P32 Pre-go-live simulation testing of new electronic prescribing systems in a specialist paediatric hospital

AimSingle-site cross-sectional evaluation of a specialist paediatric hospital electronic clinical systems designed to support the medication process. This included simulation testing and evaluation of three electronic systems: PICS an electronic prescribing system designed in an adult hospital and being adapted for paediatric use; BDD an in-development electronic drug dictionary database that will serve as a clinical decision support tool; and Ascribe the existing pharmacy dispensing and management system (used to provide target levels). Simulation testing is used to assess the utility of the systems in the local (paediatric hospital) setting and gauge readiness for use in the live environment.MethodsUnique drug regimens from consecutive hand written outpatient pharmacy prescriptions and the hepatology ward paper drug charts were harvested and used as the simulation test. Each regimen was therefore in current use at the study site. The test prescriptions were used to identify each systems’ ability to accommodate that regimen, such that:PICS (electronic prescribing system) – can the regimens be prescribed on PICS?BDD (drug dosing database) – are these regimens held within the database?Ascribe (hospital pharmacy system) – can the regimens be recorded on Ascribe to facilitate medication supply?The system tests were undertaken in early July 2015 following suitable training on how to use each of the three systems. Trained researchers attempted to enter the regimens into PICs and Ascribe; and to identify if the regimens were available within the BDD database.Approval was granted by the study site, and Aston University Ethics Committee.ResultsOutpatients (89 unique regimens)PICS: 74% (66/89) of drug regimens could be completely reproduced electronically, with 34% (30/89) matching default dosing regimens.BDD: 40% (36/89) of drug regimens were found in the database (drug name, indication, route and dose in relation to the age of patient)Ascribe: 77.5% (69/89) of drug regimens were reproducible and had labelling templates that existed on the system, a further 17% (15/89) drug regimens were available but required some amendment to existing templates.Hepatology ward – (126 unique regimens)PICS: 71% (90/126) could be prescribed as written on the drug charts.BDD: 58% (73/126) of drug regimens were found in the database (drug name, route and dose in relation to the age of patient)Ascribe: 94% (118/126) of drug regimens were reproducible and had labelling templates that existed on the ascribe system, a further 18% (23/126) drug regimens were available but required some amendment to existing templates.ConclusionOverall, at the time of testing, the electronic prescribing system (PICS) could accommodate approximately 72% of drug regimens, the BDD database could accommodate approximately 51% – compared to the Ascribe (target figure) of 87%. The findings suggest that further work is required to ensure the systems in development (PICS and BDD) are ready for use.

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A NATIONAL SURVEY TO IDENTIFY HOW DISPLACEMENT VALUE INFORMATION IS USED AND PRESENTED TO CLINICAL STAFF IN NHS HOSPITALS

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311535.9 ◽

2016 ◽

Vol 101 (9) ◽

pp. e2.75-e2

Author(s):

Nanna Christiansen ◽

Zinab Kehk ◽

Susan Keeling ◽

Bryony Dean

Keyword(s):

Hospital Setting ◽

Visual Presentation ◽

National Standard ◽

Survey Study ◽

Easy Access ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Paediatric Hospital ◽

Method Of Calculation ◽

The Uk

AimThe use of displacement values (DVs) when preparing intravenous (IV) medication for children enables accurate doses to be given1 and is assumed to be common paediatric practice. This survey aimed to assess views of UK paediatric pharmacists on DVs in practice to explore:▸ How prevalent is DV use in the paediatric hospital setting▸ Which type of IV administration guidelines were being used▸ Which form of DV presentation is perceived to be most practical▸ Which method of calculation is preferredMethodA national cross-sectional survey study was undertaken. The questionnaire comprised of 13 closed and open questions as well as samples of how DVs are currently displayed on the Medusa Injectable Medicines Guide2. After piloting the questionnaire the survey was sent to 365 paediatric pharmacists across 120 UK hospitals utilising Qualtrics Survey Software.ResultsFifty-five completed questionnaires covering 52 (43%) United Kingdom (UK) hospital trusts were received. Of 55 respondents, 52 (95%) reported the clinical significance of DVs in paediatric care. This was reflected in the fact that all local guides provided information on DVs. The majority (32;59%) used locally produced guides, while 15 (27%) of respondents used Medusa as a resource. All respondents commented on methods of presentation and calculation of DV information. Of four methods presented, the method involving presentation of reconstitution information in a brand-specific table was ranked as most practical (46;84% respondents). This method was viewed as being clear and concise. Respondents also expressed the importance of having this tabulated method visually embedded in the monograph to allow easy access to information on the wards. This concurs with suggested information presentation to aid error reduction in the literature.3 National standardisation of DV information was viewed as ‘very useful' or ‘preferred' by 52 (95%) of respondents; reasons for this preference were risk reduction due to errors or misinterpretation.ConclusionThe use of DVs in paediatrics is commonplace in the UK; this is reflected in local IV guides used by the majority of centres. Improving visual presentation of DVs is important and tabulated expression of DVs is preferred by pharmacists and a national standard presentation of DVs is encouraged. The results from the survey will inform the monograph layout for the Medusa. Prior to implementation nurse feedback should also be sought.

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Patient and clinician perspectives of an integrated electronic medication prescribing and dispensing system: A qualitative study at a multisite Australian hospital network

Health Information Management Journal ◽

10.1177/1833358317720601 ◽

2017 ◽

Vol 48 (1) ◽

pp. 12-23 ◽

Cited By ~ 4

Author(s):

Grace Lau ◽

Jayde Ho ◽

Susan Lin ◽

Karen Yeoh ◽

Tiffany Wan ◽

...

Keyword(s):

Positive Impact ◽

Electronic Prescribing ◽

Cross Sectional Survey ◽

Cross Sectional ◽

System A ◽

Clinician Perspectives ◽

Perceived Impact ◽

Effective Use ◽

Clinician Attitudes ◽

Australian Hospital

Background: While clinician attitudes towards electronic prescribing (e-prescribing) systems have been widely studied, little is known about the perspectives of patients, despite being the primary beneficiaries of these systems. Objective: The objective of this study is to explore and compare patient and clinician attitudes towards an integrated e-prescribing and dispensing system, in order to guide improvements in system implementation, service delivery and enhancements to system functionality. Method: A cross-sectional survey was developed and administered to patients and multidisciplinary clinicians at a multisite Australian metropolitan teaching hospital network in all areas where e-prescribing was fully implemented. Participants’ views on perceived impact and valued features of the e-prescribing system were elucidated. Results: Overall, 783 participants (400 patients and 383 clinicians) completed the survey. Although 98% of clinicians were aware of the transition to e-prescriptions, only 36% of patients were aware prior to the study. Over 80% of patients and clinicians perceived improvements in prescribing and dispensing safety and clinician workflow; 90% of patients were comfortable with information privacy associated with e-prescriptions; and 86% of patients preferred e-prescriptions to handwritten prescriptions. Although over 80% of patients valued features that improved access to information and medication safety, clinicians were more discerning about valued system features. Conclusion: The majority of patients and clinicians reported a positive impact of e-prescribing on safety and efficiency. Both groups valued safe and effective use of medicines, although differences existed in the importance placed on key system features. A greater focus on patient engagement and communication is needed to optimise the delivery of patient-centred care.

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Factors influencing nursing students’ intention to accept COVID-19 vaccination – A pooled analysis of seven countries

10.1101/2021.01.22.21250321 ◽

2021 ◽

Author(s):

Evridiki Patelarou ◽

Petros Galanis ◽

Enkeleint A. Mechili ◽

Agathi Argyriadi ◽

Alexandros Argyriadis ◽

...

Keyword(s):

Nursing Students ◽

Clinical Decision ◽

Pooled Analysis ◽

Male Gender ◽

Effective Vaccine ◽

List Type ◽

Cross Sectional ◽

Healthcare Facilities ◽

Level Of Knowledge ◽

High Level

AbstractExperiencing the second wave of COVID-19 pandemic, high vaccination coverage by a safe and effective vaccine globally would be a great achievement. Acceptance of vaccination by healthcare students is an important issue as they have a key role as future professionals in educating patients, informing and guiding them to the right clinical decision. The aim of this study was to explore the intention of nursing students to get vaccinated for SARS-CoV-2 infection and the factors acting either as motivators or barriers towards vaccination. A multicenter cross-sectional study was conducted in 7 countries (Greece, Albania, Cyprus, Spain, Italy, Czech Republic and Kosovo) through a web survey. In total 2249 undergraduate nursing students participated. Forty three point eight percent of students agreed to accept a safe and effective COVID-19 vaccine, while the acceptance was higher among Italian students. The factors for intention to get vaccinated were male gender (p=0.008), no working experience in healthcare facilities during the pandemic (p=0.001), vaccination for influenza in 2019 and 2020 (p<0.001), trust in doctors (p<0.001), governments and experts (p=0.012), high level of knowledge (p<0.001) and fear of COVID-19 (p<0.001). Understanding of factors that influence students’ decision to accept COVID-19 vaccination could increase the acceptance rate contributing to a management of the pandemic.HighlightsLess than half of the sample intended to accept COVID-19 vaccinationFactors that influenced nursing students to get vaccinated against COVID-19 were male gender, no working experience in healthcare facilities during the pandemic, vaccination for influenza in 2019 and 2020, trust in doctors, governments and experts, high level of knowledge and fear of COVID-19.

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Parental Perceptions of Giardiasis: A Study in an Outpatient Paediatric Hospital Setting in Havana, Cuba

ISRN Preventive Medicine ◽

10.5402/2013/364647 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Pedro Almirall ◽

Angel A. Escobedo ◽

Yohana Salazar ◽

Maydel Alfonso ◽

Ivonne Ávila ◽

...

Keyword(s):

Formal Education ◽

Hospital Setting ◽

Integrated Approach ◽

Diarrhoeal Disease ◽

General Level ◽

Cross Sectional Survey ◽

Modern Problem ◽

Cross Sectional ◽

Paediatric Hospital ◽

Transmission Prevention

Background. Giardia lamblia is an important cause of diarrhoeal disease throughout the world. Giardiasis— a mild and self-limiting disease that this protozoan causes— is perceived as a harmful disease. Aim. To explore the general level of awareness about giardiasis, clinical features, mode of transmission, prevention, and consequences and describe the sources and channels of information caregivers would prefer using to be informed about this disease. Methods. A cross-sectional survey was conducted among caregivers attending to the outpatient paediatric hospital setting in Havana. Results. A total of 202 caregivers were interviewed. Nearly 73% considered giardiasis as a modern problem, and 39% considered that it could be a fatal disease. Although 76.7% were aware that small intestine is the organ affected, other localizations were cited. Abdominal pain and diarrhoea were recognized as the commonest symptoms. Around one-third could identify that giardiasis may spread through drinking unboiled water and unwashed vegetables other incorrect ways were mentioned; respondents with more than 12 years of formal education were more likely to have better knowledge. Discussion. Strategies to control giardiasis need to be through an integrated approach aiming at boosting caregivers’ knowledge and encouraging healthcare workers to act as a readily available source for health information.

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P24 Developing a paediatric electronic prescribing system

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314584.35 ◽

2018 ◽

Vol 103 (2) ◽

pp. e1.29-e1

Author(s):

Asif Yusuf ◽

Choudhury Camrul

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Secondary Care ◽

Clinical Decision ◽

Support Staff ◽

Electronic Prescribing ◽

List Type ◽

Care Hospital ◽

Paediatric Drug ◽

Clinical Support

AimTo develop an electronic prescribing system (EPS), in a tertiary care paediatric hospital.MethodOne of the many benefits of electronic prescribing (EP) in secondary care, is the reduction in prescribing error rates.1 However, implementing EP in paediatrics, presents many challenges such as the increased complexity of medication dosing2 and varying doses of drugs depending on indication.2 An EPS was acquired from a local adult secondary care hospital and developed to include a specialist paediatric drug library with clinical decision support. The pharmacy department used a dispensing patient medication record system that was incompatible with the EPS, so the latter had to work side-by- side with the former, as the drug chart. A smaller training team was deployed with external trainers, from the hospital where the system was acquired from and they were enlisted for the pilot.ResultsThe pilot was launched in April 2017, on the hepatology ward, consisting of 14 beds. All patients that were treated under the hepatology medical and surgical teams were placed on the e-prescribing system and this accounted for 95 patients, from the launch over a period of 3 months. Although the benefits of an EPS became a reality, which included a reduction in medication and administration errors, many drawbacks still existed that hindered a more complete EPS. Certain drugs were found to be missing from the drug library and drug monographs lacked the appropriate clinical decision support for prescribers and administrators alike. This was observed by the sharp rise in incident reporting from 20 reports, in the 3 months prior to the launch, to 55 reports, in the 3 months post-launch. Pharmacy processes, that proved effortless on drug charts and discharge prescriptions, became complex for pharmacists and technicians, as the EPS lacked the necessary features including insufficient message functionality to document patient’s own medicines and supply from pharmacy, discharge prescription alerting and modification of prescriptions once printed. The absence of sufficient and relevant clinical support staff became apparent soon after external trainers returned to their respective bases; with only one support member remaining that had held a clinical position previously. Difficulties quickly became apparent when attempting to explain specific clinical EP functions to non-clinical support staff.ConclusionIn preparation for rollout across the trust, many areas could be improved upon to ensure substantial progress could be made, from the pilot. Developing a more robust system to build and review drug monographs to include both medical and nursing input, from their respective clinical specialities and ensuring that all drugs whether supplied with or without pharmacy involvement are included in the paediatric drug library. Observing the work of pharmacists and other healthcare professionals, to ensure their day-today tasks, on drug charts or discharge prescriptions, are replicated successfully on the EPS. Increased pharmacy involvement in training and support, would benefit the EPS greatly, from a clinical perspective.ReferencesFranklin G, O’Grady K, Donyai P, Jacklin A, Barber N. The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: A before-and-after study. QualSaf Health Care2007;16:279–84.Johnson KB, Lehmann CU. Council on clinical information technology. Technical report: Electronic prescribing in paediatrics: Toward safer and more effective medication management. Paediatrics2013;131(4):e1350–e1356.

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Development and Validation of HSCAPS-1: A Clinical Decision Support Tool for Diagnosis of Hidradenitis Suppurativa over Cutaneous Abscess

Dermatology ◽

10.1159/000511077 ◽

2020 ◽

Vol 237 (5) ◽

pp. 719-726

Author(s):

Amit Garg ◽

Sarah Reddy ◽

Joslyn Kirby ◽

Andrew Strunk

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Hidradenitis Suppurativa ◽

Decision Support Tool ◽

Clinical Decision ◽

Diagnosis Delay ◽

Cross Sectional ◽

Support Tool ◽

Clinical Decision Support Tool ◽

Validation Set

Background: A clinical decision support tool may improve recognition of hidradenitis suppurativa (HS) and reduce diagnosis delay. Objective: To develop and initially validate a clinical decision support to predict diagnosis of HS and distinguish it from cutaneous abscess of the axilla, groin, perineum, and buttock. Methods: This was a retrospective, cross-sectional analysis between January 2012 and June 2017 (development set) and July 2017 and March 2019 (validation set). We used an electronic records sample of 56 million patients from the Explorys database to identify patients with an ambulatory visit associated with either HS or cutaneous of the axilla, groin, perineum, and buttock. The outcome was predicted probability of HS diagnosis. Results: Development set included 7,974 patients with mean age of 41.4 years, who were predominantly female (66%) and white (62%). Validation set included 1,560 patients with similar demographic composition. Factors which were stronger independent predictors of HS included female sex (OR 2.17 [95% CI 1.96–2.40]); African American race (1.28 [95% CI 1.15–1.44]); increasing BMI (OR 1.05 [95% CI 1.05–1.06)]; history of acne (OR 3.46 [95% CI 2.83–4.23]); Down syndrome (OR 5.35 [95% CI 2.03–14.12]); and prescription for at least 7 opioid medications in the past year (OR 1.05 [95% CI 0.83–1.33]). Up to age 45 years, increasing age was a stronger predictor of HS diagnosis. The simplified model showed good discrimination (c-statistic 0.746 [SE 0.013]) and moderate calibration (calibration intercept –0.260 [SE 0.055]; calibration slope 1.142 [SE 0.076]). Conclusion: This clinical decision support tool shows good performance in predicting diagnosis of HS and distinguishing it from cutaneous abscess that involves the axilla, groin, perineum, and buttock.

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Assessing Vaccine Hesitancy among Healthcare Workers: A Cross-Sectional Study at an Italian Paediatric Hospital and the Development of a Healthcare Worker’s Vaccination Compliance Index

Vaccines ◽

10.3390/vaccines7040201 ◽

2019 ◽

Vol 7 (4) ◽

pp. 201 ◽

Cited By ~ 2

Author(s):

Sonia Paoli ◽

Chiara Lorini ◽

Francesco Puggelli ◽

Antonino Sala ◽

Maddalena Grazzini ◽

...

Keyword(s):

Healthcare Workers ◽

Intervention Program ◽

Seasonal Influenza ◽

Cross Sectional Study ◽

University Hospital ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Paediatric Hospital ◽

System A ◽

Strategic Training

Healthcare workers (HCWs) in paediatric hospitals are an important source of advice on vaccinations, but vaccine hesitancy can affect even these professionals. The aim of this study is to assess this phenomenon, measuring it by means of a scoring system. A survey was conducted in five departments of an Italian paediatric university hospital of national interest. Vaccination against influenza was considered a behavioral indicator of vaccination uptake. Using the collected data, the healthcare worker’s vaccination compliance index (HVCI) was computed. The results demonstrate statistically significant differences between departments and professional profiles. Nearly 80% of the sample was not immunized against seasonal influenza. According to the HVCI scores, the most hesitant departments are the intensive care unit, emergency room, and oncohematology department, while the most hesitant professional profiles are nurses and auxiliary staff. The score of the unvaccinated is significantly lower than that of the vaccinated, and the same difference was found between those who self-perceive to be skilled versus unskilled. The HVCI score was statistically verified as a predictive parameter to assess vaccination against seasonal influenza. By means of strategic training policies, both HVCI and perceived skills could be improved, suggesting that hospital management should draw a complex intervention program to fight against hesitancy.

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P19 Direct observational study of infusion errors associated with smart-pump technology in paediatric intensive care

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-nppg.28 ◽

2020 ◽

Vol 105 (9) ◽

pp. e15.2-e16

Author(s):

Moninne Howlett ◽

Erika Brereton ◽

Cormac Breatnach ◽

Brian Cleary

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

The United States ◽

Error Rates ◽

Paediatric Intensive Care ◽

Electronic Prescribing ◽

List Type ◽

Paediatric Hospital ◽

Smart Pumps ◽

Smart Pump

AimsProcesses for delivery of high-risk infusions in paediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps and electronic prescribing are recommended medication error reduction strategies.1 2 Implementation rates are low in Irish and UK hospitals.2 3 Since 2012, the PICU of an Irish tertiary paediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA®). The incidence of infusion errors is unknown. This study aims to determine the frequency, severity and distribution of smart-pump infusion errors and to identify contributory factors to the occurrence of infusion errors.MethodsProgrammed infusions are directly observed at the bedside. Parameters are compared against medication orders and auto-populated infusion data. Identified deviations are categorised as either medication errors or discrepancies. Five opportunities for error (OEs) were identified: programming, administration, documentation, assignment, data transfer. Error rates (%) are calculated as: infusions with errors; and errors per OE. Pre-defined definitions, multi-disciplinary consensus and grading processes are employed.ResultsA total of 1023 infusions for 175 patients were directly observed on 27 days between February and September 2017. 74% of patients were under 1 year, 32% under 1 month. The drug-library accommodated 96.5% of all infusions. Compliance with the drug-library was 98.9%. 55 infusions had ≥ 1 error (5.4%); a further 67 (6.3%) had ≥ 1 discrepancy. From a total of 4997 OEs, 72 errors (1.4%) and 107 discrepancies (2.1%) were observed. Documentation errors were most common; programming errors were rare (0.32% OE). Errors are minor, with just one requiring minimal intervention to prevent harm.ConclusionThis study has highlighted the benefits of smart-pumps and auto-populated infusion data in the PICU setting. Identified error rates are low compared to similar studies.4 The findings will contribute to the limited existing knowledge base on impact of these interventions on paediatric infusion administration errors.ReferencesInstitute for Safe Medication Practices, ISMP. 2018–2019 Targeted medication safety best practices for hospitals2018 [Available from: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitalsv2.pdf [Accessed: June 2019]Oskarsdottir T, Harris D, Sutherland A, et al. A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom. J Pharm Pharmacol 2018;70:1324–1331.Howlett M, Curtin M, Doherty D, Gleeson P, Sheerin M, Breatnach C. Paediatric standardised concentration infusions – A national solution. Arch Dis Child. 2016;101:e2.Blandford A, Dykes PC, Franklin BD, et al. Intravenous Infusion Administration: A comparative study of practices and errors between the United States and England and their Implications for patient safety. Drug Saf. 2019;42:1157–1165

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P16 An audit of domperidone prescribing in children

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314585.25 ◽

2018 ◽

Vol 103 (2) ◽

pp. e2.18-e2

Author(s):

Lauren Williams ◽

Kazeem Olalekan ◽

Caroline Cole ◽

Andy Fox

Keyword(s):

Side Effects ◽

Drug Safety ◽

Pharmacological Treatment ◽

Hospital Setting ◽

Electronic Prescribing ◽

Cardiac Monitoring ◽

European Medicines Agency ◽

List Type ◽

Cardiac Side Effects ◽

Number Of Patients

Introduction/aimThe European Medicines Agency (EMA) reviewed the use of domperidone containing medicines in March 2014, due to concerns about cardiac abnormalities. The Medicines and Healthcare products Regulatory Agency (MHRA) then responded and issued a drug safety update in May 2014,1 which listed new restricted indications, dosing, duration and contraindications for domperidone.In May 2015 the Neonatal and Paediatric Pharmacists Group (NPPG) released a statement on the use of domperidone.2 This was a highly significant document in child health, and empowered paediatric pharmacists to react to national alerts and implement changes locally. The aim of the audit was to collect information on the current prescribing of domperidone in paediatric patients in a hospital setting, and to evaluate the effects of the alerts on prescribing.MethodPatients aged 0–18 years were retrospectively identified within a children’s hospital (n=60) as having domperidone prescribed between the 1 st of January 2014 and the 31 st of July 2015 using electronic prescribing records. For each patient, data was collected regarding domperidone dose, indication, duration, monitoring and non-pharmacological interventions for gastro-oesophageal reflux disease (GORD).ResultsA total of 60 patients were included in the audit, of which 10 (17%) were prescribed domperidone after the publication of the NPPG alert.In terms of dosing, 43/50 (86%) achieved the standard before the NPPG alert; for duration 6/50 (12%), for indication 9/50 (18%); for ECG monitoring in high risk patients 12/33 (36%) and for the trial of non-pharmacological treatment in GORD 11/17 (64%).For the patients post implementation, these figures were 10/10 (100%), 1/10 (10%), 1/10 (10%), 0/4 (0%) and 2/3 (66%) respectively.ConclusionIn conclusion, this audit has shown that the drug safety updates have been received and acted upon within a secondary care setting, and hospital teams are following the new domperidone prescribing guidelines. Whilst many of the children audited were still receiving domperidone off-licence and long-term to improve gastric motility, this is to be expected as there are currently no licensed paediatric medicines for the management of these conditions.After the NPPG alert no patients received unsafe doses or interacting medicines, and the number of patients trialling non-pharmacological treatment for GORD increased. However, there remains a concern that cardiac monitoring is not being undertaken in patients at risk of cardiac defects. It is important to educate healthcare professionals on the cardiac risks of domperidone, and suggest appropriate monitoring in patients with underlying cardiac disease and those receiving concomitant drugs that prolong the QT interval. Clear national guidance, and the introduction of local protocols that recommend which patients need to be monitored and how often may improve domperidone prescribing.ReferencesMHRA. Drug safety update: Domperidone: Risks of cardiac side effects. Gov.uk [Internet]. https://www.gov.uk/drug-safety-update/domperidone-risks-of-cardiac-side-effects [Accessed: 30 May 2014].NPPG. The use of domperidone in infants and children. Neonatal and Paediatric Pharmacy Group [Internet]. http://www.nppg.scot.nhs.uk/news/Domperidone%20NPPG%20final.pdf [Accessed: May 2015].

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P048 The efficiency of an electronic prescribing system on clinician’s prescribing through the pharmacist’s review function

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-nppc.57 ◽

2019 ◽

Vol 104 (7) ◽

pp. e2.53-e2

Author(s):

Yusuf Asif ◽

Amrita Garcha

Keyword(s):

Patient Outcomes ◽

Royal College ◽

Healthcare Professionals ◽

Clinical Decision ◽

Electronic Prescribing ◽

List Type ◽

Clinical Knowledge ◽

Pharmaceutical Society ◽

Effective Use ◽

Royal Pharmaceutical Society

AimTo assess the efficiency of an electronic prescribing system (EPS) on clinician’s prescribing through the implementation and use of the pharmacist’s review function.IntroductionAn electronic prescribing system, PICS, was launched in one ward, the liver unit, in April 2017. Many features were available on the EPS to support safer prescribing such as clinical decision support and prescribing guidance. One particular feature was the review note function, which was available for pharmacists, to attach a review note to a selected drug, highlighting an intervention, in order for the clinician to review. Once a review note was added, an eye icon appeared next to the selected drug on the drug chart. Once the prescription was reviewed, it could be signed off to signify the note was acknowledged and actioned. Implementing the review function, pharmacists are guiding safer prescribing of clinicians based on their clinical knowledge and expertise.This is evidenced by the Royal College of Physicians who have highlighted how healthcare professionals should support each other on the safer use of medicines,1 and The Royal Pharmaceutical Society, that stated ‘the pharmacy team provides expertise and advice to support the safe and effective use of medicines by patients’.2MethodsAn audit was completed, over a two-week period, to assess the type of interventions, the timeliness in which the intervention was noted once the prescription was added and the timeliness in which the clinicians reviewed and actioned a prescription which had a review note attached to it by the pharmacist. Pharmacists annotated all interventions using the review function on PICS. The date and time when the prescription was added, the review note was added and the review note was signed off was recorded. The type of review note (intervention) and the change made, if made, was also noted. It is recognised that there will be a delay from when the pharmacist adds the review note and the clinician views it. For urgent reviews, the clinician was verbally notified.Results29 interventions were recorded over the two-week period, with the majority of interventions involving dosing issues (41%), followed by interventions regarding formulation (17%), drug and frequency (both 14%). Most review notes were added 24 hours (34%) after the prescription was added onto the patient’s drug chart followed by those noted within an hour (21%) of the prescription being added. 25 prescriptions (86%) were amended upon the advice of the pharmacist whilst 4 prescriptions (14%) were not, due to a clinical requirement or if the patient had been discharged. 21 review notes (72%) did not require the pharmacist to verbally inform the clinician to amend the prescription.ConclusionThe audit highlighted the importance of the pharmacist’s review function in highlighting interventions, whether this was related to dosing, formulation, frequency or drug. In addition, it highlighted the value of the pharmacist’s interventions via the review function as most review notes were amended as per the pharmacists’ advice and the majority did not require verbal notification to the prescriber, stressing the importance of the function.ReferencesSupporting safe prescribing. Royal College of Physicians 2017.Royal Pharmaceutical Society. Professional standards for hospital pharmacy services: optimising patient outcomes from medicines. London: RPS, 2014.

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