Assessing the effect of providing a pharmacist with patient diagnosis on electronic prescription orders: a pilot study

Abstract

Background: As a result of the US Omnibus Reconciliation Act of 1990 (OBRA '90), pharmacists have the obligation to ensure that prescription orders are appropriate and are not likely to cause adverse events. However, patient diagnosis information is not a requirement for a legal prescription order in any state in the US.

Objective: To compare a pharmacist's interventions before and after patient diagnosis is added by prescribers to their electronic prescription orders.

Methods: This prospective, pre-post study was conducted during two consecutive 4-week periods in a community health center pharmacy. During the first data collection period, the clinical pharmacist prospectively evaluated e-prescriptions using a standard DUR protocol. All problematic prescriptions were documented using a medication intervention form. During the second data collection period, providers included the patient's diagnosis on each e-prescription and the same clinical pharmacist again evaluated prescribed therapy and documented interventions.

Results: Pharmacist intervention rates on e-prescription orders were significantly lower following addition of the patient diagnosis information to the e-prescription order (3.9% pre- vs. 1.0% post-, P < 0.001).

Conclusions: While preliminary, the results of this pilot suggest that the addition of patient diagnosis to the e-prescription order can reduce confusion and uncertainty on the part of a DUR pharmacist, thereby decreasing the overall number of interventions and the subsequent number of contacts with prescribers.

Keywords: Information exchange; Intervention; Pharmacist; e-prescription.