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Goud, Anil, Elizabeth Kiefer, Michelle S. Keller, Lyna Truong, Spencer SooHoo, and Richard V. Riggs. "Calculating maximum morphine equivalent daily dose from prescription directions for use in the electronic health record: a case report." JAMIA Open 2, no. 3 (May 27, 2019): 296–300. http://dx.doi.org/10.1093/jamiaopen/ooz018.
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Abstract To demonstrate a process of calculating the maximum potential morphine milligram equivalent daily dose (MEDD) based on the prescription Sig for use in quality improvement initiatives. To calculate an opioid prescription’s maximum potential Sig-MEDD, we developed SQL code to determine a prescription’s maximum units/day using discrete field data and text-parsing in the prescription instructions. We validated the derived units/day calculation using 3000 Sigs, then compared the Sig-MEDD calculation against the Epic-MEDD calculator. Of the 101 782 outpatient opioid prescriptions ordered over 1 year, 80% used discrete-field Sigs, 7% used free-text Sigs, and 3% used both types. We determined units/day and calculated a Sig-MEDD for 98.3% of all the prescriptions, 99.99% of discrete-Sig prescriptions, and 81.5% of free-text-Sig prescriptions. Analyzing opioid prescription Sigs to determine a maximum potential Sig-MEDD provides greater insight into a patient’s risk for opioid exposure.
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Zerillo, Jessica A., Erin Santacroce, Mary Ann Zimmerman, Melissa Freeman, Teresa Lau Greenberg, Phuong Nguyen, Susan N. Chi, et al. "Building a new process: Nursing verification of pediatric oral chemotherapy." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 199. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.199.
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199 Background: While team-based safety checks ensure safe prescribing of parenteral chemotherapy, oral chemotherapy is usually prescribed by a single clinician. With the growing use of oral chemotherapy, processes are needed to protect these vulnerable patients from prescription errors. Methods: A team of nurses, clinicians, pharmacists and administrators developed a new process and checklist for nursing verification of oral chemotherapy prescriptions at Dana-Farber’s pediatric neuro-oncology program. Prescriptions are verified against the treatment plan by two pediatric oncology nurses. The verification checklist includes drug, dose with any modifications, height and weight, laboratory values and patient instructions. When available, the prescription bottle is also verified. Data was collected over a three-month pilot period. Results: From 6/18/15-9/16/15, 56 prescription verifications occurred. Verification rate of on-site retail pharmacy filled prescriptions was 47% (32/68 prescriptions). Median time for verification was 20 minutes (IQR 15, 40) per nurse. Nurses identified problems outside of prescription verification, including missing prior authorizations and unclear treatment plans. Medication bottles were not routinely available for verification. One identified near miss would have resulted in an 80% under-dose of everolimus. Conclusions: Prescription verification by nursing in a pediatric oncology clinic was feasible. While it was successful in identification of one medication error before it reached the patient, only 47% of prescriptions were verified. Since prescription bottles are usually obtained after a visit, verification of the actual bottles will require new workflows, such as additional clinic visits or uploading a picture via the patient portal. Involving the nurse in the review of oral chemotherapy not only identified a prescription error, but also highlighted issues within other aspects of patients’ care, including inconsistent documentation of the treatment plan. The inclusion of nursing in the review and management of oral chemotherapy has the potential to improve safety and outcomes for these patients.
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Bevan, Amanda, and Niesh Patel. "AN ELECTRONIC PRESCRIPTION ALERTING SYSTEM-IMPROVING THE DISCHARGE MEDICINES PROCESS." Archives of Disease in Childhood 101, no. 9 (August 17, 2016): e2.55-e2. http://dx.doi.org/10.1136/archdischild-2016-311535.59.
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BackgroundWhilst the prescribing of both in-patient and discharge medicines is electronic, there was no automatic notification to clinical pharmacists when a discharge prescription was ready to be screened. The notification required a member of medical or nursing staff to bleep their pharmacist informing them of a prescription's availability. This manual process led to a delay in pharmacist screening which impacted on discharge. Prescriptions designated for pre-packed or patient's own medicine use were not seen at all by a clinical pharmacist. The initial intention was to develop a text messaging service; however this was not possible due to significant cost implications and its inflexibility.AimTo decrease the time to clinical pharmacist screening for children's discharge prescriptions.MethodA clinical pharmacist prescription alerting system was designed and implemented. The hospital's eDischarge Summaries are created and stored in the Trust's EPR database. A database query is executed that examines documents that have been signed by a prescriber which contain drug orders. The query runs every 15 minutes, Monday to Friday from 0800–2000. The database query exports a HTML data extract which is then packaged and sent using Exchange.Email was preferred as users access hospital WiFi, only receiving notifications on those laptops or smartphones connected to the Trust's email application. The HTML is embedded within the email body. The email is sent to named individuals within a given distribution list. The function is scalable to support all areas using Trust eDischarge Summaries.The system was introduced in April 2015. Data from before (June 2014–January 2015) and after (June 2015) implementation was compared.ResultsPrior to the introduction of an electronic alerting system the average time from a prescriber signing a prescription to clinical pharmacist screening was 93 minutes. Three months after starting the new system this time has reduced to 62 minutes, a reduction of 31 minutes or 33%. During the same time period, the number of discharge prescriptions screened by pharmacists rose from 172 to 218, an increase in workload of 26%.It has been possible to intervene on prescriptions containing errors which the clinical pharmacists would not previously have screened.ConclusionThe use of an electronic messaging system has met its primary aim to decrease the time delay from signing to pharmacist screening it has also increased pharmacist efficiency as evidenced by the increased workload.One limitation of this system is that it requires a regular e-mail check, for available prescriptions. The report runs every 15 minutes, an email is only sent if a prescription is found.The notification of all discharge prescriptions containing medicines has led to the identification of errors which have required intervention, in those prescriptions that a pharmacist would not have previously seen. These interventions have been for children who have received pre-packed antibiotics directly from the wards or for those where we have provided one-stop dispensing.It is hoped to role out this system across other areas of the organisation which should also enjoy this significant improvement in discharge prescription turnaround.
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Sachedina, Ayaaz Kazmir, Sonia Mota, Julie Lorenzin, Marlene Allegretti, Maureen Leyser, Alan Gob, and Robert McKelvie. "Effect of a formalised discharge process which includes electronic delivery of prescriptions to pharmacies on the incidence of delayed prescription retrieval." BMJ Open Quality 9, no. 2 (May 2020): e000849. http://dx.doi.org/10.1136/bmjoq-2019-000849.
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BackgroundLack of prescription adherence after discharge from the inpatient hospital setting is a barrier to the delivery of optimal patient care. Non-adherence to medication for cardiac diseases can lead to substantial morbidity, mortality and healthcare costs. Electronic delivery of prescriptions by fax is a potential method of improving patient satisfaction and reducing pharmacy wait times.MethodsThis study was completed in the cardiology inpatient wards at a hospital in London, Ontario, Canada. ‘Delayed prescription retrieval’ was defined as the retrieval of a prescribed medication by a patient from their local pharmacy after the documented calendar day of discharge. The current discharge process on the cardiology wards was assessed and an initial monitoring period of study participants was completed to determine the baseline delayed prescription retrieval rate (preintervention group). A formalised discharge process, which included electronic delivery of prescriptions to pharmacies by fax, was implemented for study participants (postintervention group). The rate of delayed prescription retrieval was assessed in both groups.Results15 of 42 patients (35.7%) in the preintervention group and 9 of 72 (14.3%) in the postintervention group had delayed prescription retrieval suggesting relative and absolute risk reductions of 65% and 23.2% (p=0.0045). Of the participants with delayed prescription retrieval, 100% in the preintervention group and 77.8% in the postintervention group were due a new prescribed medication on the day of discharge.ConclusionsPatients who experienced a formalised discharge process, which included electronic delivery of prescriptions by fax, at the time of discharge from cardiac inpatient care had a lower rate of delayed prescription retrieval. Future studies are required to examine the impact of formal discharge processes on patient morbidity and mortality.
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Santoyo-Fexas, L., R. A. Uriarte Botello, B. R. Vázquez Fuentes, C. V. Solis, C. M. Skinner Taylor, I. D. J. Hernandez-Galarza, M. Eguia Bernal, and D. Á. Galarza-Delgado. "AB1292-HPR NUMBER OF DRUGS IN THE PRESCRIPTION, A PREDISPOSING FACTOR FOR MEDICATION ERRORS IN RHEUMATOLOGY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1936. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2940.
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Background:Medication error can be defined as a failure in the treatment process that leads to or has the potential to lead to harm to the patient, this fault can happen in two different phases: prescribing and prescription.Prescribing is the process of deciding what to prescribe and naming it. Various types of faults can occur in the decision-making process: underprescribing, overprescribing, irrational, inappropriate and ineffective prescribing. All these covers one type of errors, but these are different kind of errors that those that occur in the act of writing a prescription. This leads to the distinct concepts of ‘prescribing faults’ and ‘prescription errors’A prescription is ‘a written order, which includes detailed instructions of what medicine should be given, to whom, in what formulation and dose, by what route, when, how frequently, and for how long’. Thus, a prescription error can be defined as ‘a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription’. The ‘normal features’ include the identity of the patient, the identity of the drug, the formulation and dose, and the route, timing, frequency, and duration of administration. (1)It is not record about the rate of medication errors in rheumatology consultation.Objectives:To evaluate whether there is a relationship between prescribing errors and the number of drugs in the prescription.Methods:A descriptive, observational, and retrospective study was made.It was carried out a random search of medical prescriptions, generated by the electronic records (REPAIR®) of the rheumatology consultation of the Hospital Universitario “Dr. José Eleuterio González” during 2019, in which the prescriptions that contained any error were identifiedT student test was performed to see the difference in the prescription error based on the number of medications. P <0.05 was taken as statistically significant.Results:A review of 867 medical prescriptions was performed, among which 5503 medications were indicated with an average of 6.34 medications per prescription, a total of 30 (6.9%) prescriptions were found with error, where a total of 71 (3.9%) medications had errors. In the prescriptions with medication error, all the errors were prescription type; 68 (95.7%) had a mistake in the duration of administration and 3 (4.22%) in the identity of the drug.In the prescriptions with medical errors the average number of prescription drugs was 7.50, only 2/30 (0.6%) had less than 7 indicated medications (4 and 6), meanwhile the prescriptions in which no error was found had a mean of 6.30 indicated medications. P < 0.001.Conclusion:According to the study findings, it could be established that when the number of prescribed medications is greater than 7, there is an increased risk of making a prescription error. Further studies should carry out to look for other factors that influence medical errors in rheumatology clinics.References:[1]Aronson JK. Medication errors: definitions and classification. Br J Clin Pharmacol. 2009;67(6):599-604.AcknowledgmentsDisclosure of Interests:None declared
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Al Badi, Khalid. "Discrete event simulation and pharmacy process re-engineering." International Journal of Health Care Quality Assurance 32, no. 2 (March 11, 2019): 398–411. http://dx.doi.org/10.1108/ijhcqa-05-2018-0105.
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Purpose The purpose of this paper is to describe a case study undertaken at Al Buraimi Hospital in Oman, which used computer simulation and the Delphi approach to improve efficiency by reducing prescription dispensing waiting times. Design/methodology/approach This study’s framework was based on a discrete event simulation (DES) to identify the as-is pharmacy process and to create a to-be (future situation) to achieve an improvement in pharmacy workflow and service quality. Owing to healthcare environment complexity, and to gain a deeper understanding about Al Buraimi Hospital pharmacy problems, a Delphi technique was also used. Findings Based on Delphi, and according to the expert panel suggestions, two alternative scenarios were proposed to improve Al Buraimi Hospital pharmacy efficiency: fast-track and direct-dispensing, which should help to reduce the prescription dispensing waiting time process by 7.3 and 9.8 min, respectively. Research limitations/implications The main limitation is the pharmacists’ shortage, which may affect the prescription dispensing process’s quality as insufficient manpower to check the prescriptions may increase the medication errors’ risk. Originality/value Based on this case study’s real-world data, findings can be used to improve public healthcare sector pharmacy efficiency. The DES can be used in healthcare services to describe and test actual and proposed situations.
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Sinanis, Naralys, Osama Abdelghany, Michael Strait, Catherine A. Lyons, and Kerin B. Adelson. "Development of a complex patient identification process for the CMS’ Oncology Care Model." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 32. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.32.
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32 Background: The CMS’ Oncology Care Model (OCM) provides practices with enhanced monthly payments for beneficiaries with cancer receiving chemotherapy. While the program will distribute a retrospective beneficiary list, practices need to track and identify eligible patients upfront to initiate care management and financial counseling processes and to bill for the enhanced payment. The eligibility criteria require information that many practices do not have. We describe a stepwise approach to patient identification that can be used by other OCM practices. Methods: We ran a report that identified patients with Medicare who received an OCM-eligible drug. We classified drugs into four categories: IV chemo confirmed by our own billing, oral specialty tracked and/or filled by our specialty pharmacy, general prescriptions filled at offsite pharmacies, and oral drugs billed under Medicare Part B. Because patients on general oral drugs receive 11 refills when first prescribed, we could not rely on a new prescription to trigger enrollment; we created a candidate list of patients who received oral prescriptions in the last year. Our pharmacists manually checked QS1, to verify Medicare Part D status and Surescripts to confirm that patients filled their prescription. Results: The build took time to validate due to disparate data and incomplete insurance information. 1039 IV chemo, 249 oral chemo, 196 oral Medicare Part B, were definitively eligible. 2991 with general prescriptions made the oral candidate list, which required additional verification of last visit date, Medicare Part D status, and prescription fill date. Approximately 70% of our patients have Medicare Part D and over 90% filled their prescription. We billed IV for July and August and are awaiting final confirmation of drug fill before billing the patients from the oral categories. Conclusions: The patient identification process was more complex than expected. Implementation required a multi-disciplinary effort with extensive collaboration across several departments as well as a time-intensive manual insurance and drug fill-verification process. Opportunities exist to automate Medicare Part D verification using our real-time eligibility software.
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Middleton, Peter, and Barry McCollum. "Management of process improvement by prescription." Journal of Systems and Software 57, no. 1 (April 2001): 9–19. http://dx.doi.org/10.1016/s0164-1212(00)00113-8.
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Chmielewski, Eric, and Joseph L. Cesarz. "A framework to increase prescription capture from health-system clinics." American Journal of Health-System Pharmacy 77, no. 8 (March 11, 2020): 658–62. http://dx.doi.org/10.1093/ajhp/zxaa023.
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Abstract Purpose To develop and implement an interprofessional framework to increase the capture of health system–generated prescriptions within health system–owned pharmacies. Summary Low prescription capture rates within a health system’s internal pharmacies led to an interdisciplinary process improvement effort. A framework was developed to assess the baseline prescription capture rate, select clinics for improvement, understand clinic workflows and key drivers of pharmacy selection, design strategies to increase prescription capture, implement targeted efforts, and measure the effectiveness of the intervention(s). Employing this framework provided revised workflows for nursing and medical assistant staff scripting and for referral of patients to internal pharmacies. These workflows were pilot tested at 3 system clinics. Results indicated that overall prescription capture increased by 2.9 to 4.1 percentage points (range, 10 to 86 prescriptions per month) and specialty prescription capture increased by 11.6 to 26.7 percentage points (range, 4 to 26 prescriptions per month) for each clinic within the first 2 months. A total of 99 new patients were referred to internal pharmacies within the first month. Conclusion Development and implementation of a framework to increase prescription capture from health system clinics helped increase capture, enhanced clinic engagement and knowledge about pharmacy services, and supported positive clinic-pharmacy relationships.
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Breaud, Alan H., Audrea H. Szabatura, Laura Cedro, Anna Shanedling, Hakim Lakhani, Caryn Caparrotta, Teresa Mazeika, et al. "Impact of early release of oral investigational prescriptions on safety and efficiency at a comprehensive cancer center." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 257. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.257.
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257 Background: At Dana-Farber Cancer Institute (DFCI), timing of order release to the pharmacy is a contributing factor to safety and processing concerns for oral investigational medications. Day-of release can lead to delayed delivery to the patient, creating a risk of missing timed specific protocol data collection, and rushed critical pharmacy safety checks, an issue raised in a comprehensive proactive systems safety risk assessment. We conducted a pilot project aimed at improving the safety and efficiency of oral investigational medication processing within the pharmacy by releasing prescription orders at least 24 hours in advance of a patient’s appointment. Methods: A team of pharmacists, nurses, process improvement professionals, and a physician designed a pilot project where the prescriber released oral investigational prescriptions, from 9 selected research protocols, at least 24 hours before a patient’s appointment. From 11/2/2018-3/1/2019, we used manual timestamp data to compare prescription processing times for prescriptions released at least 24 hours in advance (“released early”) to prescriptions released less than 24-hours in advance (“not released early”). Qualitative feedback was obtained to assess pilot impact on prescription processing safety. Results: As shown in the table below, prescription processing time on day of patient appointment for prescriptions released early was shorter, on average, compared to those not released early (p < 0.05). Due to orders being released early, pharmacy staff noted feeling less pressure during prescription checks and a better ability to proactively assess inventory and prescription issues. Conclusions: Releasing oral investigational prescriptions early reduced the prescription processing time and increased time available for safety checks. Expanding this workflow change to all investigational medication orders can increase the safety and efficiency of prescription processing at DFCI. [Table: see text]
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Phipps, Amy, Wendy Saegenschnitter, Lizzie Hutchison, Vanessa McLelland, Sam Whiting, and Heather Weerdenburg. "P023 Improving parenteral nutrition prescribing." Archives of Disease in Childhood 104, no. 7 (June 19, 2019): e2.27-e2. http://dx.doi.org/10.1136/archdischild-2019-nppc.33.
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BackgroundInpatient parenteral nutrition (PN) is historically administered by nurses against a fluid prescription with flow rates for aqueous and lipid phases. The prescription used to order PN from the aseptic unit is held with clinical pharmacists and not kept on the ward. On call doctors who are not familiar with the patient are asked to write the fluid prescription using an insert sheet accompanying the product. This process is fraught with delays and creates extra work for nurses and doctors. Nurses can’t plan the optimal time to start PN in relation to other patient care, PN often starts late and often coincides with the end of shift or handover. Setting up PN at busy times is recognised within the hospital as a potential contributor towards errors. An audit on the oncology/bone marrow transplant and haematology ward (Starlight) in 2016 showed that only 33% of fluid prescriptions for PN were written before 6pm. During 2016–2017 Starlight ward piloted a new prescribing system whereby nurses administered PN directly from the prescription used to order PN from the aseptic unit. An audit in early 2018 showed that PN was routinely set-up, checked and started by 1800hours, nurses were able to plan their time effectively and oncall doctors were only involved if patient condition warranted review. In March 2018 the pilot was replaced with similar redesigned process.AimTo eliminate the process of prescribing volumes and flow rates for PN on fluid prescriptions. To trial a new PN prescription process on one ward, refine and improve as necessary then adopt across the whole of the hospital.MethodsOn Starlight ward in March 2018 a new process for prescribing and administering PN was implemented. Nurses used the prescription for ordering PN from the aseptic unit plus the product insert to set-up, start and sign for administration. A new aseptic unit prescription was created, nursing training was provided and written guidance was issued for nurses on how to use perform set-up checks. PN prescriptions were kept on the ward. Stickers that highlighted the patient required PN were placed onto fluid prescriptions to prevent PN inadvertently not being administered.ResultsAll patients prescribed PN on Starlight ward received it as expected. As nurses had flexibility in PN set-up time once the product was on the ward, patient routine and preference (e.g. going out for day leave) was increasingly taken into account leading to PN often starting after 18 hours. One minor incident relating to stickers occurred which did not affect the patient. Nursing feedback was very positive. By eliminating transcribing, the process was perceived as safer. In July the trial was evaluated and one change was made to the prescription to allow clearer adjustment of PN rate/volume after the infusion began. The prescribing process was implemented on a surgical ward in August and will be rolled out across the rest of the hospital pending the outcome.ConclusionSimplifying the prescribing process meant PN was administered at a time that suited the patient and nurse. Nurse satisfaction was improved and avoiding transcription was perceived as safer. The process will be rolled out in stages to the rest of the hospital.
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Feng, Yan, Yu Qiu, Xuezhong Zhou, Yixin Wang, Hao Xu, and Baoyan Liu. "Optimizing Prescription of Chinese Herbal Medicine for Unstable Angina Based on Partially Observable Markov Decision Process." Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/532534.
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Objective. Initial optimized prescription of Chinese herb medicine for unstable angina (UA).Methods. Based on partially observable Markov decision process model (POMDP), we choose hospitalized patients of 3 syndrome elements, such asqideficiency, blood stasis, and turbid phlegm for the data mining, analysis, and objective evaluation of the diagnosis and treatment of UA at a deep level in order to optimize the prescription of Chinese herb medicine for UA.Results. The recommended treatment options of UA forqideficiency, blood stasis, and phlegm syndrome patients were as follows: Milkvetch Root + Tangshen + Indian Bread + Largehead Atractylodes Rhizome (ADR=0.96630); Danshen Root + Chinese Angelica + Safflower + Red Peony Root + Szechwan Lovage Rhizome Orange Fruit (ADR=0.76); Snakegourd Fruit + Longstamen Onion Bulb + Pinellia Tuber + Dried Tangerine peel + Largehead Atractylodes Rhizome + Platycodon Root (ADR=0.658568).Conclusion. This study initially optimized prescriptions for UA based on POMDP, which can be used as a reference for further development of UA prescription in Chinese herb medicine.
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U. S., Nuthan Kumar, Nalini G. K., Deepak P., Prema M., Geeta Rathod, and Mohith N. "Prescription audit of outpatients in tertiary care government hospital." International Journal of Basic & Clinical Pharmacology 7, no. 4 (March 23, 2018): 636. http://dx.doi.org/10.18203/2319-2003.ijbcp20181161.
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Background: Prescription audit is a tool as well as a technique by its application,all professionals will improve the quality of prescribing drugs. Standards of medical treatment can be assessed by prescription audit. It is based on documented evidences to support diagnosis, treatment and justified utilization of hospital facilities. Prescription audit is a quality improvement process that seeks to improve patient care. In this background the present study was conducted. The objectives of the study were to know the frequently prescribed drugs in OPD, number of the drugs used per prescription and to find out the rationality.Methods: Study was conducted at Sri Chamarajendra Hospital, HIMS, Hassan in OPD of General Medicine.1000 prescriptions were collected and noted down the frequently used medication, number of drugs prescribed and their type of formulations for the particular diagnosis.Results: From the study it is noted that 1910 drugs out of 1000 prescriptions were prescribed which is approximately 1.91 drugs per prescription about 55% of the prescriptions contained single drug. Very few received 4-5 drugs (7%). Almost all the drugs in prescriptions were in Generic names. Around 95% of prescriptions doses were mentioned in mg, ml etc. The most commonly prescribed drugs in order are Antibiotics, antidiabetics antihypertensives, bronchodilators, steroids antiemetics and ORS were prescribed.Conclusions: Polypharmacy was not found in our prescriptions which indicates our prescriptions improved the patient conditions. This type of study will ensure to know the ‘P’ drug development and select the essential medicine list for various levels of health care.
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Kranthi A, Priyanka G, Sravani G, and Linga Naik A. "Registration Process in Drugs Delivery Process." International Journal of Novel Trends in Pharmaceutical Sciences 8, no. 3 (June 28, 2018): 25–27. http://dx.doi.org/10.26452/ijntps.v8i3.1319.
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Prescription movement is the system or method of dealing with a pharmaceutical compound to obtain a beneficial impact on persons or animals. For the remedy of human afflictions, nasal and aspiratory publications of remedy transport are increasing extending hugeness. These publications supply promising options as a substitute than parenteral prescription transport, especially for peptide and protein therapeutics. Thus, a couple of drug motion structures have been organized and are being investigated for pneumonic and nasal transport. These fuse liposomes, proliposomes, microspheres, gels, prodrugs, cyclodextrins, amongst others. Nanoparticles made out of biodegradable polymers exhibit insistence in pleasurable the intense necessities set on these transport structures. For instance, potential to be stimulated into an airborne, unfaltering pleasant in opposition to powers made at some point of aerosolization, biocompatibility, centering of specific objections or mobile phone loads in the lung, look of the drug in a predestined way, and corruption inside a palatable time.
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Ho, Jackie, Carolyn E. Wrzesniewski, and Noelle K. Hasson. "Integrating patient-centric indications into the prescribing process: Experience at a tertiary academic medical center." American Journal of Health-System Pharmacy 77, Supplement_2 (May 19, 2020): S26—S33. http://dx.doi.org/10.1093/ajhp/zxaa065.
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Abstract Purpose To describe the development of and implementation of a patient-centric clinical indications library (CIL) into the prescribing process and determine the operational and humanistic outcomes (from prescriber, pharmacist, and patient perspectives) of including indications on outpatient prescription labels. Methods A descriptive retrospective data analysis was conducted. Multiple stakeholder groups were engaged to develop and integrate the CIL into the prescription package. After CIL integration, prescribers, pharmacists, and patients were surveyed. A focus group discussion consisting of Veterans and caregivers was held. Results Following implementation of the CIL, the proportion of prescriptions associated with an indication increased from 88% to 96%. Surveyed clinicians responded that indications helped them better understand a patient’s profile (61.1% of prescribers and 100% of pharmacists). Among surveyed pharmacists, 61.5% and 53.8%, respectively, believed that indications helped them catch instances of wrong medications and wrong doses ordered. Veterans surveyed found that indications on their prescription labels helped them know what their medications were for (91.0% of respondents) and why it is important to take their medications (70.7%). In focus group discussions, Veterans and family members and/or caregivers expressed a preference to see indications that describe how a medication works (eg, “to lower blood sugar” vs “for diabetes”) because they felt that type of phrasing is measurable, action oriented (which was appealing due to Veterans’ military background), provides surreptitious education, and tells the users what to expect. Conclusion Engaging multidisciplinary stakeholder groups, optimizing the electronic health record system, and authorizing pharmacists to add known indications to prescriptions increased the number of prescriptions with indications, decreased the perceived time spent on order entry and verification, and enabled better understanding of each medication’s purpose by providers and patients.
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ZHOU, YONG. "GAUGE DEPENDENCE OF FERMION MASS RENORMALIZATION PRESCRIPTIONS." Modern Physics Letters A 24, no. 04 (February 10, 2009): 291–304. http://dx.doi.org/10.1142/s0217732309026930.
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We discuss the gauge dependence of fermion mass definition under the on-shell and pole mass renormalization prescriptions. By the two-loop-level calculation of the cross section of the physical process [Formula: see text], we prove for the first time that the on-shell fermion mass renormalization prescription makes physical result gauge-dependent. On the other hand, such gauge dependence does not appear in the result of the pole mass renormalization prescription. Our calculation also implies that the difference of physical results between the two mass renormalization prescriptions cannot be neglected at two-loop level.
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Siu, Emily, Kalaimaran Sadasivam, and Nanna Christiansen. "CREATING AND AUDITING A NEW ELECTRONIC CONTINUOUS INFUSION PRESCRIPTION CHART FOR A PAEDIATRIC CRITICAL CARE UNIT." Archives of Disease in Childhood 101, no. 9 (August 17, 2016): e2.23-e2. http://dx.doi.org/10.1136/archdischild-2016-311535.3.
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IntroductionPrescription errors, including continuous infusion prescriptions are one major source of concern in the paediatric population. Evidence suggests that use of an electronic or web-based calculator could minimise these errors. In our paediatric critical care unit (PCCU) we have created an electronic continuous infusion prescription chart to target errors in this area and conducted an audit to assess its effect on error reduction.AimTo create an electronic continuous infusion prescription chart and audit its effect on prescription errors.MethodSimilar electronic continuous infusion prescription charts were evaluated. A Choice of electronic formats were considered and excel was chosen for its simplicity and flexibility. The choice of medications to be included, dilution method, and dosage range was agreed between PCCU consultant, pharmacy and nursing staff. Formulas for calculating each medication infusion was created and validated for different age and weight ranges by at least 2 PCCU trained pharmacists, accounting for capping at certain age and weight bands as appropriate for the medication. These were programmed into the spreadsheet for automatic calculation using inputted age and weight for the selected medications. Continuous infusion prescriptions were audited 6 months before and after implementation in April 2015 of this electronic chart. Parameters audited include medication dose, infusion rate, concentration, route, legibility, and missing or incorrect patient details. A trial period of 4 weeks preceded implementation.ResultsThe electronic continuous infusion prescription form was created and used on PCCU. Hand written prescriptions had higher error rate (30.7%) as compared to electronic charts (0.7%) with a p-value <0.002. No errors were found in electronic prescriptions in regards to dose, volume and rate calculation.Discussion and conclusionThe use of an electronic continuous infusion prescription chart has been successfully set up and used on PCCU. Its use has significantly reduced continuous infusion prescription error rates. The one error on electronic prescription charts was due to incorrect data input.Whilst similar formats exist for transferring patients between intensive care units in the UK, this differs by its use on inpatients. As a new project, various learning points were gained during the process. Some discrepancies in the formulas were identified during the validation process and trial period and the flexibility to change these quickly was paramount. The need to standardise prescribing habits and administration preferences was also important before proceeding to the formulation stage. Security and version control was another factor to consider ensuring restricted use of the most updated version.Major advantages of this prescription chart include ease of set up and low cost compared to established commercial programs. Another was the ability to quickly adapt information to the changing needs of the unit or updated dosage recommendations.In summary, the use of the electronic continuous infusion prescription chart has significantly reduced prescription error rates on PCCU. It has also allowed more efficient use of medical and pharmacy time resources.
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Kroth, Elmar. "Switch – The German process for moving medicines from prescription to non-prescription status." Gesundheitsökonomie & Qualitätsmanagement 23, no. 02 (July 20, 2017): 97–102. http://dx.doi.org/10.1055/s-0043-115561.
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Abstract Background Germany has a long tradition of switch and has long been considered one of the most liberal countries in terms of the release of modern active substances from prescription, the so-called switch. In the period 2000–2016, a total of more than 30 active ingredients – partly in different dosage strengths, dosage forms or indications – were released from prescription status in Germany. Of these, almost half can be described as “innovative” switches. Recently a significant decline of filed switch proposals can be noted, with only a few being successful. Methods Reflecting that the German switch procedure is barely mentioned in the literature it is the aim of this article to describe the German approach. The legal framework in the national and European Legislation are assessed as well as the experience of the author and his predecessor over more than 35 years of membership in the German Switch Committee were described. Results Although the German switch procedure is based on European legislation a successful switch application demands insights in the national particularities. The process is complex and partly intransparent. After a phase of restraint there are positive developments recently particularly the possibility for a scientific advice in pre-submission meetings.
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Kumar, Vinod, Minakshi Dhar, Shailendra Handu, Vikas Kumar, and Puneet Dhamija. "Study of the effect of pharmacotherapeutic audit meetings on prescription writing in a tertiary care center-an interventional study." International Journal of Advances in Medicine 8, no. 1 (December 22, 2020): 113. http://dx.doi.org/10.18203/2349-3933.ijam20205482.
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Background: Rational drug prescription is a practice when an appropriate drug with correct dosage, formulation, frequency and duration is prescribed. Prescription audit with the help of regular Pharmaco-therapeutic audit meetings (PTAM) is a continuous cycle, involving observing practice, setting standards, comparing practice with standards, implementing changes and observing new practice. World health organization (WHO) and international network for rational use of drugs (INRUD) jointly provided a few prescription and drug use indicators to guide rational prescription writing practice. Aim of the study was to assess the effect of pharmaco-therapeutic audit meetings on prescription writing and its rationality.Methods: This was a single center cross-sectional, prospective study conducted over a period of 14 months (December 2018-February 2020). Prescriptions from outpatient departments of general medicine, pulmonary medicine, physical medicine and rehabilitation (PMR), community and family medicine (CFM), pediatrics and psychiatry were collected. All the collected prescriptions were screened for rationality using WHO/INRUD core indicators and the index of rational drug prescribing was calculated. Prescriptions beyond acceptable limit were discussed in PTAM and same process was repeated over next 2 months to assess change in prescribing patterns after PTAM. Chi-square and student’s t-test was used for statistical analysis.Results: Statistically significant change in proportions for antibiotic prescribing was 3.4% [95% CI (-1.7%-9.4%), p=0.20] and prescriptions with generic name drugs was 10.5% [95% CI (6.1-14.6%) p<0.0001 was seen while no significant change was seen in injectable preparation use 0.6% [95% CI (-0.6%-1.5%); p=0.26)] and prescriptions from essential drug list (EDL) 0.5% [95% CI (-4.2%-5.4%) p=0.83].Conclusions: Our study showed that PTAM is an effective way to improve rationality of prescriptions and must be done regularly for improving prescribing practices.
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Wilson, Debbie L. "Preventing Prescription Drug Abuse: A Pharmacy Technician Tool Kit." Journal of Pharmacy Technology 36, no. 5 (July 4, 2020): 218–19. http://dx.doi.org/10.1177/8755122520939639.
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The misuse of prescription medications in the United States is a worsening public health problem. Pharmacy technicians are often the first pharmacy staff member to receive newly dropped off prescriptions and to interact with patients in the pharmacy. Having a tool kit of the knowledge and skills needed to distinguish prescriptions that may result in misuse from the legitimate ones and to respond appropriately and professionally to each is essential to pharmacy technicians performing their role and function in the dispensing process.
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Lehocká, Ľ., M. Fulmeková, and L. Masaryková. "Analysis of prescription and consumption of medicines in children and adolescents." Acta Facultatis Pharmaceuticae Universitatis Comenianae 59, Supplement-VI (January 1, 2012): 44–51. http://dx.doi.org/10.2478/v10219-012-0004-x.
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Analysis of prescription and consumption of medicines in children and adolescentsIn our study we analysed the prescription and consumption of medicines in children and adolescents. A total of 5200 medical prescriptions realized by a community pharmacy were evaluated. By selection of medical prescriptions prescribed to patients in the age group of up to 18 years of age a study group of 233 prescriptions was made. The group was identified by age and sex of the patients. In the group of prescriptions we analysed the incidence of individual diagnoses and consumption of medicines from different points of view, according to age, sex and rate of individual diagnoses according to the ATC system. Based on our analysis it was concluded, that the most frequent diseases affecting children and adolescents are diseases of the respiratory system, diseases of the ear and mastoid process, digestive system and skin diseases. With the exception of diseases of the skin and subcutaneous tissue, the incidence of all diseases is quite similar in both sexes. In the present, the consumption of prescription medicines used by children and adolescents is still very high mainly in the age group from 7 to 15 years of age.
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Carro, George W., Bruce Brockstein, Thomas A. Hensing, Patrick Joseph Fleming, Shannon Maureen Gavin, Wayne Spath, Abigail Harper, Wendy Hui, William J. Uhlig, and Brad Hughes. "Evaluation of oral chemotherapy prescribing at an outpatient oncology clinic." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 191. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.191.
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191 Background: Oral chemotherapy’s exponentially increasing role in the treatment of malignancies continues to pose unique challenges to oncology. The American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) drafted measures in the Chemotherapy Administration Safety Standards that help address some of these issues concerning oral chemotherapy. There is a lack of data describing the prescribing process for oral chemotherapy. In a retrospective chart review, prescriptions at a hospital-based outpatient oncology center were evaluated for completeness of prescribing and follow up measures. Methods: A retrospective chart review of ten oral chemotherapy medications from May 2012 to July 2012 was conducted. The primary outcome measure was compliance with ASCO and ONS Chemotherapy Administration Safety Standards. A secondary outcome was frequency of pharmacist interventions on oral chemotherapy prescriptions. Results: 412 prescriptions were evaluated. Prescriptions were graded on a scale from 1 to 8. One point was given for inclusion of each of the following: prescribing physician, patient name, drug name, dose, dosing methodology, quantity, refills, and accurate directions. Of all the prescriptions, 23% contained all aspects of a complete prescription. The most common reasons for point deductions were contradictory or unclear directions and allowing refills for oral chemotherapy which should not be refillable. Four percent of prescriptions had a documented pharmacist intervention. Conclusions: This study revealed areas for improvement in the prescribing process of oral chemotherapy. Targeting directions and refill fields within prescription templates will improve compliance with ASCO and ONS standards. This can be accomplished by implementing customized oral chemotherapy prescription templates within treatment plans in the electronic medical record system. Unlike chemotherapy administered in the clinic setting, oral chemotherapy prescriptions are not generally reviewed by oncology trained pharmacists. With the collaboration of medical and nursing staff, a new work flow was implemented which includes pharmacist review of electronic oral chemotherapy prescriptions.
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Zhuo, Lin, Yinchu Cheng, Shaoqin Liu, Yu Yang, Shuang Tang, Jiancun Zhen, Junfeng Zhao, and Siyan Zhan. "A Multiview Model for Detecting the Inappropriate Use of Prescription Medication: Machine Learning Approach." JMIR Medical Informatics 8, no. 7 (July 6, 2020): e16312. http://dx.doi.org/10.2196/16312.
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Background The inappropriate use of prescription medication has recently garnered worldwide attention, but most national policies do not effectively provide for early detection or timely intervention. Objective This study aimed to develop and assess the validity of a model that can detect the inappropriate use of prescription medication. This effort combines a multiview and topic matching method. The study also assessed the validity of this approach. Methods A multiview extension of the latent Dirichlet allocation algorithm for topic modeling was chosen to generate diagnosis-medication topics, with data obtained from the Chinese Monitoring Network for Rational Use of Drugs (CMNRUD) database. Topic mapping allowed for calculating the degree to which diagnoses and medications were similarly distributed and, by setting a threshold, for identifying prescription misuse. The Beijing Regional Prescription Review Database (BRPRD) database was used as the gold standard to assess the model’s validity. We also conducted a sensitivity analysis using random samples of validated prescriptions and evaluated the model’s performance. Results A total of 44 million prescriptions were used to generate topics using the diagnoses and medications from the CMNRUD database. A random sample (15,000 prescriptions) from the BRPRD was used for validation, and it was found that the model had a sensitivity of 81.8%, specificity of 47.4%, positive-predictive value of 14.5%, and negative-predictive value of 96.0%. The model showed superior stability under different sampling proportions. Conclusions A method that combines multiview topic modeling and topic matching can detect the inappropriate use of prescription medication. This model, which has mediocre specificity and moderate sensitivity, can be used as a primary screening tool and will likely complement and improve the process of manually reviewing prescriptions.
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Wang, Lidong, Yin Zhang, Yun Zhang, Xiaodong Xu, and Shihua Cao. "Prescription Function Prediction Using Topic Model and Multilabel Classifiers." Evidence-Based Complementary and Alternative Medicine 2017 (2017): 1–10. http://dx.doi.org/10.1155/2017/8279109.
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Determining a prescription’s function is one of the challenging problems in Traditional Chinese Medicine (TCM). In past decades, TCM has been widely researched through various methods in computer science, but none concentrates on the prediction method for a new prescription’s function. In this study, two methods are presented concerning this issue. The first method is based on a novel supervised topic model named Label-Prescription-Herb (LPH), which incorporates herb-herb compatibility rules into learning process. The second method is based on multilabel classifiers built by TFIDF features and herbal attribute features. Experiments undertaken reveal that both methods perform well, but the multilabel classifiers slightly outperform LPH-based method. The prediction results can provide valuable information for new prescription discovery before clinical test.
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Helm, David P. "“Physician’s prescriptions accurately prepared” - The Mid-Nineteenth-Century Prescription Books of Four Gloucester Chemists." Journal of the History of Medicine and Allied Sciences 75, no. 3 (May 22, 2020): 270–98. http://dx.doi.org/10.1093/jhmas/jraa016.
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Abstract Britain’s mid-nineteenth-century healthcare economy has often been described as a “medical marketplace” in which struggling doctors faced intense competition from a range of unqualified rivals. Chemists and druggists, who proliferated in industrial cities and supposedly prospered by exploiting the poor and the gullible, are widely regarded as having presented a serious threat to medical livelihoods. However, the activities of four Gloucester chemists show how the dispensing of medical prescriptions brought individual chemists and doctors closer together. Competition between chemists and druggists for this trade was intense and it was instrumental in establishing them as trusted community pharmacists and giving impetus to the process of professionalization. Prescription books, an under-represented source in the literature, also show that customers for prescription medicines were surprisingly socially diverse and that most prescriptions were collected by women, with significant variation in dispensing activity through the week. This, and the volume of prescriptions being dispensed, suggest prescription medicines were regularly being used to treat chronic and less serious ailments, where collection could await normal shopping days. Significantly, prescriptions were the property of the patients and could be re-presented whenever they thought fit. For some patients, it thus effectively became an instrument of self-medication.
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DIXON, BRUCE K. "Software Speeds Research Process Required for Prescription Refills." Rheumatology News 5, no. 12 (December 2006): 65. http://dx.doi.org/10.1016/s1541-9800(06)71621-0.
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Chou, Ying-Chyi, Been-Yuan Chen, Ya-Yun Tang, Zheng-Ji Qiu, Ming-Fen Wu, Shuw-Chuan Wang, Hui-Shin Lin, and Wen-Chi Chuang. "Prescription-Filling Process Reengineering of an Outpatient Pharmacy." Journal of Medical Systems 36, no. 2 (July 13, 2010): 893–902. http://dx.doi.org/10.1007/s10916-010-9553-5.
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Lester, Corey A., Liyun Tu, Yuting Ding, and Allen J. Flynn. "Detecting Potential Medication Selection Errors During Outpatient Pharmacy Processing of Electronic Prescriptions With the RxNorm Application Programming Interface: Retrospective Observational Cohort Study." JMIR Medical Informatics 8, no. 3 (March 11, 2020): e16073. http://dx.doi.org/10.2196/16073.
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Background Medication errors are pervasive. Electronic prescriptions (e-prescriptions) convey secure and computer-readable prescriptions from clinics to outpatient pharmacies for dispensing. Once received, pharmacy staff perform a transcription task to select the medications needed to process e-prescriptions within their dispensing software. Later, pharmacists manually double-check medications selected to fulfill e-prescriptions before dispensing to the patient. Although pharmacist double-checks are mostly effective for catching medication selection mistakes, the cognitive process of medication selection in the computer is still prone to error because of heavy workload, inattention, and fatigue. Leveraging health information technology to identify and recover from medication selection errors can improve patient safety. Objective This study aimed to determine the performance of an automated double-check of pharmacy prescription records to identify potential medication selection errors made in outpatient pharmacies with the RxNorm application programming interface (API). Methods We conducted a retrospective observational analysis of 537,710 pairs of e-prescription and dispensing records from a mail-order pharmacy for the period January 2017 to October 2018. National Drug Codes (NDCs) for each pair were obtained from the National Library of Medicine’s (NLM’s) RxNorm API. The API returned RxNorm concept unique identifier (RxCUI) semantic clinical drug (SCD) identifiers associated with every NDC. The SCD identifiers returned for the e-prescription NDC were matched against the corresponding SCD identifiers from the pharmacy dispensing record NDC. An error matrix was created based on the hand-labeling of mismatched SCD pairs. Performance metrics were calculated for the e-prescription-to-dispensing record matching algorithm for both total pairs and unique pairs of NDCs in these data. Results We analyzed 527,881 e-prescription and pharmacy dispensing record pairs. Four clinically significant cases of mismatched RxCUI identifiers were detected (ie, three different ingredient selections and one different strength selection). A total of 546 less significant cases of mismatched RxCUIs were found. Nearly all of the NDC pairs had matching RxCUIs (28,787/28,817, 99.90%-525,270/527,009, 99.67%). The RxNorm API had a sensitivity of 1, a false-positive rate of 0.00104 to 0.00312, specificity of 0.99896 to 0.99688, precision of 0.00727 to 0.04255, and F1 score of 0.01444 to 0.08163. We found 872 pairs of records without an RxCUI. Conclusions The NLM’s RxNorm API can perform an independent and automatic double-check of correct medication selection to verify e-prescription processing at outpatient pharmacies. RxNorm has near-comprehensive coverage of prescribed medications and can be used to recover from medication selection errors. In the future, tools such as this may be able to perform automated verification of medication selection accurately enough to free pharmacists from having to perform manual double-checks of the medications selected within pharmacy dispensing software to fulfill e-prescriptions.
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Zhang, Peng, Breck Stodghill, Cory Pitt, Cavin Briody, Douglas C. Schmidt, Jules White, Alan Pitt, and Kelly Aldrich. "OpTrak." International Journal of Information Systems and Social Change 10, no. 2 (April 2019): 45–61. http://dx.doi.org/10.4018/ijissc.2019040104.
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This article describes the structure and functionality of OpTrak, a decentralized app implemented using the Ethereum blockchain that targets the opioid epidemic currently plaguing the United States. Over-prescription and distribution of opioids cost the national healthcare system over $78 billion every year. Problems persist in every stage of the process, from doctors prescribing the medication to the pharmacists fulfilling prescriptions. These problems arise from a combination of factors, including lack of accountability, transparency, and reliability in the current prescription drug monitoring programs. This work provides three key contributions to research on a technical approach to mitigate the opioid epidemic. First, the authors pinpoint key problems in the current opioid prescription system. Second, they propose an integrated approach for addressing the problems by leveraging distributed ledgers, focusing on blockchain technology. Third, the authors describe the structure and functionality of OpTrak that allows a consortium of care providers to exchange patient prescription data securely.
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Sonawane, Prof Nayana. "Providing Security for Patient’s E-Prescription using Cryptography Technique." International Journal for Research in Applied Science and Engineering Technology 9, no. VI (June 20, 2021): 1996–98. http://dx.doi.org/10.22214/ijraset.2021.35389.
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The benefits of electronic medical prescriptions and the information and communication technologies that benefit those areas have led to significant improvements in healthcare over the years. In the overall context of health care information protection, the confidentiality of data reported by doctors requires special treatment. This paper introduces an e-prescription system that addresses some of the challenges associated with prescription privacy protection in the process of prescribing drugs. The main purpose is to provide security and protect prescription from being stolen. The benefit of project is that it provides the different results in short time. Our goal is to provide online user with the appropriate tools to secure their medical prescription from being misuse by intruder. Our solution is not only straight forward but also easy to grasp by those who will join us to make a global difference. .The biggest advantage we have is that we can encrypt and decrypt by using proper algorithm so that only intended user can decrypt it.
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Van Gorder, Charles M., Scott H. Yost, Jenna M. Negrelli, Scott H. Anderson, and Carolyn Chew. "Effective Decentralization of a Pharmacy Technician to Facilitate Delivery of Medications Prior to Discharge in a Community Hospital." Journal of Pharmacy Technology 33, no. 4 (April 28, 2017): 123–27. http://dx.doi.org/10.1177/8755122517705398.
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Background: There are many benefits to a well-designed prescription process and delivery service at the time of discharge from the hospital. However, the discharge prescription delivery service in our hospital has historically been infrequently utilized. Objective: To assess the number of patients with prescriptions in hand prior to discharge, the number of prescriptions filled, the duration of time to get discharge prescriptions to the floor, and the motivation patients had for declining the service. Methods: This single-center, quality improvement project was initiated as a pilot program from March through December 2015, utilizing a certified pharmacy technician (CPhT) on a 56-bed cardiovascular floor from Monday through Friday, 9:00 am to 5:30 pm. All patients discharged during the pilot time period were included in the analysis. The CPhT was responsible for collecting, inputting, processing, delivering, and charging for discharge prescriptions. Results: The number of patients utilizing the service increased from an average of 68 to 132 per month, pre- and postintervention, respectively. Total prescriptions increased from 296 preintervention to 456 postintervention per month. Prescription delivery time to the patient was decreased by 28 minutes. Conclusions: The utilization of a decentralized CPhT in a 56-bed cardiology unit at a large community hospital increased both the number of patients and total number of prescriptions filled prior to discharge. Future studies are warranted to evaluate medication interventions at discharge and readmission rates in patients who have prescriptions in hand prior to discharge versus those that do not.
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Pattin, Anthony J., Nathan Devore, Jonathan Fowler, and David Weldy. "An Examination of the Prescription Renewal Process and Implications for Primary Care Physicians and Community Pharmacists." Journal of Pharmacy Practice 33, no. 2 (September 16, 2018): 187–91. http://dx.doi.org/10.1177/0897190018799217.
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In physician practices and pharmacies, staff members work to process prescription renewals so that patients receive a steady supply of medications. These functions are essential to ensure patients have continuous access to medications and remain adherent to prescribed therapies. Despite the incorporation of e-prescribing software programs to ease management of these processes, barriers to effective management of the prescription renewal process exist. Mismanagement of pharmacy adherence programs can ultimately lead to patients receiving inappropriate medications and excessive use of staff resources. The objective of this article is to examine the prescription renewal process in both the primary care setting and the pharmacy and report challenges associated with the process. A literature review was conducted to find studies that describe pharmacists’ and physicians’ handlings of prescription renewals, use of e-prescribing software, and benefits and barriers to using these technologies. Although studies report e-prescribing software improves efficiency in the prescription renewal process, there is a need to reduce technological problems that create challenges in use. It is recommended that staff within physician practices and pharmacies standardize prescription renewal processes and educate patients about the prescription renewal process.
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Shelton, D., V. Teo, K. Ding, and D. Hefferon. "MP35: Targeting the opioid crisis by influencing opioid prescribing in the emergency department." CJEM 22, S1 (May 2020): S55. http://dx.doi.org/10.1017/cem.2020.183.
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Background: Liberal prescribing of opioids is a major contributing factor to the opioid crisis. Patients who take opioids for >5 consecutive days are at greater risk of long-term use. Evidence shows that significantly more opioids are prescribed for emergency department (ED) patients with acute pain compared to amounts consumed. Guidelines recommend prescribing a 3-day supply or 10-15 tablets of opioids for patients with acute pain Aim Statement: By January 2020, >70% of opioid prescriptions from our ED will be for <15 tablets of morphine 5 mg equivalents. Measures & Design: Emergency physicians were educated on best practice of prescribing opioids for discharged patients. An electronic prescription writer was built for discharged ED patients with a pop-up reminder for quantities >15 tablets (indicating a recommended quantity of 10-15 tablets) and a pop-up reminder for quantities >30 tablets (indicating a maximum quantity of 30 tablets and recommended quantity). A feature was built to auto-populate a prescription for morphine 5 mg po q4h prn x 10 tablets to facilitate adherence to guidelines. Outcome Measure % opioid prescriptions for <15 tablets of morphine 5 mg equivalents Process Measure Amount of opioids prescribed for discharged ED patients, measured as morphine 5 mg equivalents Number of opioid prescriptions for >30 tablets of morphine 5 mg equivalents Balancing Measure Number of patients that return to ED within 7 days and receive a repeat opioid prescription. Evaluation/Results: Prior to implementation of the electronic prescription writer a sample audit revealed that 50% of opioid prescriptions were written for <15 tablets of morphine 5 mg equivalents. For the first three quarters of 2019, 62%, 61% and 69% of opioid prescriptions were written for <15 tablets of morphine 5 mg equivalents. Only two prescriptions during the study period were for >30 tablets of morphine 5 mg equivalents. An average number of 7 patients per quarter were given a repeat opioid prescription during a return ED visit. Discussion/Impact: We were successful in influencing emergency physicians to prescribe fewer opioids to discharged patients. This has the potential to avoid converting ED patients with acute pain into long-term opioid users and to avoid the diversion of unused opioid tablets.
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Zimenkovsky, A. B., and M. Ya Sekh. "New approaches to increasing the value of drug prescription by the means of systematic integration of professional communication, standardization of pharmaceutical care and drug behavior." Acta Medica Leopoliensia 26, no. 4 (2020): 91–100. http://dx.doi.org/10.25040/aml2020.04.091.
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The aim of the study was to find new approaches to increase the value of drug prescription by the means of systematic integration of professional communication, standardization of pharmaceutical care and drug behavior of physicians, pharmacists and patients to improve the quality of pharmacotherapy in Ukraine. Materials and Methods. Objects of the study: a set of relevant terms and their interpretations concerning "prescription" (n = 23); the evolution of the interpretation of the term "prescription" in a historical perspective; prognostic model of drug communication of the participants of the medication process; electronic prescription and the prospects of its use. Bibliosemantic comparative studies in the format of "pharmaceutical care vs. prescription", "medical standard vs. prescription" were conducted. Methods used: bibliosemantic, bibliographic, historical, analytical and methods of systematization and comparison. Results and Discussion. The results of the comparative bibliosemantic study concerning the interpretations of the definition of "prescription" allowed us to substantiate the claim that the latter can be considered one of the key elements of professional communication between participants of the medication process. The results of the analysis of common and distinctive features in the interpretation of the definitions of pharmaceutical care and prescription showed that it is feasible to regard it as a form of pharmaceutical care, and therefore it is one of its first and basic standards, moreover, a documented one. Such written messages of pharmaceutical care can likely be important tools to influence the drug behavior of all participants of pharmacotherapy. According to the results of the bibliosemantic search for common features in the interpretations of the definitions of "prescription" and "standard", it is established that both terms have numerous common characteristics, which allow us to claim that prescription can be regarded as a certain standard of action given by a physician to a particular patient. Therefore, a drug prescription can be considered the standard of appropriate medical behavior of the patient. A model of professional communication of the key participants in the medication process with the help of a prescription is proposed. Written information (on the requirements for the release of the finished medicinal product) or certain pharmaceutical care (in the case of indicating the composition and instructions for the manufacture of the drug) is transferred from the clinician to the pharmaceutical worker. The physician provides the patient with pharmaceutical care and a standard of proper medical behavior. The pharmacist provides the patient with verbal pharmaceutical care according to the prescription. In case of absence of prescription, the main connecting mechanism of drug communication of the pharmacotherapy participants in particular and the medication process in general is lost, in our opinion. For the first time a prescription-centric model of drug communication of key participants in the medication process was developed. Conclusions. 1. According to the results of the study, new approaches to increase the value of drug prescription by the means of systematic integration of professional communication, standardization of pharmaceutical care and drug behavior of physicians, pharmacists and patients to improve the quality of pharmacotherapy in Ukraine are proposed. At the same time, the results of a comparative bibliosemantic study of interpretations of the definition of "prescription" allowed us to substantiate the claim that the latter can be considered one of the key elements of professional communication between the participants of the medication process (physician, pharmacist and patient) and an important tool for influencing patient behavior. 2. The results of the comparative analysis of common and distinctive features in the interpretation of the definitions of "pharmaceutical care" and "prescription" made it possible to claim that a prescription can be regarded as a certain form of pharmaceutical care. Such written messages can likely be important tools to influence the drug behavior of all participants of pharmacotherapy. 3. The results of the bibliosemantic search for common features in the interpretation of the definitions "prescription" and "standard" showed the presence of numerous common characteristics that suggest that the prescription can be regarded as a certain standard of action provided by a physician to a particular patient according to a significant clinical situation and can be considered the standard of appropriate medical behavior of the patient. 4. The use of e-prescriptions, in our opinion, opens new perspectives for assessing the drug behavior of patients, and can become a powerful lever in its management, which requires, accordingly, further research Key words: drug behavior, e-prescription, model of drug communication, pharmaceutical care, prescription, standard
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Ong, Kheng Yong, Li Li Chen, Jane Ai Wong, Jin Cheng Lim, Doris Bee Hoon Teo, and Mui Chai Tan. "Dispensing medication refills without counselling." International Journal of Health Care Quality Assurance 29, no. 8 (October 10, 2016): 846–52. http://dx.doi.org/10.1108/ijhcqa-04-2016-0040.
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Purpose The purpose of this paper is to assess the safety and efficiency of, and acceptance by, patients for an express refill service (ERS). Design/methodology/approach A pilot uncontrolled, cross-sectional, single-centred study was conducted at the outpatient pharmacy of a tertiary acute care hospital. Under ERS, prescriptions were dispensed without clinical review and counselling for patients refilling prescription medications. Efficiency was assessed by comparing processing times of ERS prescriptions with regular prescriptions. Safety was assessed by independent review of prescriptions by two pharmacists. Patient acceptance was assessed by a survey. Findings ERS reduced processing time of prescriptions by more than 30 per cent compared to the regular fill process. ERS was generally safe for patients, with drug-related problems identified in only one prescription which may have warranted closer monitoring. It was accepted by patients who opted for the service, as 91.4 per cent agreed or strongly agreed that they were satisfied with the service. Research limitations/implications The study was conducted on a small convenience sample of patients in a single centre, with no control group. Practical implications Results showed that ERS was efficient, safe and well-accepted for select patients refilling their prescriptions. This leads to shorter waiting times and greater patient satisfaction. Originality/value This is the first published study that has explored the feasibility of an express prescription refill service. Despite some limitations, this study showed that omitting prospective clinical review and patient counselling for a defined population segment is safe, and can reduce processing time and improve patient satisfaction.
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Majhee, Lakhan, Anshuman Chandra, Manju Gari, and Aasim Shakeel. "Prescription audit of online booked outpatients for department of medicine and dermatology in a tertiary care hospital: a comparative observational study." International Journal of Basic & Clinical Pharmacology 8, no. 12 (November 25, 2019): 2689. http://dx.doi.org/10.18203/2319-2003.ijbcp20195279.
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Background: A regular and effective prescription audit is a key tool to ensure rational use of drugs and to assess drug utilization in the health care system. This study is first of its kind, in Rajendra Institute of Medical Sciences (RIMS), Ranchi, highlighting comparative assessment of prescriptions of online booked appointments in department of medicine and dermatology via online registration system (ORS) using WHO prescribing indicators. This ORS is an integral part under Digital India Initiative.Methods: This was a comparative, observational study conducted in Department of Pharmacology of RIMS, Ranchi. The study period was 6 months from 1 March 2019 to 31 August 2019. Prescriptions details of outpatient department (OPD) patients were collected from the government authorized pharmacy facility “Dawai Dost “at RIMS. 75 prescriptions from each of the departments were analyzed.Results: 75 prescriptions from patients who attended medicine and dermatology outpatient department (OPD) during the study period, after registering appointment via ORS, was collected and comparative assessment was done. This audit highlights important correctable parameters although legibility was not the major concern. Adherence to National List of Essential Medicines (NLEM) was 45% and 49% for department of medicine and dermatology respectively.Conclusions: The prescription audit process should be done regularly to assess ORS prescription to ensure high quality rational prescribing and support Digital India initiative. Adherence to NLEM of India should be 100%. The latest NLEM of India should be provided to the concerned departments and feedback should be provided to the physicians.
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Gaborcik, Joshua W., Brigid K. Groves, Aaron Clark, Marilly Palettas, and Alexa Sevin Valentino. "An Ambulatory Care Clinic and Community Pharmacy Collaboration to Address Prescription Abandonment." INNOVATIONS in pharmacy 10, no. 1 (March 8, 2019): 14. http://dx.doi.org/10.24926/iip.v10i1.1540.
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Purpose: The purpose of this research is to evaluate a collaborative workflow aimed at decreasing prescription abandonment.
Setting: A federally qualified health center and a 340B contracted grocery store-based community pharmacy.
Practice Workflow: An ambulatory care clinic with an established partnership with a community pharmacy chain identified a need to decrease prescription abandonment rates. A process was developed whereby an ambulatory care pharmacy technician received a report from the pharmacy of prescriptions filled for at least 7 days since the initial fill date and at risk for abandonment at the community pharmacy. The pharmacy technician identified health-system barriers, attempted to remedy any identified barriers, and conducted patient reminder phone calls. Health-system barriers were classified by the following categories: incorrect contact information at the community pharmacy, incorrect 340B copayment, incorrect insurance information at the community pharmacy, and need for prior authorization.
Evaluation: A prospective cohort study was conducted from February 2016 to April 2016 in order to evaluate the effectiveness of this workflow.
Results: 551 prescriptions and 350 patients were included in this cohort. Of the 551 prescriptions, 362 had at least one identified barrier that may have led to prescription abandonment. There were 111 health-system identified barriers, and 96 of these barriers were acted upon. Additionally, there were 459 patient identified barriers, and 179 of these barriers were acted upon. When a pharmacy technician was able to identify and act upon at least one barrier, 106 prescriptions (46.9%) were picked-up from the pharmacy.
Conclusion: From the information gathered in this quality improvement project, operational changes have been implemented at the ambulatory care clinic and community pharmacy as a means to further decrease modifiable health-system barriers that may lead to prescription abandonment.
Article Type: Clinical Experience
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Khurshid, Faraz, Samra Bashir, and Babu Noushad. "Prescription writing through the lens of the threshold concept framework: a narrative review." Research and Development in Medical Education 9, no. 1 (June 10, 2020): 11. http://dx.doi.org/10.34172/rdme.2020.011.
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Background : Although challenging, writing prescriptions is an essential practical competency of medical graduates. This process is transformative as it reflects medical students’ ways of thinking and practising. A conceptual framework, similar to "way of thinking and practising", known as ‘threshold concepts’ can help students to establish meaningful connections between the transformative and conceptually difficult ideas underlying prescription writing. This enables them to think, practice and demonstrate the competence required for rational drug prescription conducive to effective pharmacotherapeutic care. Methods: A narrative review was conducted on a subset of articles retrieved during the course of an another literature review using four bibliographic databases from 15th August to 15th September 2019. The literature review is focussed on instructional interventions and their impact on university-level students learning pharmacology. Seminal papers on threshold concepts were also included to draw a comparison between prescription writing and key attributes of the threshold concepts framework. Results: An alignment supported by examples was observed between different aspects and challenges of prescription writing and key attributes of the threshold concept framework. Conclusion: Using the threshold concepts framework as a lens in prescription writing offers an insight to the curriculum designers employing it as a pedagogical utility in transforming medical students’ way of thinking and practising for rational prescribing. Moreover, it also informs the likelihood of unidentified threshold concepts for beginners within the course of prescription writing.
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Blunt, Wendy, Dawn P. Gill, Brendan Riggin, Judith Belle Brown, and Robert J. Petrella. "Process evaluation of the HealtheSteps™ lifestyle prescription program." Translational Behavioral Medicine 9, no. 1 (February 21, 2018): 32–40. http://dx.doi.org/10.1093/tbm/iby005.
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Marra, Carlo A., Larry D. Lynd, Aslam H. Anis, and John M. Esdaile. "Approval process and access to prescription drugs in Canada." Arthritis & Rheumatism 55, no. 1 (2006): 9–11. http://dx.doi.org/10.1002/art.21709.
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Chen, Hung-Kai, Fueng-Ho Chen, and Shien-Fong Lin. "An AI-Based Exercise Prescription Recommendation System." Applied Sciences 11, no. 6 (March 16, 2021): 2661. http://dx.doi.org/10.3390/app11062661.
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The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool has been developed for digital training and decision support in cardiovascular disease patients in clinical practice. Exercise prescription recommendation systems for sub-healthy people are essential to enhance this dominant group’s physical ability as well. This study aims to construct a guided exercise prescription system for sub-healthy groups using exercise community data to train an AI model. The system consists of six modules, including three-month suggested exercise mode (3m-SEM), predicted value of rest heart rate (rest HR) difference after following three-month suggested exercise mode (3m-PV), two-month suggested exercise mode (2m-SEM), predicted value of rest HR difference after following two-month suggested exercise mode (2m-PV), one-month suggested exercise mode (1m-SEM) and predicted value of rest HR difference after following one-month suggested exercise mode (1m-PV). A new user inputs gender, height, weight, age, and current rest HR value, and the above six modules will provide the user with a prescription. A four-layer neural network model is applied to construct the above six modules. The AI-enabled model produced 95.80%, 100.00%, and 95.00% testing accuracy in 1m-SEM, 2m-SEM, and 3m-SEM, respectively. It reached 3.15, 2.89, and 2.75 BPM testing mean absolute error in 1m-PV, 2m-PV, and 3m-PV. The developed system provides quantitative exercise prescriptions to guide the sub-healthy group to engage in effective exercise programs.
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Ladani, Sonal, Mohammed AbouDaya, William Thornhill, and Nanna Christiansen. "P26 Pharmacy discharge service to facilitate early discharges and to improve the quality of electronic discharge letters (EDL’s)." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e19.2-e20. http://dx.doi.org/10.1136/archdischild-2020-nppg.35.
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AimThe current discharge process on the paediatric wards involves transcribing medications from one electronic system to another, this has led to errors and compromises patient safety. Discharges are also sometimes delayed due to patients waiting for their medications. The newly implemented discharge service involves pharmacists working closely with the medical team to identify patients for discharge as early as possible and to accurately transcribe medications onto the electronic patient record (EPR).MethodThe pharmacist would attend the consultant-led morning handover or would liaise with the nurse in charge on the ward to establish discharges and transfers for that day or over the weekend if on a Friday. The most urgent discharges and any complex patients were prioritised. The EPR system would be used to generate the EDL’s, transcribe the medicines for discharge and add any other relevant written information. Any medication related issues would be clarified with the medical team. The prescription would be handed over to the medical team to be reviewed and signed. This would then be dispensed and checked by the pharmacy team. The patient/parent or carer would be counselled on their medications. Data was collected from November 2018 – March 2019, this included time informed about discharge, time EDL started, time EDL printed and time EDL completed. Other data collected included if any additional written information was provided to the GP and if any amendments were required after the doctor had reviewed the prescription. The data was inputted into an Excel spreadsheet and was compared against August – October 2018.Results152 discharge prescriptions were included in the service. The data was compared to the data from August – October 2018 which showed more than double of the prescriptions were completed in the morning between 9am-12noon (compared to 12noon-5.30pm) since the service started. Less prescription needed amendments at the point of screening and more prescriptions included additional medication related information. The quality of the prescriptions had improved and completing prescriptions earlier meant timely discharges, improved bed utilisation and improved patient quality. Positive feedback was given by patients, doctors and nurses as well as the rest of the ward teams.ConclusionCommunication has improved between the hospital and community care, as well as patient satisfaction and bed availability. A future development would be to introduce prescribing pharmacists within medical teams to streamline the discharge prescription process further, freeing up medical time and increasing the focus on medicines optimisation for all patients.
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Iles, Susannah. "Prescription Restriction: Why Birth Control Must Be Over-the-Counter in the United States." Michigan Journal of Gender & Law, no. 26.2 (2020): 389. http://dx.doi.org/10.36641/mjgl.26.2.prescription.
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This Note argues that it is harmful and unnecessary to require women to obtain prescriptions for access to hormonal birth control. Requiring a prescription is necessarily a barrier to access which hurts women and hamstrings the ability to dictate their own reproductive plans. It is also an irrational regulation in light of the relative safety of hormonal birth control pills, particularly progestin-only formulations, compared to other drugs readily available on the shelves. Leading medical organizations, including the American College of Obstetrics and Gynecologists, advocate for over-the-counter access to hormonal birth control. While acknowledging that not every woman will have positive outcomes taking hormonal birth control pills, this Note argues that women are capable of taking hormonal birth control as directed and are able to self-identify if they themselves are at risk for complications. Following a long line of cases that establish reproduction as a fundamental right in the United States, it follows that requiring a prescription for access can and should be analyzed under the Fifth and Fourteenth Amendment Due Process clauses, particularly under the Undue Burden standard. Certain prerequisites, such as pelvic exams, once thought to be necessary to safely prescribe hormonal birth control, are now widely considered unnecessary in determining whether a particular woman can safely take birth control pills. This Note goes further and argues that such prerequisites are an unconstitutional method of holding vital medication hostage from women who desire to control their reproductive health.
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Guharoy, Roy, Gregory Cwikla, Andrew Burgdorf, and Madan Joshi. "Prescription for a Stronger FDA." Journal of Pharmacy Practice 19, no. 5 (October 2006): 295–96. http://dx.doi.org/10.1177/0897190007299704.
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Recently, an Institute of Medicine panel concluded that years of negligence, mismanagement, inadequate resources, infighting among staff members, and lack of a systemic drug approval and postmarketing surveillance process have diluted the effectiveness of the Food and Drug Administration (FDA) in protecting public health. The panel was commissioned by the FDA to assess the U.S. drug safety system, and they recommended 25 sweeping changes, most of which would require congressional authorization. The recommendations focus on the life cycle of a drug product, rather than just the approval process, and they would go a long way in protecting public health in the future.
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McIsaac, Warren J., and Vivek Goel. "Effect of an Explicit Decision-Support Tool on Decisions to Prescribe Antibiotics for Sore Throat." Medical Decision Making 18, no. 2 (January 1998): 220–28. http://dx.doi.org/10.1177/0272989x9801800211.
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Studies of scoring rules for sore throat have failed to show that they lower antibiotic prescription rates. The authors studied the effect of an explicit decision-support tool, incorporating a modified score, on antibiotic-prescription decisions. Four hundred and fifty family physicians received an information package, a score card, and a recording form to use during one sore-throat encounter. The physicians randomly received either a control form or an intervention form that required them to interact with the score during the clinical recording process. There was a trend towards a reduction in antibiotic prescriptions (21%, p = 0.09) in the physicians using the intervention form. A greater reduction (45%, p = 0.06) was observed for patients whose probabilities of infection with group A streptococcus were low. Sore-throat-scoring rules may reduce unnecessary antibiotic prescriptions if physicians are specifically cued to use them during clinical encounters and appropriate management responses are linked to score estimates for the likelihood of group A streptococcus infection.
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Kahn, Kenneth B. "NPD process formality across global regions." International Journal of Innovation Science 11, no. 1 (March 26, 2019): 102–18. http://dx.doi.org/10.1108/ijis-02-2018-0024.
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Purpose The paper aims to address the issue of generalizability by examining process formality across the global regions of North America, Europe and Asia. A common prescription in the new product development (NPD) discipline is to employ a formal process. Because generalizability of this prescription has not been fully investigated across global regions, the present manuscript addresses the issue of generalizability by examining process formality across the global regions of North America, Europe and Asia. Design/methodology/approach Recently made available to researchers, data of the Product Development and Management Association’s 2012 Comparative Performance Assessment Study (CPAS) were analyzed. The uniqueness of the 2012 CPAS data set is its global composition with sizable samples from North America, Europe and Asia. Chi-square tests and multivariate analysis of variance were applied. Findings Results support use of a formal process, as companies with a formal NPD process perceived higher performance than companies with no standard process. Process formality appears to differ across regions and be influenced by innovation strategy. European firms tended to not use a formal process when pursuing radical innovation, and these firms perceived higher performance. North American firms tended to not use a formal process when pursing incremental innovation, but these firms perceived lower performance. Practical implications Having some NPD process is generally better than not having any process at all. Process differences across regions appear to exist when pursuing radical innovation or incremental innovation. Originality/value This is one of few studies comparing global regions to examine generalizability of a best practice prescription, namely, the extent to which a formal process should be implemented.
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Qassemi, Soraya, Arnaud Pagès, Laure Rouch, Serge Bismuth, André Stillmunkes, Maryse Lapeyre-Mestre, Cécile McCambridge, Charlène Cool, and Philippe Cestac. "Potentially Inappropriate Drug Prescribing in French Nursing Home Residents: An Observational Study." Pharmacy 8, no. 3 (July 30, 2020): 133. http://dx.doi.org/10.3390/pharmacy8030133.
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Purpose: To identify the prevalence of potentially inappropriate drug prescription in a sample of nursing home residents in France, combining explicit criteria and implicit approach and to involve pharmacists in the multi-professional process of therapeutic optimization. Methods: A cross-sectional, observational, multicenter study was conducted during a five-month period in a sample of French nursing homes. Information on drug prescription, diseases, and socio-demographic characteristics of nursing home residents was collected. For each prescription, identification of potentially inappropriate drug prescription was done, based on explicit and implicit criteria. Results: Nursing home residents were administered an average of 8.1 (SD 3.2, range 0–20) drugs per day. Nearly 87% (n = 237) of the residents had polypharmacy with five or more drugs prescribed per day. Among the 274 nursing home residents recruited from five nursing homes, 212 (77.4%) had at least one potentially inappropriate drug prescription. According to the Laroche list, 84 residents (30.7%) had at least one drug with an unfavorable benefit–harm balance. An overdosing was found for 20.1% (n = 55) of the residents. Nearly 30% (n = 82) of the residents had a drug prescribed without valid medical indication. Conclusions: This study shows that potentially inappropriate drug prescriptions are highly prevalent among nursing home residents, nevertheless pharmacists can take part in drug utilization review in collaboration with the nursing home staff.
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Heins, Marianne J., Inge Bruggers, Liset van Dijk, and Joke C. Korevaar. "ADHD medication prescription." Journal of Child Health Care 20, no. 4 (October 5, 2016): 483–93. http://dx.doi.org/10.1177/1367493515620913.
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Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6–18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel analyses, we examined predictors of ADHD medication prescription. Children diagnosed as ‘hyperactive’ were 16 times more likely to be prescribed ADHD medication than those with ‘behavioural concerns’. Children with a parent or sibling receiving ADHD medication were three to four times more likely to be prescribed ADHD medication themselves. Children from GP practices with a high percentage of children with ADHD were twice as likely to be prescribed ADHD medication. Concluding, factors on the individual, family and GP practice level determine ADHD medication prescription. Future research into the decision-making process for ADHD medication is warranted.
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Zhang, Sufang, Wanqing Chen, Yuli Wang, Jianchun Wu, Lili Xu, Yongchun Yu, Jianhui Tian, et al. "Chinese Herbal Prescription Fu-Zheng-Qu-Xie Prevents Recurrence and Metastasis of Postoperative Early-Stage Lung Adenocarcinoma: A Prospective Cohort Study Followed with Potential Mechanism Exploration." Oxidative Medicine and Cellular Longevity 2021 (May 12, 2021): 1–22. http://dx.doi.org/10.1155/2021/6673828.
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Chinese herbal Fu-Zheng-Qu-Xie (FZQX) prescription has been found to improve the immune function and survival of patients with early-stage lung cancer. However, the therapeutic efficacy needs to be evaluated objectively, and the precise mechanism remains unclear. In the present study, a double-center, prospective cohort study was carried out to assess the clinical efficacy of the FZQX prescription in preventing the recurrence and metastasis of postoperative early-stage lung adenocarcinoma. Our results indicated that the FZQX prescription could significantly reduce the 3-year postoperative recurrence rate and improve the life quality. Moreover, the peripheral blood indices showed that the positive immune index (CD4+T/CD8+T) increased and the negative immune indices (CD8+T, Myeloid-derived suppressor cells (MDSCs), Treg) decreased after treatment with the FZQX prescription. Since the positive regulatory effect of the FZQX prescription on immune function, a series of experiments were conducted to verify the tumor-suppressive effect and elucidate the underlying mechanisms. Through the MDSC clearance xenograft model, we confirmed that the FZQX prescription could effectively suppress tumor growth with lesser side effects in vivo, and MDSCs may be involved in the biological process of the FZQX prescription’s intervention in lung cancer progression. By establishing the coculture system of MDSCs/LLC to simulate the immune microenvironment of lung cancer, the tumor suppression effect of the FZQX prescription was further validated by in vitro experiments. Besides, it was confirmed that the FZQX prescription could regulate MDSCs to remodel the immunosuppressive tumor microenvironment, thus exerting its preventive effect on relapse of lung cancer. Finally, the pathway activator and inhibitor were further used to explore the potential molecular mechanism. Results demonstrated that the IL-1β/NF-κB signaling pathway was one of the critical signaling pathways of FZQX prescription regulating MDSCs to prevent the recurrence and metastasis of lung adenocarcinoma.
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McGranahan, Tresa, Megan Gershon, Justine Pena, Chamnjot Bains, Margaret Elizabeth McCormick Van Meter, Sarah Salas, and Seema Nagpal. "Developing a standardized process for oral chemotherapy management for neuro-oncology." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 258. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.258.
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258 Background: Oral chemotherapies (OC) have transformed cancer care for millions of patients. While this has improved the patient experience, it presents significant challenges to safety of prescription, administration and side effect monitoring. While there are guidelines for documentation, there is not a best practices system for managing OC. This project identified areas of latent errors and implemented a standardized process for OC management. Methods: After review of the literature, we developed a process map for OC prescriptions at our institution. We then compared processes at three other neuro oncology clinics. We completed a hazard analysis and implemented several changes (see table). We identified binary measures in the medical record for every OC prescription that related to the process changes. Chart review of the 6 months prior to process change was used to create a baseline process mean for each variable. These same variables were monitored every 2 weeks after process change implementation using run charts. Successful process shift was defined as 7 consecutive 2-week averages that were continually on one side of the baseline process mean. Results: 5 months after process change was implemented, we had successfully reduced refills for OC and increased documentation of dose and dose calculation. There is a trend towards improvement in independently verified dose calculation and dedicated chemotherapy teaching visits, however these have not yet reached criteria for process change. Conclusions: This project used published studies, multi-institutional process mapping and hazard analysis to develop and implement a standardize process for OC. This process can be implemented for OC management in other oncology practices. [Table: see text]