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Published on 1 May 2007

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Computerised prescribing order entry and the hospital pharmacist

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Waly Fager
PharmD
Hospital Pharmacist

Xavier Armoiry
PharmD
Hospital Pharmacist

Xavier Dode
PharmD
Hospital Pharmacist

Martine Billard
PharmD
Hospital Pharmacist

Gilles Aulagner
PharmD
Hospital Pharmacist
Head of Department
Pharmacy Department
Neurocardiological Hospital
Hospices Civils de Lyon
Lyon
France
E: wfager@free.fr

Adecree passed in France on 25 August 2005 aimed at making delivery of drugs in hospitals as safe as possible. To achieve this, nominative prescribing and dispensing are necessary. In French hospitals, drugs were globally delivered to wards several times a week, without pharmacists knowing which drug was to be administered to which patient. The use of computerised prescribing order entry (CPOE) was therefore necessary in order to ensure that pharmaceutical analysis was being performed.

In our hospital, CPOE with Cristal Net’s environment is being implemented ward by ward. Implementation began in July 2005 with a neurology ward. A year later, an extra four medical care units (two neurology and two cardiology wards) had been computerised. Implementation is in progress in ­several other wards.

Discussion
Pharmacists have been particularly involved in the implementation of CPOE, especially as the Cristal Net environment allows discussions between pharmacists and prescribers and between pharmacists and nurses.

Hospital pharmacists and their students carry out pharmaceutical analyses in each care unit on a daily basis.
Evaluation and assessment of prescription relevance in daily pharmaceutical analysis was carried out in two wards (neurology and cardiology) for four months.

The number of prescriptions analysed, the time taken to carry out the pharmaceutical analysis and the various types of pharmaceutical interventions (PIs) carried out were recorded daily. PIs were ­classified depending on their nature:

  • A: Assistance from CPOE.
  • B: Information about the hospital’s drug therapeutic formulary and economic interventions.
  • C1a: Unusual posology.
  • C1b: Pharmacological redundancy.
  • C1c: Inadequate drug distribution.
  • C1d: Posology adapted to patients with renal failure­, elderly patients, etc.
  • C2: Re-evaluation of treatment.
  • C3: Physical-chemical incompatibilities and drug interactions.
  • C4: Drug administration.

In addition, prescriptions were validated conditionally or unconditionally, depending on the severity of the problem.

Between 2 January and 28 April, 2,316 prescriptions were analysed. In both wards, the time taken to carry out a pharmaceutical analysis was about five minutes per prescription.

Of the 439 PIs carried out, 57% and 24% were taken into account by prescribers in cardiology and in neurology respectively, with a higher rate for prescriptions conditionally validated (79% and 67%, respectively; see Table 1). The most frequent types of PI were, in cardiology, C1 (44%), C4 (15%) and B (13%), and in neurology, C1 (32%), B (30%) and A (16%) (see Figures 1 and 2). The drugs that appeared most frequently in the PIs were those for treating cardiovascular, neurological and metabolism/digestive tract conditions.

[[HPE32_table1_75]]

[[HPE32_fig1_74]]

[[HPE32_fig2_74]]

Conclusion
Prescribers are paying more attention to prescriptions validated conditionally, which indicate possible risks for the patient.



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