Evaluating the Appropriateness of Free Text Notes in Electronic Prescriptions Across Time and Electronic Prescribing Version (Preprint)

2021 ◽  
Author(s):  
Deborah Surescripts
Keyword(s):  
No Value ◽  
Negative Impact ◽  
Original Study ◽  
Electronic Prescribing ◽  
Free Text ◽  
Error Risk ◽  
Incorrect Information ◽  
Electronic Prescriptions ◽  
Population Rate

BACKGROUND The free-text note field of the NCPDP SCRIPT schema allows prescribers to communicate information which the schema does not otherwise accommodate. Including inappropriate (could be sent in a dedicated field) or unnecessary (provides no value to the prescription) notes has a negative impact on patient care, ranging from wasted clinician time to introducing error risk by including conflicting, or incorrect information. OBJECTIVE The research team hypothesized that appropriate usage of the notes field would improve using NCPDP SCRIPT version 2017071 (V2017071) in comparison to NCPDP SCRIPT version 10.6 (V10.6). METHODS As a follow up to the study “Analysis of Prescribers’ Notes in Electronic Prescriptions in Ambulatory Practice”, a qualitative analysis was performed on 5 000 randomly selected prescriptions for which the note field was populated. Notes were classified as appropriate, inappropriate, or unnecessary and then sub-categorized based on content. The team performed three analyses: 1) Comparing the original study to current results 2) Comparing current notes in V10.6 to V2017071, and 3) An updated evaluation of V2017071 notes with reclassified sub-categories. RESULTS No difference was found in the rate of inappropriate and unnecessary notes from the original study (71.45%) to the present-day sample (71.64%), nor when comparing current V10.6 (71.28%) to current V2017071 (72.00%). A 3.23% lower note population rate for V2017071 did reduce the normalized rate of inappropriate and unnecessary notes when comparing V10.6 (11.62%) to V2017071 (9.41%). Lastly, when reclassifying V2017071 sub-categories, the rate of inappropriate and unnecessary notes increased to 89.24%. CONCLUSIONS For most prescriptions containing a note, the note is either inappropriate or unnecessary. This highlights a need to develop e-prescribing and pharmacy software to better utilize available schema elements and influence users to reduce the overall note population rate.

scholarly journals Evaluating the implementation of RxNorm in ambulatory electronic prescriptions

2015 ◽  
Vol 23 (e1) ◽  
pp. e99-e107 ◽  
Author(s):  
Ajit A Dhavle ◽  
Stacy Ward-Charlerie ◽  
Michael T Rupp ◽  
John Kilbourne ◽  
Vishal P Amin ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Electronic Prescribing ◽  
Free Text ◽  
National Library ◽  
Unique Identifier ◽  
Software Applications ◽  
National Drug ◽  
Electronic Prescriptions ◽  
Term Type ◽  
Pharmacy Chain

Abstract Objective RxNorm is a standardized drug nomenclature maintained by the National Library of Medicine that has been recommended as an alternative to the National Drug Code (NDC) terminology for use in electronic prescribing. The objective of this study was to evaluate the implementation of RxNorm in ambulatory care electronic prescriptions (e-prescriptions). Methods We analyzed a random sample of 49 997 e-prescriptions that were received by 7391 locations of a national retail pharmacy chain during a single day in April 2014. The e-prescriptions in the sample were generated by 37 801 ambulatory care prescribers using 519 different e-prescribing software applications. Results We found that 97.9% of e-prescriptions in the study sample could be accurately represented by an RxNorm identifier. However, RxNorm identifiers were actually used as drug identifiers in only 16 433 (33.0%) e-prescriptions. Another 431 (2.5%) e-prescriptions that used RxNorm identifiers had a discrepancy in the corresponding Drug Database Code qualifier field or did not have a qualifier (Term Type) at all. In 10 e-prescriptions (0.06%), the free-text drug description and the RxNorm concept unique identifier pointed to completely different drug concepts, and in 7 e-prescriptions (0.04%), the NDC and RxNorm drug identifiers pointed to completely different drug concepts. Discussion The National Library of Medicine continues to enhance the RxNorm terminology and expand its scope. This study illustrates the need for technology vendors to improve their implementation of RxNorm; doing so will accelerate the adoption of RxNorm as the preferred alternative to using the NDC terminology in e-prescribing.

scholarly journals ‘I Sat Filling in This Form While Smoking and It Was Divine’. An Analysis of Free-Text Comments from Smokers Who Report They Have No Intention of Quitting in the Next Six Months

2014 ◽  
Vol 11 (4) ◽  
pp. 219-228 ◽  
Author(s):  
M. Sweeney-Magee ◽  
D. Kale ◽  
A. Hamill ◽  
H. Gilbert
Keyword(s):  
Smoking Cessation ◽  
Negative Impact ◽  
Controlled Trial ◽  
Health Behaviours ◽  
Smoking Behaviour ◽  
Future Research ◽  
Free Text ◽  
Positive Health ◽  
Quit Attempts

Introduction: Smokers unmotivated to quit are neglected by smoking cessation research. Free-text comment analysis is a potentially useful way to gain insight into this group's beliefs.Aims: To analyse the free-text comments provided by smokers unmotivated to quit as part of a randomized controlled trial of computer-tailored feedback for smoking cessation.Method: A random sample of 58,660 smokers were sent a smoking behaviour questionnaire (SBQ). The responses and follow-up outcomes of those providing free-text comments were compared to those who did not to assess the representativeness of the former group of smokers. The comments of participants unmotivated to quit (631) were thematically analysed.Results: Those who provided a comment differed from those who did not on variables including education level and quit attempts at six-month follow-up. Emergent themes included; justification of smoking and restricting smoking instead of quitting.Conclusions: The findings illustrate the value of free-text comments in identifying issues important to respondents. The identified themes highlight areas for future research in smokers unmotivated to quit including cutting down as a path to quitting and explicit messages regarding the inability of positive health behaviours to balance out the negative impact of smoking on health.Trial registration: Current Controlled Trials ISRCTN05385712.

scholarly journals Communication failure: analysis of prescribers’ use of an internal free-text field on electronic prescriptions

2018 ◽  
Vol 25 (6) ◽  
pp. 709-714 ◽  
Author(s):  
Angela Ai ◽  
Adrian Wong ◽  
Mary Amato ◽  
Adam Wright
Keyword(s):  
Safety Concern ◽  
Medical Center ◽  
Academic Medical Center ◽  
Electronic Prescribing ◽  
Free Text ◽  
Potential Harm ◽  
Administrative Personnel ◽  
Academic Medical ◽  
Record Data ◽  
Electronic Prescriptions

Abstract Importance Electronic prescribing promises to improve the safety and clarity of prescriptions. However, it also can introduce miscommunication between prescribers and pharmacists. There are situations where information that is meant to be sent to pharmacists is not sent to them, which has the potential for dangerous errors. Objective To examine how frequently prescribers or administrative personnel put information intended for pharmacists in a field not sent to pharmacists, classify the type of information included, and assess the potential harm associated with these missed messages. Design, Setting, Participants Medication record data from our legacy electronic health record were requested for ambulatory care patients seen at an academic medical center from January 1, 2000, to May 31, 2015 (20 123 881 records). From this database, 6 060 272 medication orders met our inclusion criteria. We analyzed a random sample of 10 000 medication orders with internal comments. Main Outcomes and Measures Reviewers classified internal comments for intent. Comments intended for pharmacists were also sorted into descriptive categories and analyzed for the potential for patient harm. Results We found that 11.7% of the prescriptions in our sample contained comments that were intended to be sent to pharmacists. Many comments contained information about the dose, route, or duration of the prescription (38.0%). Approximately a third of the comments intended for pharmacists contained information that had the potential for significant or severe harm if not communicated. Conclusion We found undelivered comments that were clearly intended for pharmacists and contained important information for either pharmacists or patients. This poses a legitimate safety concern, as a portion of comments contained information that could have prevented severe or significant harm.

scholarly journals P005 Rheumatology virtual clinics during COVID-19: are our patients satisfied?

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Fajer A Altamimi ◽  
Una Martin
Keyword(s):  
Medical Information ◽  
Worker Safety ◽  
University Hospital ◽  
Free Text ◽  
Risk Of Infection ◽  
Further Training ◽  
Return Envelope ◽  
The Right ◽  
Reduced Risk

Abstract Background/Aims  Telemedicine can be broadly defined as the use of telecommunication technologies to provide medical information and services. It can be audio, visual, or text. Its use has increased dramatically during the COVID-19 pandemic to ensure patient and healthcare worker safety. Any healthcare professional can engage with it. It carries benefits like reduced stress and expense of traveling, maintenance of social distancing, and reduced risk of infection. There are some potential drawbacks such as lack of physical examination, liability and technological issues. Methods  A questionnaire was sent to 200 patients, selected from different virtual clinics (new and review, doctor and ANP led) run between March and May 2020 in the rheumatology department of University Hospital Waterford. We formulated 14 questions to cover the following aspects: demography, the purpose of the consult, punctuality, feedback, medico-legal concerns, and free text for comments. A self-addressed return envelope was included. Results  83 responses were received. 2 were excluded. The ratio of females to male respondents was 59: 41, with the majority over 60 years old. The main appointment type was review 67 (83%). 80% of patients were called either before or at the time of their scheduled appointment. The vast majority (98.8%) of our patients had confidence in our data protection and trusted our system to maintain their confidentiality. 95% stated that they felt comfortable, were given enough time to explain their health problem and felt free from stress. The respondents who preferred attending the clinic in person (17 in total) compared to the virtual were mostly follow up patients- 12 vs. 5 new. Conclusion  Patient satisfaction among those surveyed was high, despite having to introduce the service abruptly during the COVID-19 pandemic. There are many improvements we can adopt to improve our service and even maintain after the pandemic as a way of communicating with our stable patients. As we are covering a large geographical catchment, we can continue to implement the virtual clinic for some appointments. We should prioritize our efforts on identifying the right patient and the type of service we can offer, further training of staff, and increasing awareness of the patients as to how to get the most out of a virtual appointment. Disclosure  F.A. Altamimi: None. U. Martin: None. C. Sheehy: None.

scholarly journals 764 Human Factors in Operative Theatres During the Covid-19 Pandemic: A Cross-sectional Analysis of Operating Theatre Staff Experiences in a Regional Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L E Murchison ◽  
R Anbarasan ◽  
A Mathur ◽  
M Kulkarni
Keyword(s):  
Human Factors ◽  
Online Survey ◽  
Situational Awareness ◽  
Negative Impact ◽  
High Stress ◽  
Operating Theatre ◽  
Free Text ◽  
Cross Sectional ◽  
Chi Squared ◽  
Theatre Staff

Abstract Introduction In the already high-risk, high-stress environment of the operating theatre, operating during Covid-19 has brought its own unique challenges. Communication, teamwork and anxiety related new operating practices secondary to Covid-19 are hypothesised to have a negative impact on patient care. Method We conducted a single-centre online survey of operating theatre staff from 22nd June–6th July 2020. Respondents completed 18 human factors questions related to COVID-19 precautions including communication, teamwork, situational awareness, decision making, stress, fatigue, work environment and organisational culture. Questions consisted of yes/no responses, multiple choice and Likert items. Kruskall-Wallis tests, Chi-Squared, Mann Whitney U tests, Spearman’s correlation coefficient, lambda and Cramer’s V tests were used. Free-text responses were also reviewed. Results 116 theatre staff responded. Visual (90.5%), hearing/ understanding (96.6%) difficulties, feeling faint/lightheaded (66.4%) and stress (47.8%) were reported. Decreased situational awareness was reported by 71.5% and correlated with visors (r = 0.27 and p = 0.03) and FFP2/3 mask usage (r = 0.29 and p = 0.01). Reduced efficiency of theatre teams was reported by 75% of respondents and 21.5% felt patient safety was at greater risk due to Covid-19 precautions in theatre. Conclusions Organisational adjustments are required, and research focused on development of fit-for-purpose personal protective equipment (PPE).

scholarly journals Mental Health, Information and Being Connected: Qualitative Experiences of Social Media Use during the COVID-19 Pandemic from a Trans-National Sample

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 735
Author(s):  
Schoultz Mariyana ◽  
Leung Janni ◽  
Bonsaksen Tore ◽  
Ruffolo Mary ◽  
Thygesen Hilde ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Media ◽  
Health Information ◽  
Online Survey ◽  
Negative Impact ◽  
National Study ◽  
Free Text ◽  
Cross Sectional ◽  
Mental Health Information ◽  
The Uk

Background: Due to the COVID-19 pandemic and the strict national policies regarding social distancing behavior in Europe, America and Australia, people became reliant on social media as a means for gathering information and as a tool for staying connected to family, friends and work. This is the first trans-national study exploring the qualitative experiences and challenges of using social media while in lockdown or shelter-in-place during the current pandemic. Methods: This study was part of a wider cross-sectional online survey conducted in Norway, the UK, USA and Australia during April/May 2020. The manuscript reports on the qualitative free-text component of the study asking about the challenges of social media users during the COVID-19 pandemic in the UK, USA and Australia. A total of 1991 responses were included in the analysis. Thematic analysis was conducted independently by two researchers. Results: Three overarching themes identified were: Emotional/Mental Health, Information and Being Connected. Participants experienced that using social media during the pandemic amplified anxiety, depression, fear, panic, anger, frustration and loneliness. They felt that there was information overload and social media was full of misleading or polarized opinions which were difficult to switch off. Nonetheless, participants also thought that there was an urge for connection and learning, which was positive and stressful at the same time. Conclusion: Using social media while in a shelter-in-place or lockdown could have a negative impact on the emotional and mental health of some of the population. To support policy and practice in strengthening mental health care in the community, social media could be used to deliver practical advice on coping and stress management. Communication with the public should be strengthened by unambiguous and clear messages and clear communication pathways. We should be looking at alternative ways of staying connected.

scholarly journals Factor Structure of the Edinburgh Postnatal Depression Scale in a Sample of Postpartum Slovak Women

2021 ◽  
Vol 18 (12) ◽  
pp. 6298
Author(s):  
Zuzana Škodová ◽  
Ľubica Bánovčinová ◽  
Eva Urbanová ◽  
Marián Grendár ◽  
Martina Bašková
Keyword(s):  
Factor Structure ◽  
Postnatal Depression ◽  
Convergent Validity ◽  
Edinburgh Postnatal Depression Scale ◽  
Negative Impact ◽  
Depression Scale ◽  
Depression Symptoms ◽  
Three Dimensional Model

Background: Postpartum depression has a negative impact on quality of life. The aim of this study was to examine the factor structure and psychometric properties of the Slovak version of the Edinburgh Postnatal Depression Scale (EPDS). Methods: A paper and pencil version of the 10-item EPDS questionnaire was administered personally to 577 women at baseline during their stay in hospital on the second to fourth day postpartum (age, 30.6 ± 4.9 years; 73.5% vaginal births vs. 26.5% operative births; 59.4% primiparas). A total of 198 women participated in the online follow-up 6–8 weeks postpartum (questionnaire sent via e-mail). Results: The Slovak version of the EPDS had Cronbach’s coefficients of 0.84 and 0.88 at baseline (T1) and follow-up, respectively. The three-dimensional model of the scale offered good fit for both the baseline (χ2(df = 28) = 1339.38, p < 0.001; CFI = 0.99, RMSEA = 0.02, and TLI = 0.99) and follow-up (χ2(df = 45) = 908.06, p < 0.001, CFI = 0.93, RMSEA = 0.09, and TL = 0.90). A risk of major depression (EPDS score ≥ 13) was identified in 6.1% in T1 and 11.6% in the follow-up. Elevated levels of depression symptoms (EPDS score ≥ 10) were identified in 16.7% and 22.7% of the respondents at baseline and follow-up, respectively. Conclusions: The Slovak translation of the EPDS showed good consistency, convergent validity, and model characteristics. The routine use of EPDS can contribute to improving the quality of postnatal health care.

scholarly journals Transvaginal Hybrid-NOTES procedures—do they have a negative impact on pregnancy and delivery?

2021 ◽  
Author(s):  
Panagiotis Thomaidis ◽  
Niklas J. Weltermann ◽  
Claudia S. Seefeldt ◽  
Dana C. Richards ◽  
Axel Sauerwald ◽  
...  
Keyword(s):  
Negative Impact ◽  
Male Partner ◽  
Current Data ◽  
Reproductive Age ◽  
Negative Effects ◽  
Desire For Children ◽  
Pregnancy And Delivery ◽  
Hybrid Notes ◽  
Type Of Delivery

Abstract Purpose We conducted a retrospective observational study in order to identify negative effects of NOTES procedures (Natural Orifice Transluminal Endoscopic Surgery) with transvaginal specimen removal on pregnancy and delivery. Methods From the total population of 299 patients in our NOTES registry, we tried to contact the 121 patients who were of reproductive age (≤ 45 years) at the time of a transvaginal NOTES procedure. They were interviewed by telephone regarding their desire for children, post NOTES-operation pregnancies, and type of delivery using a structured questionnaire. The collected data was analyzed and compared with current data. Results We were able to contact 76 patients (follow-up rate: 62.8%) with a median follow-up of 77 months after surgery (33–129 months). Twenty of 74 participating patients had a desire for children (27.0%). One of them and another's male partner were diagnosed as infertile. Regarding the remaining 18 patients, 14 became pregnant, and three of them became pregnant twice. Considering these 17 pregnancies, there was one miscarriage (5.9%) and one twin birth (5.9%). On average, childbirth occurred 44 months after the NOTES procedure. With regard to the type of delivery, 10 vaginal births (58.8%) and 7 caesarean sections (41.2%) occurred. Thus, the rate of fulfilled desire for children was 77.8%. Compared with the literature, no difference to the normal course could be detected. Conclusion There is no sign that the transvaginal approach in Hybrid-NOTES, with removal of the specimen through the vagina, has a negative effect on conception, the course during pregnancy, or the type of delivery.

scholarly journals The Perceived Impact of The First UK Covid-19 Lockdown on Companion Animal Welfare and Behaviour: A Mixed-Method Study of Associations with Owner Mental Health

2021 ◽  
Vol 18 (11) ◽  
pp. 6171
Author(s):  
Emily Shoesmith ◽  
Luciana Santos de Assis ◽  
Lion Shahab ◽  
Elena Ratschen ◽  
Paul Toner ◽  
...  
Keyword(s):  
Mental Health ◽  
Animal Welfare ◽  
Online Survey ◽  
Negative Impact ◽  
Companion Animals ◽  
Principal Component ◽  
Companion Animal ◽  
Free Text ◽  
Cross Sectional ◽  
Human Animal

Background: Companion animals may be a positive presence for their owners during the Covid-19 pandemic. However, the welfare of a companion animal is strongly influenced by the behaviour of their owners, as well as their physical and social environment. We aimed to investigate the reported changes in companion animal welfare and behaviour and to examine the association between these changes and companion animal owners’ mental health. Methods: A cross-sectional online survey of UK residents over 18 years of age was conducted between April and June 2020 (n = 5926). The questionnaire included validated, bespoke items measuring outcomes related to mental health, human-animal bonds and reported changes in animal welfare and behaviour. The final item of the survey invited open-ended free-text responses, allowing participants to describe experiences associated with human-animal relationships during the first UK lockdown phase. Results: Animal owners made up 89.8% of the sample (n = 5323), of whom 67.3% reported changes in their animal’s welfare and behaviour during the first lockdown phase (n = 3583). These reported changes were reduced to a positive (0–7) and negative (0–5) welfare scale, following principal component analysis (PCA) of 17 items. Participants reported more positive changes for cats, whereas more negative changes were reported for dogs. Thematic analysis identified three main themes relating to the positive and negative impact on companion animals of the Covid-19 pandemic. Generalised linear models indicated that companion animal owners with poorer mental health scores pre-lockdown reported fewer negative changes in animal welfare and behaviour. However, companion animal owners with poorer mental health scores since lockdown reported more changes, both positive and negative, in animal welfare and behaviour. Conclusion: Our findings extend previous insights into perceived welfare and behaviour changes on a very limited range of species to a wider a range of companion animals. Owner mental health status has a clear, albeit small, effect on companion animal welfare and behaviour.

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