Evaluating Incorporation of Drug Restrictions into Computerized Drug Order Entries after Transition to an Electronic Health Record

Abstract

Background: Incorporation of drug restriction policy into electronic drug order entries (DOEs) can promote responsible medication use and resource utilization when implemented systematically. Objective: To identify drugs that require further incorporation of formulary restriction policy into their DOEs after migration to an electronic health record with computerized prescriber order entry (CPOE). Methods: After transition to CPOE, test orders for formulary restricted drugs were entered in the CPOE environment. Data were collected about rationale for drug restriction, type of formulary restriction, presence of incorporation of restriction policy into the DOE, and whether incorporation was consistent with a recommended method. Restricted drugs requiring revision of policy incorporation into their DOEs were analyzed to create a prioritized task list based on rationale for the restriction. Results: Of all restricted drugs, 63.6% (287/451) did not have restriction policy incorporated into their DOEs consistent with the recommended method and therefore required revision. Eighteen percent (81/451) of restricted drugs had no incorporation of restriction policy in their DOEs. Safety was the rationale for restriction in 21% (17/81) of these, which received highest priority for revision. When drugs were orderable but restricted, 61.9% (78/126) lacked optimal incorporation of policy in DOEs to promote adherence. When drugs were not orderable, 64% (206/322) did not provide guidance to formulary alternatives in DOEs when they should have. Conclusion: After transition to CPOE, almost two-thirds of all analyzed restricted drugs lacked optimal incorporation of formulary restriction policies in their DOEs. DOEs with restrictions related to safety reasons were among those most frequently requiring revision. Some DOEs can better promote adherence and provide guidance to prescribers through revision. Predefined, systematic implementation strategies should be used during changes in computerized drug use processes.

Policy parameters for optimising hospital ePrescribing: An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development

“…One paper was a comparison of policy between the UK and the US, 33 while most of the articles ( n = 9) were from the US. 28 , 30 – 32 , 34 – 38 The other article was from the UK. 29 Overall, therefore, we are able to provide information on policies related to optimisation only in the UK, mainland Europe and the US.…”

“…In a number of the research articles from our initial literature search we encountered policy being used to target particular problems, or aspects of the ePrescribing process, for example, medicines reconciliation or the use of smart pumps. 30 , 38 We were interested in learning how policy interventions aimed at optimising ePrescribing both rested upon and encouraged existing digitally maturity in the hospital setting. We considered how eHealth policy has been employed to address problems or push forward improvements to ePrescribing at a national level.…”

Development of a quality assessment tool for pharmacy and therapeutics committees and subsequent pilot testing

“…1. Publication type: practice guideline (seven points), literature review, 6 survey, 4 research article, 3 decision-making tool 2 and overview or summary. 1 2.…”

“…[1][2][3] The PTC should also provide guidance on subprocesses of the medication use process; for example, generic substitution and therapeutic interchange guidelines, or strategies integrating computerised physician order entry systems combined with clinical decision support systems. [4][5][6][7] Assessment tools allow hospitals to determine the implementation level and quality of activities. For example, the Swiss Society of Public Health Administration and Hospital Pharmacists (GSASA) has developed the quality management standards for hospital pharmacies (QRHP).…”

“…For example, the Swiss Society of Public Health Administration and Hospital Pharmacists (GSASA) has developed the quality management standards for hospital pharmacies (QRHP). [4][5][6][7][8] Numerous surveys related to PTCs and formulary systems exist and some have developed tools to improve PTC decision-making. However, no validated tool is available to comprehensively assess PTCs' operating qualities.…”