Barriers to electronic prescribing of controlled substance, especially opioids.

OBJECTIVE: Electronic prescriptions are now the standard of practice for all discharge and outpatient prescriptions. The intention is to increase patient safety, provide a more complete medication record for patients, lessen the burden on prescribers, and shorten the time it takes for medication orders to reach the pharmacy. DESIGN: This cross-sectional questionnaire survey study was conducted between January and August 2022 in three areas of a large urban safety net hospital. SETTING: A large single academic medical center. PARTICIPANTS: Emergency department, inpatient clinicians, and procedural areas. The subjects of the study were trainees, attending physicians, and advance practice providers (APPs) Interventions: Data were collected from the participants using a self-reported questionnaire, including sociodemographic characteristics, ease of use, reliability, and preference. Additionally, the perception of the strengths and limitations associated with electronic prescribing (e-prescribing) were analyzed. MAIN OUTCOME MEASURE: The purpose of this study was to evaluate the barriers to e-prescribing of opioids. RESULTS: A total of 121 prescribers completed the survey. The majority trusted that e-prescribing were transmitted successfully (62 percent), saved time (78 percent), and did not interrupt their workflow (78 percent). However, many prescribers indicated that additional improvements are needed, such as updating the patient's preferred pharmacy in the electronic medical record during each visit (52 percent) and having a 24-hour pharmacy readily available (66 percent). CONCLUSION: Prescribers value the ease of use of e-prescribing and how time efficient the process can be. Nevertheless, there is a need to improve the system's service, design, and usefulness.

Modafinil for the Improvement of Patient Outcomes Following Traumatic Brain Injury.

Objective: The authors sought to assess the literature evidence on the efficacy of modafinil use in patients with fatigue or excessive daytime sleepiness (EDS) secondary to traumatic brain injury (TBI). Method of Research: A literature search of Medline and PubMed was performed using the EBSCOhost database. Primary literature, observational studies, meta-analyses, case reports, and systematic reviews were assessed for content regarding modafinil and psychostimulant use in patients with TBI. Of the 23 articles collected, three randomized, controlled studies, three observational studies, one case report, and two systematic reviews gave a description of modafinil use in TBI patients. Results and Conclusion: Modafinil is a central nervous system stimulant with well-established effectiveness in the treatment of narcolepsy and shift-work sleep disorder. There is conflicting evidence about the benefits of modafinil in the treatment of fatigue and EDS secondary to TBI. One randomized, controlled study states that modafinil does not significantly improve patient wakefulness, while another concludes that modafinil corrects EDS but not fatigue. An observational study provides evidence that modafinil increases alertness in fatigued patients with past medical history of brainstem diencephalic stroke or multiple sclerosis. Modafinil appears to have the potential to improve wakefulness in patients with TBI. A prospective, double-blinded, randomized, crossover trial of modafinil for the management of fatigue in ischemic stroke patients is currently being conducted, and further studies demonstrating consistent results are needed before making a conclusive decision.

Implementation of a hypertension clinic using a streamlined treatment algorithm.

PURPOSE: The implementation of a pharmacist-managed clinic based on the Simplified Treatment Intervention to Control Hypertension (STITCH) algorithm is described, with insights on physician acceptance and implementation challenges. SUMMARY: After a medical records review indicating gaps in the follow-up care of emergency department (ED) patients found to have elevated blood pressures (BPs), the ED of a large public hospital sought to create a "bridge" to ongoing primary care by applying a modified version of the STITCH algorithm, which aims to address compliance barriers to adequate BP control through a streamlined stepped-care approach derived from national consensus guidelines. Following the guidelines of the STITCH algorithm, the goals of the clinic implemented in this project were to (1) coordinate initial pharmacotherapy, (2) monitor patients pending their first primary care clinic appointment, (3) assess for potential antihypertensive-related complications, and (4) provide comprehensive and ongoing patient education. Physician support for the clinic (staffed by one pharmacist one day weekly) was cultivated through both broad and individually targeted education to allay concerns about initiating BP-lowering therapy in the ED setting, especially given patients' typical one- to six-month wait time for a primary care clinic appointment. Early experience at the clinic indicated increased physician willingness to initiate hypertension treatment in the ED due to the availability of appropriate follow-up services within a shorter time frame (about two weeks). CONCLUSION: One hospital's experience suggests that a hypertension-focused clinic using a streamlined treatment algorithm can serve as a bridge from urgent care to ongoing primary care, facilitating adequate BP control in a transient, low-income patient population.

Comparison of computer-mediated learning and lecture-mediated learning for teaching pain management to pharmacy students.

OBJECTIVES: To assess the effectiveness, efficiency, and student satisfaction with computer-mediated instruction (CMI) versus lecture-mediated instruction (LMI) of pain management to doctor of pharmacy (PharmD) students. METHODS: This study compared the instruction of pain management by CMI versus LMI. An examination was administered and a student survey was conducted to determine effectiveness and student perception of efficiency and satisfaction with these teaching methods. RESULTS: Mean examination scores were not significantly different between the 2 groups, with 62 (91%) of the LMI group and 46 (94%) of the CMI group scoring > or =70% (p = 0.73). Efficiency and student perception of learning significantly increased in the CMI group. CONCLUSIONS: CMI appears to be at least as effective as LMI in teaching pain management to pharmacy students and students perceive that efficiency and learning is increased with CMI. Therefore, CMI seems to be a viable teaching option.