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OBJECTIVE To provide reference for the regulation of electronic prescription circulation under the mode of “medical science + pharmacy”. METHODS Based on evolutionary game theory， a tripartite evolutionary game model was constructed for related parties of electronic prescription circulation （government agencies， internet hospitals and third-party drug platforms） under the mode of “medical science + pharmacy”. The influential factors of the three parties’ strategy selection were analyzed and verified by simulation. RESULTS & CONCLUSIONS The strategic choices of all parties in the game were affected by the other two parties. Reducing the cost of strict supervision or increasing the punishment for the other two parties would increase the probability of strict supervision of government agencies. Enhancing reputation losses， increasing penalties， and reducing the cost difference when choosing different strategies would have regulatory and binding effects on internet hospitals and third-party drug platforms. It is suggested that government agencies can introduce diversified supervision mode and establish an integrated “intelligent supervision + traceability” system； pay attention to the construction of reputation mechanism， and promote the coordinated linkage of all parties； increase the punishment for violations， provide policy support， reduce the cost of compliance behavior to promote the high-quality development of electronic prescription circulation under the mode of “medical science + pharmacy”.
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Introducción. Los errores en prescripción médica (EPM) son la causa más frecuente de errores prevenibles. El empleo de sistemas de prescripción informatizada (PI) contribuiría a disminuir el error y a mejorar la calidad de atención. Objetivos. Evaluar el efecto de la PI en la prevalencia de EPM y eventos adversos (EA) relacionados en pacientes pediátricos hospitalizados. Evaluar la adherencia, aceptabilidad y apropiabilidad de la herramienta por parte de los usuarios. Método. Diseño híbrido, descriptivo y cuasiexperimental tipo antes-después. Se incluyeron prescripciones médicas de pacientes hospitalizados, calculando la prevalencia de EPM y EA relacionados, en los períodos pre-y pos implementación de la PI en un hospital pediátrico (HP) y en uno general (HG) que se tomó como control. Se evaluó la adherencia mediante la proporción de las PI sobre las totales registradas en el período posimplementación. Se evaluó la aceptabilidad y apropiabilidad de la implementación por encuesta a los usuarios. Resultados. Al comparar la prevalencia de EPM pre- y posimplementación en el HP, se observó una disminución estadísticamente significativa en los dos hospitales: HP 29,1 versus 19,9 EPM/100 prescripciones (OR: 1,65; IC95 %: 1,34-2,02; p < 0,01). En el HG 24,9 versus 13,6 EPM/100 prescripciones (OR: 2,1; IC95 %: 1,5-2,8; p < 0,01). La tasa de adherencia global a la PI fue del 83 %. La implementación presentó aceptabilidad y apropiabilidad satisfactoria. Conclusión. La prevalencia de EPM se redujo un 30 % posimplementación. La adherencia global a la herramienta fue satisfactoria
Introduction. Prescription errors are the most common cause of preventable errors. Electronic prescription (EP) systems may help to reduce errors and improve the quality of care. Objectives. To assess the effect of EP on the prevalence of prescription errors and related adverse events (AE) among hospitalized pediatric patients. To assess EP adherence, acceptability, and suitability among users. Method. Hybrid, descriptive, and quasi-experimental, before-and-after design. Prescriptions made to hospitalized patients were included, estimating the prevalence of prescription errors and related AE in the pre- and post- EP implementation periods at a children's hospital (CH) and a general hospital (GH) used as control. Adherence was assessed based on the proportion of EP among all prescriptions registered in the post-implementation period. The acceptability and suitability of EP implementation was assessed via a user survey. Results. The prevalence of prescription errors pre- and post-EP implementation at the CH was compared and a statistically significant reduction was observed in both hospitals: CH: 29.1 versus 19.9 prescription errors/100 prescriptions (OR: 1.65; 95% CI: 1.34-2.02;p < 0.01). GH: 24.9 versus 13.6 prescription errors/100 prescriptions (OR: 2.1; 95% CI: 1.5-2.8; p < 0.01). The rate of overall adherence to EP was 83%. The implementation of EP was adequately acceptable and suitable. Conclusion. The prevalence of prescription errors reduced 30% after the implementation of EP. The overall adherence to EP was adequate.
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Humans , Child , Electronic Prescribing , Hospitals, Pediatric , Medication Errors/prevention & controlABSTRACT
OBJECTIVE From the perspective of licensed pharmacist ，provide reference for improving the risk management ability of electronic prescription circulation in the internet hospitals . METHODS The methods of literature review and comparative analysis were used to interpret the risk factor of electronic prescription circulation ，stakeholders’responsibilities and the situation of prescription reviewed by pharmacists . The responsibilities of pharmacists in internet hospitals ，brick and mortar stores and third - party drug platforms were analyzed specifically to propose the institutional arrangements for the licensed pharmacist ’s provision in the risk management of electronic prescription circulation . RESULTS & CONCLUSIONS Through the establishment of internet hospital pharmacovigilance system ，the preparation of double -reviewing specification for licensed pharmacists ，and the remote reviewing of the chief licensed pharmacist system ，the licensed pharmacists ’responsibilities should be promoted to fulfill the risk management of electronic prescription circulation in the internet hospital .
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Abstract Introduction A broad range of practices aimed at improving the effectives and safety of this process have been documented over the past few years. Objective To establish the effectiveness, safety and results of the implementation of these strategies in adult patients in university hospitals. Methodology A review of systematic reviews was conducted, in addition to a database search in the Cochrane Library of Systematic Reviews, Embase, Epistemonikos, LILACS and gray literature. Any strategy aimed at reducing prescription-associated risks was included as intervention. This review followed the protocol registered in the International Prospective Registry of Systematic Reviews (PROSPERO): CRD42020165143. Results 7,637 studies were identified, upon deleting duplicate references. After excluding records based on titles and abstracts, 111 full texts were assessed for eligibility. Fifteen studies were included in the review. Several interventions grouped into 5 strategies addressed to the prescription process were identified; the use of computerized medical order entry systems (CPOE), whether integrated or not with computerized decision support systems (CDSS), was the most effective approach. Conclusions The beneficial effects of the interventions intended to the prescription process in terms of efficacy were identified; however, safety and implementation results were not thoroughly assessed. The heterogeneity of the studies and the low quality of the reviews, preclude a meta-analysis.
Resumen Introducción En los últimos años se han documentado gran variedad de prácticas dirigidas a mejorar la efectividad y la seguridad de este proceso. Objetivo Establecer la efectividad, seguridad y resultados de implementación de estas estrategias en pacientes adultos en hospitales universitarios. Metodología Se realizó una revisión de revisiones sistemáticas. Igualmente, la búsqueda en las bases de datos de la Biblioteca Cochrane de Revisiones Sistemáticas, Medline, Embase, Epistemonikos, LILACS y literatura gris. Se incluyó como intervención cualquier estrategia dirigida a reducir el riesgo asociado a un error de prescripción. Esta revisión siguió el protocolo registrado en el Registro Prospectivo Internacional de Revisiones Sistemáticas (PROSPERO): CRD42020165143. Resultados Se identificaron 7.637 estudios después de eliminar las referencias duplicadas. Después de la exclusión de registros basados en títulos y resúmenes, se evaluaron 111 textos completos para elegibilidad. Se incluyeron quince estudios en la revisión. Se identificaron varias intervenciones agrupadas en 5 estrategias dirigidas al proceso de prescripción, de las cuales el uso de sistemas computarizados de entrada de órdenes médicas (CPOE) integrados o no a sistemas de soporte de decisión computarizados (CDSS) la estrategia más eficaz. Conclusiones Se identificaron efectos benéficos de las intervenciones dirigidas al proceso de prescripción en términos de eficacia; sin embargo, la seguridad y los resultados de implementación no fueron ampliamente evaluados. La heterogeneidad de los estudios y la baja calidad de las revisiones impiden la realización de un metaanálisis.
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Humans , Adult , Middle Aged , Aged , Drug Prescriptions , Preventive Health Services , Hospitals, University , Medication Errors , Outcome Assessment, Health Care , Medical Errors , Electronic Prescribing , Inappropriate PrescribingABSTRACT
Resumen Los errores de prescripción representan un relevante problema en salud. Este trabajo se propone analizar el error de prescripción de medicación en pacientes hospitalizados antes y después de una intervención múltiple. Se trata de un estudio cuasi experimental de tipo antes-después no controlado. La intervención consistió en la estandarización del proceso de prescripción y el entrenamiento del personal que prescribe. El porcentaje de error de prescripción antes de la intervención fue del 28.8% (n = 182), es decir 28.8 prescripciones incorrectas cada 100 prescripciones médicas. El dominio más frecuente de error fue: dosis in adecuada 52.2% (n = 95), medicamento incorrecto 33% (n = 60), días de tratamiento inapropiado 4.4%(n = 8) y otros 10.4% (n = 19). Luego de la intervención el error descendió a 4.3% (n = 26): 4.3 prescripciones con error cada 100 efectuadas, siendo el error más frecuente la dosis incorrecta: 76.9% (n = 20), otros 23.1% (n = 6). El daño asociado a medicación inadecuadamente prescripta antes y después fue de 0.95 (n = 6) eventos y 0.33 (n = 2) eventos cada 100 admisiones, respectivamente. La intervención de mejora resultó útil para la reducción del error de prescripción en esta institución y muestra de pacientes.
Abstract Prescription errors represent a relevant health problem. This work aims to analyze the medication prescription error in hospitalized patients before and after a multiple intervention. This is a quasi-experimental study of the uncontrolled before-after type. The intervention consisted of the standardization of the prescription process and the training of the prescribing staff. The percentage of prescription error before the intervention was 28.8% (n = 182), that is, 28.8 incorrect prescriptions per 100 medical prescriptions. The most frequent domain of error was: inappropriate dose 52.2% (n = 95), followed by incorrect medication 33% (n = 60), by days of inappropriate treatment 4.4% (n = 8) and others 10.4% (n = 19 ). After the intervention, the error decreased to 4.3% (n = 26), that is, 4.3 pre scriptions with error every 100 prescriptions, the most frequent error being the incorrect dose: 76.9% (n = 20), another 23.1% (n = 6 ). The harm associated with inadequately prescribed medication before and after was 0.95 (n = 6) events and 0.33 (n = 2) events per 100 admissions respectively. The improvement intervention was useful for reducing the prescription error in this institution and patient sample.
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Humans , Drug Prescriptions , Medication Errors/prevention & controlABSTRACT
OBJECTIVE：To provide ideas for the development of electronic prescription （e-prescription）service mode under the background of “Internet+”. METHODS ：Retrieving official websites and related online resources of the national and provincial governments，health committees ，medical products administration ，and medical security bureaus （up to Jun. 2020），relevant policies，supporting documents and implementation status of e-prescription service mode were sorted out and analyzed ，and the suggestions were put forward. RESULTS ：Current e-prescription service modes included four modes ，such as pharmaceutical retail enterprise e-prescription service mode ，medical institution e-prescription information sharing service mode ，internet hospital e-prescription service mode ，and medical e-commerce e-prescription service mode. The pilot of e-prescription service mode of drug retail enterprises covered the widest range of provinces and cities ，but the participation of health departments and medical institutions was insufficient ，and the pattern of comprehensive power had not been formed. The medical institutions e-prescription information sharing service mode was mainly composed of three typical examples ，namely“Wuzhou mode ”，“Fuzhou mode ”and “Gansu mode ”. However ，it had not been unified in terms of technical standards ，access conditions ，exit mechanism and execution process，etc. At present ，this model was still in a small scope of exploration and pilot stage. The internet hospital e-prescription service mode was limited by the popularization of internet hospital medical insurance payment and the improvement of corresponding rules and regulations ，which was still at the stage of cautious pilot exploration. Medical e-commerce e-prescription service model was limited by the types of drugs within the legal service scope. Meanwhile ，the industry standards and regulations of e-prescription service were in the absence at present. CONCLUSIONS ：As an innovative service mode ，the e-prescription service mode meets the real needs of the pharmaceutical retail industries ，medical institutions and patients. Each pilot mode conforms to the development trend of “Internet+”and shows a strong development momentum ，but overall it is still in the early stage of active exploration. It is urgent to further explore and research around the leading departments ，stakeholders and prescription transfer procedures.
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OBJECTIVE：To evaluate the current situation and implementation effect of the pilot project of electronic prescription and remote pharmaceutical care in social pharmacy from the perspective of consumers ，and to provide reference for improving and optimizating the electronic prescription and remote pharmaceutical care in social pharmacy. METHODS ：Totally 264 consumers in 6 counties and 36 drugstores of Chengdu were randomly selected for the questionnaire survey. Descriptive statistics were conducted by using SPSS 23.0 software. Compare the distribution and differences of various. The influential factors in consumer satisfaction based on χ2 test and ordinal multiple Logistic regression analysis. Consumers were randomly selected for semi-structured interviews. Text analysis was conducted by Nvivo 12.0 software to refine the problem of this service . RESULTS ：A total of 271 questionnaires were distributed to consumers in various districts of Chengdu ，and 264 valid questionnaires were collected，with an effective recovery rate of 97.4％. Among 264 respondents，178（67.9％）knew about electronic prescription and remote pharmaceutical care ；197（74.6％）received electronic prescription and remote pharmaceutical care service in pharmacies ； 202（76.5％）said they needed this service ，and 63（23.9％）expressed that they would like to pay for it. Of the 197 respondents who had received the service ，163（82.2％）were satisfied or very satisfied with the service ，and only one （0.5％）was dissatisfied with the service. Waiting time ，satisfaction of drug demand ，staff attitude ，service platform configuration ，the qualifications of tele-practice pharmacists and service quality were the main influential factors of satisfaction ；while the service also suffered from difficulties in electronic prescription circulation ，inadequate service monitoring measures ，insufficient certification of physicians and pharmacists，cultural lag ，and irregular service processes. CONCLUSIONS ：Electronic prescription and remote pharmaceutical care service in social pharmacy is inadequate in terms of technical level ，institutional design and social acceptance. It is recommended that relevant departments implement incentive policies ，optimize technology ；follow up supporting policies in time ，strengthen supervision；and increase social publicity and supervision ，so as to promote the continuous improvement and long-term development of electronic prescription and remote pharmaceutical care in social pharmacy.
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OBJECTIVE:To improve the electronic prescription prior-review mode and increase the rate of qualified prescrip-tions. METHODS:The electronic prescription prior-review mode of our hospital was established by setting up outpatient and emer-gency electronic prescription review team,review evidence and enforcement measures. Aimed at these problems as low review effi-ciency at initial stage,non-unified standards and untimely feedback,quality control circle and internet tools WeChat were used to improve the mode and evaluate its effects. RESULTS:The electronic prescription prior-review mode of our hospital was improved by optimizing system settings,unifying review standard,one-to-one feedback and communication with WeChat public platform, etc. Average time of prescription prior-review had reduced from 50 s to 30.58 s;the rate of qualified prescriptions had increased from 86.77% to 95.30%;prescription review efficiency and the rate of qualified prescriptions had been improved significantly. CONCLUSIONS:The implementation and continuous improvement of electronic prescription prior-review mode can reduce the rate of unqualified prescriptions and promote rational drug use in outpatient and emergency department.
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OBJECTIVE:To promote the working efficiency of hospital prescription evaluation and improve pharmacists profes-sional quality through developmenting electronic prescription evaluation system (EPES) for outpatient department used by taking full advantage of large amount of information of electronic prescription. METHODS:By using system structure of Client/Server, Web Service middleware,programming tool of PowerBuilder and database technique of Oracle and sharing Hospital information sys-tem data,EPES was designed and applied,which could collect prescription information and generate summary form automatically after artificial prescription evaluation. RESULTS & CONCLUSIONS:Integration of outpatient electronic medical records,historical prescriptions and medical test results query system make the EPES carry comprehensive information which could make up for disad-vantages of paper prescription form in the aspect of obtaining outpatient medical records,historical prescriptions or medical test re-sults. EPES can accomplish general and special prescription evaluation and also pledges the equity and justness of process by ran-dom sampling. The operation of the system could improve the efficiency from taking 24-36 h in paper prescription form to 4-6 h to complete general prescription evaluation,which also improves professional quality of pharmacists by intensive training.
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Introduction: Informatization contributes to the integration among various sectors, cost reduction, and improved quality of services. This study aimed to assess the impact on cost/benefit of the integration of electronic prescription of pediatric formulas and enteral diets in the respective production areas in a hospital. Methods: We analyzed the quantitative consumption and financial cost of the products corresponding to 80% of the budget ceiling for the annual programming of each modality during 2 consecutive months in two steps, i.e., before and after the implementation of the new module. Results: A more effective control of the quantities produced and of the final products dispensed was observed, reducing both the traceable and untraceable demands (an 85% reduction in financial terms from R$ 3770.25/months before to R$ 566.73/month after). Conclusion: The change represented a technological innovation that improved the quality of the service provided and contributed to waste reduction.
Introducción: La informatización contribuye para la integración entre distintos sectores, la reducción de costes y la mejora de la calidad de los servicios. Este estudio tuvo como objetivo evaluar el impacto sobre los costes y beneficios que ofrece la integración de la receta electrónica de formulaciones pediátricas y la alimentación enteral con sus respectivas zonas de producción de un hospital. Métodos: Se analizaron el consumo cuantitativo y financiero de los productos correspondientes al 80% del límite máximo del presupuesto de la programación anual de cada modalidad durante 2 meses consecutivos en dos etapas, antes y después de la implementación del nuevo módulo. Resultados: Hubo un control más efectivo de las cantidades producidas, dio a conocer los productos finales, reduciendo las demandas tanto trazables y no rastreables (reducción de 85% en términos financieros, de R$ 3770,25 / mes por adelantado y R$ 566,73 / mes más tarde). Conclusión: El cambio representó una innovación tecnológica que proporciona una mejor calidad de servicio y ha contribuido a la reducción de residuos.
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Cost Control , Nutrition Therapy , Dietary Services , Electronic Prescribing , HospitalsABSTRACT
INTRODUCTION: Informatics and automation are important tools for the reduction of work, errors and costs in a hospital pharmacy. OBJECTIVES: To describe the structuring and function of an informatized system for the dispensing of medications and to assess its effect on nursing and pharmacy services during the period from 1997 to 2003. MATERIALS AND METHODS: In this descriptive and retrospective study, we performed an analysis of documents addressing the structuring and implementation of the informatized medication dispensing system. In addition, we analyzed the perceptions of nurses, pharmacists and pharmacy assistants who participated in the structuring phase of the system when interviewed about the effect of informatization on administrative aspects (e.g., requisition of medications, presentation of the dispensed medication and system operationalization). RESULTS: The major advantages provided by the new system were 1) the elimination of manual transcripts for prescribed medications, 2) increased speed, 3) better identification of the doses prescribed by physicians, 4) medication labels containing all necessary identification and 5) practicality and safety of optical bar code-based verification of the requested and dispensed medications. CONCLUSIONS: The great majority of the interviewees considered the informatized medication supply system to be of good quality. Analysis of the data provided information that could contribute to the expansion and refinement of the system, provide support for studies regarding the utilization of medications and offer new perspectives for work and productivity.
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Humans , Clinical Pharmacy Information Systems/organization & administration , Electronic Prescribing , Medication Errors/prevention & control , Medication Systems, Hospital/organization & administration , Pharmacy Service, Hospital/organization & administration , Chi-Square Distribution , Hospitals, University , Nursing Staff/organization & administration , Quality Assurance, Health Care , Retrospective Studies , Surveys and QuestionnairesABSTRACT
Errors in prescriptions are common phenomena in prescriptions produced by clinicians. With development and application of information technology in medical fields, electronic prescription system has been regarded as the best resolution for effective prevention of errors in prescriptions. A retrospective study of the prescriptions made by the electronic prescription system of the hospital studied over one year showed that this system could reduce errors easily made in manual prescriptions significantly, but it failed to reduce the errors related to dosages. Those dosage-related errors were mainly caused by change of physician prescribing behavior and defective man-machine interaction. Electronic prescription system, though functions basically, can not avoid prescription errors effectively, which poses a potential threat to safe use of medicines in patients. It is urgent at the moment to perfect the functions of electronic prescription system, promote a friendly man-machine interaction and reduce errors made by system errors.
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OBJECTIVE:To discuss measures taken to improve the auditing quality of the electronic prescriptions.METHODS:The problematic prescriptions in our hospital audited from June,2002to June,2004were analyzed statistically.RESULTS:Of the total audited621092prescriptions,8542were problematic prescriptions,which made up1.4%.Of the total problematic prescriptions,6749involved obvious misinput,which accounted for79%;1281involved overmaximal doses of narcotic drugs and psychotropic substances,which accounted for15%;427involved misinput of penicillins,which accounted for5%;85involved irrational prescriptions,which accounted for1%.CONCLUSION:The auditing quality of the electronic prescriptions can be improved through measures like improving the electronic prescription auditing system,enhancing pharmacist auditors'general quality,etc.
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Several years has passed to begin a new paradigm, job separation of a physician and a pharmaceutist, and a electronic prescription becomes common in large scale hospitals. However, the current prescription information system retains some problems such as insufficient patient usability, labor saving techniques and security. This paper is addressed to implement a voice prescription service system to solve the preceding problems. Several suggestions are presented to use voice recognition, voice compression, computer telephony and fingerprint authentication technology for the problems. Lab experimental results show that the processing time to identify drug items is reduced by 80% compared with conventional mouse usage and voice recording is more effective to direct drug usage in a complicated prescriptions. Online fingerprint authentication furnishes evidence of a patient permission and a physician prescription. This feature provides safer security than the current security system.
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Animals , Humans , Mice , Dermatoglyphics , Electronic Prescribing , Information Systems , Prescriptions , VoiceABSTRACT
Objective Due to redundant valuations and inaccurate quantities and specifications in processing temporary medical orders, expensive medicines, water and cream medications, program patches of electronic prescriptions included in the nurse work station were designed and developed. Methods Based on the software and hardware platforms of No.1 Military Medical Project, it was developed under Powerbuilder 9.0 without more tables and database expenses. Result Paperless prescription was realized. Conclusion The clinician's workload is reduced. Inaccurate patient expenses and drugs data are stopped.
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Objective In order to optimize patient's medical treatment processes, and to improve the working efficiency of health care professionals and the quality of medical services. Methods The design and application of the electronic prescription module were introduced, and its advantages and existing problems were discussed. Results The electronic prescription module were applied generally. Orthodox patient's medical treatment processes were changed and the prescription management was normalized. Conclusion The electronic prescription module is one of the core components of the workstation system for the out-patient physicians. It optimizes the patient's medical treatment processes and improves the efficiency and the quality of medical services.
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A prescription issuing system is computerized in so many hospital. While the shareable and usability of an electronic prescription is increased by computerized materials, it can be serious for an information about a patient to be exposed in public. In this paper, the proposed system to issue an electronic prescription is aimed to keep using the existing paper-based prescription issuing system and extend the system using by IC card. It is developed for the secure method of an electronic prescription to transfer between hospital and pharmacy. For this, in this paper, it is defined for the standard minimal data set of a prescription information and developed the method to store the electronic prescription to IC card. It is set the access authority to access the electronic prescription stored in IC card by classifying the access authority group. Since the security and certificate authority center is established using Windows 2000, the electronic prescription stored in IC card can be secured and certificated by an encryption, decryption and digital signature. Lastly, the terminal and server system transferred an electronic prescription of a hospital and a pharmacy is implemented. The proposed system in this paper is simulated in some hospital and pharmacy. On the result of simulation, it is hoped for increasing the prescription transferring service, because the proposed transfer system of an electronic prescription using IC card is stable, secure, available, and creditable.