eDeprescribing

Pharmacy dispensing of electronically discontinued medications

Study type/ Setting Methods Outcomes Recommendations Source
Retrospective cohort study

Setting: Ambulatory Care

- To assess the frequency of and potential patient harm associated with pharmacy dispensing of discontinued medications in the ambulatory setting within 12 months - 30,406 adult patients with an electronic discontinuation order - A large amount of prescriptions electronically canceled in EHRs were still filled at the pharmacy - Among 83,902 targeted medications that were electronically discontinued, 1,218 were subsequently dispensed by the pharmacy - The dispensing of discontinued medications represents an important ambulatory patient safety concern.  - Better communication between providers and pharmacists is needed to improve medication safety Allen et al. (2012)

 

No Open Access Version Available

Allen AS, Sequist TD. Pharmacy dispensing of electronically discontinued medications. Ann Intern Med. 2012;157:700-5. [PMID: 23165661]

Responsible e-Prescribing Needs e-Discontinuation

Study type/ Setting Methods Outcomes Recommendations Source
JAMA network Viewpoint Opinion paper E-prescribing systems that do not allow electronic cancellation of med orders, or e-discontinuation, and can lead to more medication reconciliation errors Fischer S et al. (2017)

No Open Access Version Available

Fischer S, Rose A. Responsible e-Prescribing Needs e-Discontinuation. JAMA. 2017;317(5):469–470. doi:10.1001/jama.2016.19908

The Case for Electronic Cancel or Discontinuation of Prescription Therapy at the Pharmacy

Study Type/ Setting Methods Outcomes Recommendations Source
Article Objective was to focus on integration of cancel Rx both from provider end and pharmacy end to reduce inappropriate therapy

 

- Study conducted in Brigham and Women’s - 1.5% of all discontinued prescription medications in their target medication study sample were dispensed by pharmacies.            - More importantly, investigators reported at least 50 patients, or 12% of those receiving discontinued medications, had experienced some adverse outcome that ranged from mild side effects to life-threatening allergic reactions. Prescribers and pharmacists should reach out to their software technology providers and convey to them the urgency and the need to implement the CancelRx /Response Rx transaction capability Dhavel A 

 

 

Dhavel A. The Case for Electronic Cancel or Discontinuation of Prescription Therapy at the Pharmacy. LinkedIn. https://www.linkedin.com/pulse/case-electronic-canceldiscontinuation-prescription-therapy-dhavle. Accessed May 27, 2019.

NCPDP Foundation Awards a Grant to Johns Hopkins Medicine to Support Implementation of CancelRx Functionality in NCPDP’s SCRIPT Standard

Study Type/ Setting Methods Outcomes Recommendations Source
Report by PRWeb

 

Setting: Ambulatory Care

- Primary objective is to implement CancelRx functionality in EHRs and pharmacy management systems in the ambulatory setting - Reported 3% Rx are filled erroneously following discontinuation - Implementation of CancelRx would minimize erroneous filling and medication error  

NCPDP 

Ncpdpfoundation.org. (2019). [online] Available at: http://ncpdpfoundation.org/PDF/NCPDP_Foundation_Grant_Johns_Hopkins_Medicine.pdf [Accessed 27 May 2019].

Analysis of medication therapy discontinuation orders in new electronic prescriptions and opportunities for implementing CancelRx

Study Type/ Setting Methods Outcomes Recommendations Source
Retrospective analysis - N=1,400,000 - 410,591 prescribers using 734 EHRs

- 7 day follow up (Nov 6, 2016-Nov 12, 2016)

- The sample size was calculated to be representative with a margin of 0.8% error at a confidence level of 99.9%

- Variable: New Rx with cancellation message vs CancelRx

- Identified 9735 (0.7% of the total) NewRx messages containing prescription cancellation instructions with 78.5% observed in the Notes field; 35.3% of identified NewRxs were associated with high-alert or LASA medications.

- The most prevalent cancellation instruction types were medication strength or dosage changes (39.3%) and alternative therapy replacement orders (39.0%)

- Wider adoption of CancelRx in the EHR and pharmacy systems can significantly impact patient safety by reducing duplication and inappropriate medications  

Yang Y et al. (2018)

 

 

Yang Y, Ward-Charlerie S, Kashyap N, Demayo R, Agresta T, Green J. Analysis of medication therapy discontinuation orders in new electronic prescriptions and
opportunities for implementing CancelRx. Journal of the American Medical Informatics Association. 2018;25(11):1516-1523.