From the Department of Medicine, Johns Hopkins University School of Medicine.
Armstrong Institute for Patient Safety and Quality.
J Patient Saf. 2022 Sep 1;18(6):e934-e937. doi: 10.1097/PTS.0000000000000998. Epub 2022 Apr 5.
This study aimed to evaluate the impact of electronic communication of medication discontinuation from prescribers to pharmacies (CancelRx) on medication safety.
We used electronic health record (EHR) data to identify medications that were e-prescribed from a pilot practice to a health system pharmacy and subsequently discontinued before or after CancelRx implementation (January 16-April 15, 2018 versus 2019). We matched these EHR data to pharmacy management software data to identify medications that were sold to patients in the 6 months after discontinuation. As a surrogate for unintended cancellation, we also identified medications refilled within 120 days of discontinuation. We conducted a medical record review to identify documentation of prescriber intent to discontinue these medications.
CancelRx implementation prevented prescriptions from being sold after discontinuation in the EHR (42 of 392 [10.7%] versus 0 of 387 [0.0%], P < 0.0001), but only 15 of 42 (35.7%) had documented intent to discontinue the medication (15 of 392, or 3.8% overall). There was a nonsignificant increase in the proportion of discontinued medications reordered within 120 days (10.0% versus 12.7%, P = 0.23). Medical record review of reordered prescriptions after CancelRx implementation found that 10 of 49 (10 of 387, or 2.6% overall) might have been unintentionally canceled.
Implementation of CancelRx eliminated the sale of e-prescribed medications after discontinuation in the EHR but might result in the unintentional cancellation of some prescriptions. Strategies to increase situational awareness of providers and pharmacy staff, including increased visibility of CancelRx, clear distinctions between active and expired prescriptions, and transmission of the reason for discontinuation, might reduce the risk of unintentional cancellations.
本研究旨在评估电子医嘱系统中停止向药房发送药物信息（CancelRx）对药物安全性的影响。
我们使用电子健康记录（EHR）数据，从试点实践中识别出电子处方给医疗系统药房的药物，并在实施 CancelRx 前后（2018 年 1 月 16 日至 4 月 15 日与 2019 年）停止用药。我们将这些 EHR 数据与药房管理软件数据进行匹配，以识别在停药后 6 个月内出售给患者的药物。作为意外取消的替代指标，我们还识别了在停药后 120 天内重新配药的药物。我们进行了病历审查，以确定记录表明医生有停止使用这些药物的意图。
CancelRx 的实施防止了在 EHR 中停止处方后的药物销售（42 例中有 392 例[10.7%]与 0 例中有 387 例[0.0%]，P < 0.0001），但只有 15 例（42 例中有 15 例[35.7%]）记录了停止用药的意图（392 例中有 15 例，或总体上有 3.8%）。在 120 天内重新配药的停用药物比例略有增加（10.0%比 12.7%，P = 0.23）。实施 CancelRx 后对重新配药的病历审查发现，在 49 例中，可能有 10 例（387 例中有 10 例，或总体上有 2.6%）是意外取消的。
实施 CancelRx 可消除 EHR 中停止用药后的电子处方药物销售，但可能导致一些处方意外取消。增加医护人员和药剂师对情况的认识的策略，包括增加 CancelRx 的可见度、明确区分有效和过期处方、以及传达停止用药的原因，可能会降低意外取消的风险。
