Department of Surgery and Cancer, Imperial College London, London, UK
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
BMJ Qual Saf. 2023 Jun;32(6):357-368. doi: 10.1136/bmjqs-2022-015452. Epub 2023 Feb 14.
Despite recommendations, documentation of indication on prescriptions and inpatient medication orders is not routinely practised. There has been a recent systematic review of indication documentation for antimicrobials, but not for interventions relating to indication documentation for medication more broadly. Our aims were to 1) identify, describe and synthesise the literature relating to effectiveness of interventions aimed at improving indication documentation and/or indication-based prescribing in both primary and secondary healthcare; 2) synthesise participant perspectives to identify barriers and facilitators to these interventions; and 3) make recommendations for both practice and research.
A systematic literature search was conducted using Medline, Embase and CINAHL using two search concepts: electronic prescribing systems, and indication documentation and/or indication-based prescribing. Qualitative, quantitative and mixed-methods studies were included; outcome measures and results were extracted to produce a narrative synthesis. Quality appraisal by two independent reviewers was undertaken using the Mixed Methods Appraisal Tool.
We identified 21 studies evaluating interventions to aid indication documentation. Indication documentation was either via free-text, selection from a list, or by use of pre-defined indication-based order sentences for individual medications. For a number of outcomes, there was a mostly positive impact, including appropriateness of the medication order (6 of 8 studies), rates of prescribing error (2/2) and some less commonly reported clinical (2/4) and workflow-related outcomes (2/3). There was a less favourable impact on accuracy of indication documentation and rates of medication use, highlighting some unintended consequences that may occur when implementing new interventions. Participant insights from prescribers and other healthcare professionals complemented quantitative study results, highlighting both facilitators and barriers to indication documentation and the associated interventions. For example, barriers included long drop-down lists and the need to use workarounds to navigate approval systems due to time or knowledge constraints. Facilitating factors included the perceived benefits of indication documentation on communication among the healthcare team and with the patient.
Indication documentation has the potential to improve appropriate prescribing and reduce prescribing errors. However, further benefits to the prescriber, multidisciplinary team and patient may only be realised by developing methods of indication documentation that integrate more efficiently with prescriber workflows.
CRD42021278495.
尽管有相关建议，但在开具处方和住院医嘱时，对适应证的记录并不常见。最近有一项针对抗菌药物适应证记录的系统评价，但没有针对更广泛的药物适应证记录干预措施的系统评价。我们的目的是：1）确定、描述和综合与旨在改善初级和二级保健中适应证记录和/或基于适应证的处方的干预措施相关的文献；2）综合参与者的观点，以确定这些干预措施的障碍和促进因素；3）为实践和研究提出建议。
使用 Medline、Embase 和 CINAHL 进行了系统文献检索，使用了两个检索概念：电子处方系统和适应证记录和/或基于适应证的处方。纳入了定性、定量和混合方法研究；提取了结局测量和结果，以进行叙述性综合。两名独立评审员使用混合方法评估工具进行了质量评估。
我们确定了 21 项评估干预措施以辅助适应证记录的研究。适应证记录通过自由文本、从列表中选择或使用针对个别药物的预定义基于适应证的医嘱句子来完成。对于许多结局，干预措施具有积极影响，包括药物医嘱的适宜性（8 项研究中的 6 项）、处方错误率（2/2）和一些较少报告的临床结局（4 项研究中的 2 项）和工作流程相关结局（3 项研究中的 2 项）。在适应证记录的准确性和药物使用率方面的影响较差，这突出了在实施新干预措施时可能出现的一些意外后果。来自处方者和其他医疗保健专业人员的参与者见解补充了定量研究结果，突出了适应证记录和相关干预措施的促进因素和障碍。例如，障碍包括下拉列表过长，以及由于时间或知识限制，需要使用变通方法来通过审批系统。促进因素包括认为适应证记录对医疗团队内部以及与患者之间的沟通有好处。
适应证记录有可能改善适当的处方和减少处方错误。然而，只有通过开发与处方者工作流程更有效地集成的适应证记录方法，才能为处方者、多学科团队和患者带来更多益处。
PROSPERO 注册号：CRD42021278495。
