Objective
Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic’s electronic health record (EHR) to the outpatient pharmacy’s software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.
Materials and Methods
CancelRx was implemented in October 2017 at an academic health system. For 12 months prior, and 12 months after CancelRx implementation, data were collected on discontinued medications in the health system’s EHR and whether those prescriptions were successfully discontinued in the pharmacy’s dispensing software. An interrupted time series analysis was conducted to model the occurrence of prescriptions successfully discontinued over time.
Results
There was an immediate (lag = 0), significant (P < 0.001), and sustained (post-implementation slope 0.02) increase in the proportion of successful medication discontinuations after CancelRx implementation (from 34% to 93%). CancelRx had variable impact based on whether the clinic was primary care (71.4% change prepost) or specialty care (53.9% change prepost). CancelRx reduced the time between when a medication was discontinued in the clinic EHR and pharmacy dispensing software.
Conclusion
CancelRx automated a manual process and illustrated the role for health IT in communicating medication discontinuations between clinics and pharmacies. Overall, CancelRx had a marked benefit on medication list discrepancies and illustrated how health IT can be used across different settings to improve patient care.
Objective. To explore first-year student pharmacist perspectives on the influence of individual, educational system, and health care system factors on their wellbeing during pharmacy school. Methods. As part of a required course, first-year student pharmacists were required to submit reflective essays detailing the factors that most significantly contributed to their wellbeing since starting pharmacy school. Reflections from students who consented to participate during the study period from February 2019 to July 2019 were included for analysis. Qualitative thematic analysis was performed using open and axial coding, hierarchical categorization, and representative theme determination through a process of iterative review and deliberation. Coders developed a codebook with operational definitions for each emergent code. Coders met biweekly with lead researchers to ensure consistency and reliability of data analysis and to address minor discrepancies in coding. All team members discussed and revised themes until consensus regarding final representative themes was achieved. Results. Forty-nine students (36.8% of the first-year class) submitted reflective essays for analysis. Five themes emerged for the factors most influential on student pharmacist wellbeing: workload; learning environment culture and values; meaningful pharmacy school experiences; relationships; and personal factors. Student pharmacists did not consistently identify health care system factors as influencing their wellbeing. Conclusion. Student pharmacists identified both education system and individual factors as influencing their wellbeing. Education systems should prioritize implementation of systematic strategies that address curricular and learning climate factors, maximize student engagement in meaningful experiences, optimize social connectedness, and provide individual student support.
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