Construction and refined management of a pre-prescription review system: a real-world study in a tertiary hospital

Abstract

Objective: Information technology-driven pre-prescription review system (PPRS) is critical pillars for medication safety. How to balance the efficiency and accuracy of review has become a core issue. This study aims to retrospectively analyze the establishment and application effectiveness of the PPRS for rational drug use. It summarizes the system's limitations and operational challenges encountered, further explores refined management pathways for the system, and provides insights and considerations for smart healthcare to assist clinical practice in promoting rational drug use.

Method: A single-center real-world retrospective analysis study was conducted at a tertiary hospital in Chongqing, China. Using evidence-based methods, a descriptive analysis was conducted on the construction and refined management path of PPRS, and its effectiveness was evaluated. Before and after the PPRS went online, prescription and inpatient order data were monitored. Unpaired sample t-test and one-way ANOVA were used to study the primary outcome of the rationality rate of prescriptions and medical orders, and the secondary outcome of the types of unreasonable prescriptions and the changes in system warning levels.

Results: The construction and refined management of PPRS have significantly increased the rationality rate between the total prescriptions (92.53% vs. 99.94%, P < 0.0001) and medical orders (97.77% vs. 99.99%, P < 0.0001). The proportion of prescriptions with high problem proportions decreased significantly after intervention, such as repeated medication (24.94% vs. 3.85%, P < 0.0001). In addition, following implementation, the proportion of prescriptions with usage and dosage issues (34.31% vs. 19.51%) also decreased before intervention. The number of PPRS intercepted alerts has increased annually, with the proportion of Level 3 prescription alerts (12.77% vs. 15.71%) and Level 4 medical orders alerts (42.40% vs. 55.48%) increased, while the proportion of Level 2 alerts for prescriptions (2.61% vs. 0.91%) and medical orders (2.12% vs. 1.04%) generally showed a downward trend, reducing the frequency of invalid alerts.

Conclusion: The construction and implementation of PPRS is associated with enhancing the rationality of prescriptions and medical orders. Under the guidance of the refined management pathway, a replicable template has been established to support clinical practice in smart healthcare, reduce invalid alerts, and promote personalized medication.

Keywords: pharmacist; pre-prescription review system; prescription and medical order review; refined management pathway; review efficiency and accuracy.