Community pharmacists' attitudes towards checking prescriptions: a cross-sectional survey.

BACKGROUND: The final prescription check is a mandatory but time-consuming process in Dutch community pharmacies. A safer dispensing process may have made the final prescription check obsolete. OBJECTIVE: To describe the final prescription check in Dutch community pharmacies and explore pharmacists' attitudes towards changing this. METHODS: A cross-sectional survey among Dutch community pharmacists. The online questionnaire was based on literature and previous qualitative research, piloted in three pharmacies, and took 10 min to complete. Results were analysed descriptively. RESULTS: A total of 409 pharmacists participated. They saw the final prescription check as an important quality assurance of the dispensing process. Nevertheless, most pharmacists agreed that the final prescription check could be optimized as they thought that the time invested outweighed the benefits. Automation of the dispensing process, only checking selected high-risk prescriptions, and more in-process checks could reduce the need for an extensive final prescription check, rather than delegating the task to assistants. To implement changes, most pharmacists felt current dispensing guidelines needed to be adapted. CONCLUSION: There was a widespread consensus that optimizing the final prescription check could enhance efficiency and allow more time for person-centred care. Most pharmacists expressed a preference for updated guidelines before implementing such changes.

In-Hospital Prescription Checking System for Hospitalized Patients with Decreased Glomerular Filtration Rate.

Background: Clinical decision support systems (CDSS) are reported to be useful in preventing dosage errors in renally excreted drugs by alerting hospital pharmacists to inadequate dosages for hospitalized patients with decreased GFR. However, it is unclear whether CDSS can reduce dosage errors in renally excreted drugs in hospitalized patients. To prevent dosage errors in renally excreted drugs, we introduced a prescription checking system (PCS) for in-hospital prescriptions. This retrospective study aimed to evaluate whether a prescription audit by hospital pharmacists using the PCS reduced the rate of dosage errors in renally excreted drugs. Methods: The target drugs were allopurinol, cibenzoline, famotidine, and pilsicainide. Interrupted time series analysis was used to evaluate trends in the 4-weekly dosage error rates over 52 weeks before PCS implementation and 52 weeks after PCS implementation. Results: Before and after PCS implementation, 474 and 331 prescriptions containing one of the targeted drugs, respectively, were generated. The estimated baseline level of the 4-weekly dosage error rates was 34%. The trend before the PCS implementation was stable with no observable trend. The estimated level change from the last point in the pre-PCS implementation to the first point in the PCS implementation was -20% (P<0.001). There was no change in the trend after PCS implementation. Conclusions: We demonstrated that a prescription audit by hospital pharmacists using the PCS reduced the rate of dosage errors in the target renally excreted drugs in hospitalized patients. Although further studies are needed to confirm whether our results can be generalized to other health facilities, our findings highlight the need for a PCS to prevent the overdose of renally excreted drugs.

Spread and scale of an electronic deprescribing software to improve health outcomes of older adults living in nursing homes: study protocol for a stepped wedge cluster randomized trial.

BACKGROUND: Medication overload or problematic polypharmacy is a major problem causing widespread harm, particularly to older adults. Taking multiple medications increases the risk of potentially inappropriate medications (PIMs), and residents in long-term care (LTC) are frequently prescribed 10 or more medications at once. One strategy to address this problem is for the physician and/or pharmacist to perform regular medication reviews; however, this process can be complicated and time-consuming. With a prescription review, medications may be decreased, changed, or stopped altogether. MedReviewRx is a software that runs an analysis using deprescribing rules to produce a report to guide medication reviews addressing medication overload for residents in LTC. METHODS: This study will employ a mixed methods effectiveness-implementation hybrid type 2 study design. To measure effectiveness, a stepped wedge cluster randomized trial design is planned, which allows us to approximate a randomized clinical trial. Approximately 1000 residents living in LTC will be recruited from five facilities in New Brunswick. The study will begin with 3 months of baseline data on rates of deprescribing. Thereafter, every 3 months a new cluster will enter the intervention mode. The intervention consists of medication reviews augmented with the MedReviewRx software, which will be used by staff and clinicians in the facilities. The estimated study duration is 18 months and the main outcome will be the proportion of patients with one or more PIMs deprescribed (reduced/stopped or changed to a safer alternative) in the 90 days following a prescription review. The goal is to study the impact of MedReviewRx on medication overload among older adults living in LTC. In typical fashion of a stepped wedge cluster randomized trial, each cluster acts as an internal control (before and after) as well as a control for the other clusters (external control). Qualitative data collected will include resident/caregiver attitudes towards deprescribing and semi-structured interviews with staff working in the long-term care homes. DISCUSSION: This study design addresses issues with seasonality and allows all clusters to participate in the intervention, which is an advantage when the intervention is related to quality improvement. This study will provide valuable information on PIM use, cost savings, and facilitators and challenges associated with medication reviews and deprescribing. This study represents an important step towards understanding and promoting tools to guide safe and rational reduction of PIM use among older adults. TRIAL REGISTRATION: NCT04762303 , Registered February 21, 2021.

Construction Effectiveness Analysis of Rational Drug Use Monitoring System in Our Hospital / 中国药房

OBJECTIVE:To explore the construction effect of rational drug use monitoring system on the improvement of clini-cal drug use in the hospital. METHODS:The data about the construction of rational drug use monitoring system were collected from our hospital,including pharmacist workstation prescription check(check before prescription/medical order charging to realize warning in advance),clinical pharmacy management system prescription comment(realize prescription/medical order comment after-wards)and adverse drug reaction/adverse drug event(ADR)reporting information platform(realize online ADR reporting)during 2014-2015. The data was analyzed to evaluate the effectiveness of system construction. RESULTS & CONCLUSIONS:There were a total of 3 417 329 prescriptions audited by the pharmacist workstation within 2 years through improving system functions,includ-ing 7 315 prescriptions were returned to doctors to be modified,the percentage of which declined from 0.39% to 0.08%. The pass rate of prescription comment pre-judgment increased from 81.2% to 90.4% in 2015 by clinical pharmacy management system. The valid case number of ADR monitoring and reporting increased from 186 cases to 267 cases,involving all department of our hospi-tal. The construction of rational drug use monitoring system in our hospital can improve the standardization of prescription/medical orders,the level of rational drug use and the case number of ADR,which has achieved the expected results.

Application of Rational Drug Use Software System in the Drug Dispensing in Outpatient Department of Our Hospital / 中国药房

OBJECTIVE:To discuss the application of rational drug use software system in drug dispensing in outpatient depart-ment of our hospital. METHODS:The application of rational drug use software system (included clinical decision support soft-ware,drug dispensing software and drug management software) in prescribing (warning in advance),dispensing (intervention in the event)and the prescription review(the post review)in outpatient department of our hospital were all introduced. Outpatient pre-scription checking and intervention were collected from our hospital after the application of rational drug use software system to evaluate the effect of the software system. RESULTS & CONCLUSIONS:Rational drug use software system is adopted to realize scientific,convenient and express monitoring and management of prescription drug use in advance,in the course and afterwards. A total of 721 507 outpatient prescriptions were checked in our hospital from Jan. to May in 2015;0.17‰prescriptions were intercept-ed by system warning;system pointed out and pharmacists had checked 23.25% prescriptions;the rate of qualified prescription was more than 99.96%. After pharmacists intervention,various types of irrational prescriptions decreased significantly (P<0.01). It is suggested that pharmacists should make full use of information system,at the same time,optimize and improve the system through active exploration so as to improve rational drug use.

Initial Implementation of Outpatient Prescription Checking and Intervention in Our Hospital / 中国药房

OBJECTIVE:To investigate the problems commonly occurred in outpatient prescriptions and to evaluate pharmacists’ role in the checking and intervention of prescriptions.METHODS:Questionable prescriptions recorded by outpatient pharmacists in their routine prescription checking from June,2004 to October, 2004 were classified and statistically analyzed. RESULTS:On average,the questionable prescriptions accounted for 0.35% of all the prescriptions dispensed by pharmacists. Of the questionable prescriptions,usage problems accounted for 43.0%,dosage accounted for 39.4%,volume dose accounted for 9.7%,frequency accounted for 2.7%.The results in prescribed frequency were significantly different before and after pharmacists intervention(P