident notification; Patient safety; Risk managementNotificació d'incident; Seguretat dels pacients; Gestió de riscNotificación de incidentes: Seguridad del paciente; Gestión de riesgoObjectives: (1) To describe the epidemiology of patient safety (PS) incidents registered in an electronic notification system in primary care (PC) health centres; (2) to define a risk map; and (3) to identify the critical areas where intervention is needed. Design: Descriptive analytical study of incidents reported from 1 January to 31 December 2018, on the TPSC Cloud™ platform (The Patient Safety Company) accessible from the corporate website (Intranet) of the regional public health service. Setting: 24 Catalan Institute of Health PC health centres of the Tarragona region (Spain). Participants: Professionals from the PC health centres and a Patient Safety Functional Unit. Measurements: Data obtained from records voluntarily submitted to an electronic, standardised and anonymised form. Data recorded: healthcare unit, notifier, type of incident, risk matrix, causal and contributing factors, preventability, level of resolution and improvement actions. Results: A total of 1544 reports were reviewed and 1129 PS incidents were analysed: 25.0% of incidents did not reach the patient; 66.5% reached the patient without causing harm, and 8.5% caused adverse events. Nurses provided half of the reports (48.5%), while doctors reported more adverse events (70.8%; p < 0.01). Of the 96 adverse events, 46.9% only required observation, 34.4% caused temporary damage that required treatment, 13.5% required (or prolonged) hospitalization, and 5.2% caused severe permanent damage and/or a situation close to death. Notably, 99.2% were considered preventable. The main critical areas were: communication (27.8%), clinical-administrative management (25.1%), care delivery (23.5%) and medicines (18.4%); few incidents were related to diagnosis (3.6%). Conclusions: PS incident notification applications are adequate for reporting incidents and adverse events associated with healthcare. Approximately 75% and 10% of incidents reach the patient and cause some damage, respectively, and most cases are considered preventable. Adequate and strengthened risk management of critical areas is required to improve PS

Prescribing errors in electronic prescriptions for outpatients intercepted by pharmacists and the impact of prescribing workload on error rate in a Chinese tertiary-care women and children's hospital.

BACKGROUND(#br)Prescribing errors may, influenced by some risk factors, cause adverse drug events. Most studies in this field focus on errors in prescriptions for hospital inpatients, with only a few on those for outpatients. Our study aimed to explore the incidence of prescribing errors in electronic prescriptions and illustrate the trend of prescribing workload and error rate over time.(#br)METHODS(#br)The cross-section study was performed between September, 2015 and November, 2015. Prescribing errors were intercepted by pharmacists using a prescription reviewing system under which prescriptions with errors were transferred to a specific computer and recorded by another pharmacist and the incidence of total prescribing errors and severe errors was then calculated. A subgroup analysis was conducted in accordance to the number of drug orders, the age group of patients, the seniority of physicians, the specialty of physicians, the working day when prescriptions were issued, and the prescribing workload of physicians. A time-series analysis was employed to analyze the trend of prescribing workload and error rate, and the correlation between them.(#br)RESULTS(#br)Totally, 65,407 patients were included in this study and 150,611 prescriptions with 294,564 drug orders (including 584 different drugs) were reviewed for identification of errors. A total of 534 prescribing errors (an error rate of 0.34%) were identified. Severe errors accounted for 13.62% of total errors. The subgroup analysis showed prescriptions of multiple drug orders, for pediatric patients aged 29 days to 12 years, from physicians specializing in ophthalmology and otorhinolaryngology, or prescribing on weekdays were more susceptible to errors. A time-series analysis demonstrated no correlation between prescribing workload and error rate which increased at the end of each working shift while prescribing workload decreased.(#br)CONCLUSION(#br)Less than 1% of the studied prescriptions came with errors among which one in seven were severe ones. But prescribing errors were in no relation to workloads. What’s more, further studies are needed to investigate pharmacist-led intervention to reduce prescribing errors

Prescripción inadecuada de medicamentos: aportaciones de los paradigmas científicos a su conocimiento

Se realizó una revisión narrativa con análisis temático sobre las aportaciones de los paradigmas científicos al conocimiento de la prescripción inadecuada de medicamentos. Se buscaron artículos de acceso abierto indexados en PubMed© entre 2010-2014, y se sistematizó información sobre el paradigma, tipo de publicación, perspectiva teórica, objetivo, método y resultados. De los 992 artículos encontrados, se seleccionaron 118, y se tomó una muestra propositiva de 15, según su diseño, representando los cuatro paradigmas. Los artículos positivistas reportaron prevalencia, factores asociados, efectividad de intervenciones y criterios de evaluación; los interpretativos explicaron las causas del problema según los involucrados; los críticos denunciaron la influencia de la industria farmacéutica; y el participativo abordó el problema secundariamente y lo solucionó en un escenario para una enfermedad y grupo farmacológico específicos. Se concluyó que la prescripción inadecuada de medicamentos como problema de investigación en salud pública recibe aportes de los cuatro paradigmas, con dominio del positivismo, lo que se atribuye al carácter paradigmático de la ciencia desde la que se le aborda habitualmente, y que una perspectiva multi-paradigmática es el mejor abordaje.This study conducted a narrative review with thematic analysis about contributions of scientific paradigms to knowledge of inadequate drugs prescription. We searched open access articles indexed in PubMed© between 2010 and 2014, and we systematized information about scientific paradigm, publication type, theoretical perspective, objective, method and results. From the 992 articles found, 118 were selected. From those, we chose a purposive sample of 15, according to the design of the studies, representing the four paradigms. The positivists articles reported prevalence, associated factors, effectiveness of interventions and evaluation criteria; the interpretive explained the causes of the problem according to those involved; the critics denounced the influence of pharmaceutical industry; and the participative addressed the problem secondarily and solved it in a scenario for a specific disease and pharmacological. We concluded that the inadequate drugs prescription as research problem in public health had contributions from the four paradigms, with dominance of positivism, which is attributed to the paradigmatic perspective of the science, from which it is usually studied, and that a multiparadigmatic perspective is the best approach to the public health issue

International Day of Persons with Disabilities

Poster Week 2/14. ESTeSC – Coimbra Health School. December 1-5, 2014.info:eu-repo/semantics/draf

COMBINING HUMAN FACTORS AND DATA SCIENCE METHODS TO EVALUATE THE USE OF FREE TEXT COMMUNICATION ORDERS IN ELECTRONIC HEALTH RECORDS

Medication errors are a leading cause of death in the United States. Electronic Health Records (EHR) along with Computerized Provider Order Entry (CPOE) are considered promising ways to reduce these errors. However, EHR systems have not eliminated medication errors. Moreover, in some cases they have facilitated errors due to issues such as poor usability and negative effects on clinical workflows. The use of unexpected free text within a CPOE system can serve as a marker that the system does not adequately support clinical workflow. Prior studies have looked at the use of free text within medication orders, but the inclusion of medication related information in communication for non-medication orders (CNMOs), a type of free text order, has not been adequately studied. This mixed-methods study identified the prevalence, nature and reasons for the inclusion of medication related information in CNMOs using a large sample of CNMOs placed at a mid-Atlantic hospital system in 2017, and via interviews with physicians. The study found that more than 42% of CNMOs contain medication related information. Moreover, the use of CNMOs varied significantly across provider types, hospital locations, patient settings and other factors. The study found 10 themes that might cause providers to adopt such workarounds, including missing functionality and poor usability. The viii study also identified several general challenges in communicating medication information in the EHR, and potential solutions to mitigate these challenges. This dissertation also demonstrates how natural language processing could be used to identify medication related CNMOs

Meaningful Adoption: What we Know or Think we Know about the Financing, Effectiveness, Quality, and Safety of Electronic Medical Records

What is clear is that electronic medical records facilitate documentation of services rendered by physicians and hospitals, which is used to justify billing. Doctors in particular are burdened with checking off scores of boxes on the computer screen to satisfy insurance requirements, so called "pay for performance." But again, there are no compelling data to demonstrate that such voluminous documentation translates into better outcomes for their sick patients. When doctors and hospitals use health IT, patients get better care and we save money. ... We're making great progress, but we can't wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs