The indication field became compulsory in our electronic hospital prescribing system in May 2023. The proportion of prescriptions with an indication increased from 29% to 76%. The aim of this study was to determine if the accuracy of indications decreased after indications were made compulsory. Accuracy was defined as the same indication being documented in the prescription and the patient notes. Accuracy was assessed in a random sample of 124 prescriptions before and 124 prescriptions after indications were made compulsory. The indication was accurate for 93.5% before and 94.4% after compulsory indications: a difference of 0.8% (95% CI -5.1% to 6.7%). For 84% of prescriptions, the indication was documented in the clinical notes prior to the prescription being created. Accuracy of the indication field was maintained after indications were made compulsory and completion rates increased.

Aim To examine use of antiplatelet and anticoagulant medicines for two years following thromboembolic stroke. Methods Hospital and community medicines data for adult patients with a primary diagnosis of thromboembolic stroke between 01/01/2017 and 31/12/2021 in Canterbury, New Zealand, were linked with demographic, morbidity, and outcome data. Anticoagulant use was described for patients with atrial fibrillation or prior anticoagulant therapy (group B). Antiplatelet use was described for the remaining patients (group A). Variables associated with initiation of and persistence with treatment were identified. Results In group A (1,922 patients) 78% were dispensed an antiplatelet after discharge. In group B (1,072 patients) 66% were dispensed an anticoagulant after discharge. Reduced dispensing of both antiplatelets and anticoagulants after discharge was associated with prior haemorrhage and discharge into supported care (group A adjusted odds ratios [aOR] 0.4, 95% CI 0.3-0.7, and aOR 0.4, 0.3-0.6 respectively, and group B aOR 0.6, 0.4-0.8, and aOR 0.5, 0.3-0.7 respectively). Of those dispensed treatment following discharge, 49% persisted on antiplatelet treatment and 53% persisted on anticoagulant treatment until censored. Persistence on antiplatelet treatment was greater with polypharmacy (adjusted hazard ratio [aHR] 1.6, 1.4-1.9) and persistence on anticoagulation treatment reduced with higher deprivation (aHR 0.7, 0.5-0.9). Conclusion Real-world use of antiplatelet and anticoagulant treatment following thromboembolic stroke was suboptimal when compared to guidelines. There are opportunities to improve this, particularly in managing discharge medicines and medicines prescribed at the first community visit.

Aim: To quantify the prevalence and incidence of medicines use per patient hospital admission and illustrate the importance of definitions in quantifying medicines use. Method: Data from all public hospitals in the health district of Canterbury, New Zealand between 01/07/2022 and 01/07/2023 were extracted, totalling 53,580 hospital admissions of 39,703 adult patients who survived to discharge. Patients’ medicines use from hospital admission to discharge was quantified and linked to outcomes data. Results. The average number of medicines at discharge was 3.7 (SD 3.4) long-term, 1.2 (SD 1.2) short-course, and 4.3 (SD 2.4) PRN. The prevalence of polypharmacy at discharge was 36% (19,511/53,580) for long-term medicines and 84% (45,214/53,580) for all medicines. Per admission an average of 1.0 (SD 1.9) long-term medicines were started, 0.5 (SD 1.1) were stopped, and 0.3 (SD 0.7) had dose changes. Per admission there were 11.5 (SD 6.0) different medicines prescribed, 14.4 (SD 9.9) prescriptions, and 26 (IQR 11 to 60) doses of medicines administered. For patients with five or more long-term medicines at discharge, the adjusted odds of mortality were decreased (adjusted odds ratio [aOR] 0.73, 95% CI 0.67 to 0.79), and the adjusted odds of hospital readmission and adverse drug reaction occurrence were increased (aOR 1.22, 95% CI 1.16 to 1.29, and aOR 1.34, 95% CI 1.23 to 1.45). Conclusion. Standard definitions are needed to validly quantify medicines use and compare use between health care settings. Where longitudinal data exist, changes in medicines use can be measured, rather than inferred from cross sectional studies.

Aim Recording the indication for a medicine in the prescription supports communication. In May 2023 our district hospitals made the free-text indication field in prescriptions compulsory for all medicines in the inpatient prescribing system. This study aimed to evaluate the effect of introducing a compulsory indication field in an inpatient prescribing system. Methods Text in the indication field was manually classified as an indication, ‘other text’, ‘rubbish text’, ‘to be determined’, and ‘blank’. Prescribing data were extracted from the district data warehouse. The change in proportion of prescriptions with an indication was compared for eight-weeks after introduction of a compulsory indication field to an equivalent eight-weeks in 2022. Secondary outcomes included patient outcomes, medication cessation, and indication recording before discharge. Results We analysed 81,634 prescriptions before and 82,726 after indications were made compulsory. The proportion of prescriptions with an indication increased from 29.2% to 75.6%. ‘Rubbish text’ increased from 0% to 2.3%, ‘other text’ from 2.5% to 14.7%, and ‘to be determined’ from 0.0% to 6.6%. Of 5,557 prescriptions with ‘to be determined’ initially, 18.1% were ceased and 2.7% had an indication before discharge. There was minimal change in patient outcomes. Conclusion Introducing a compulsory indication field increased the proportion of medicines with an indication from 29% to 76%, with only a small increase in ‘rubbish text’. The carefully selected compulsory field improved information quality but did not alter medicine use or patient outcomes. Compulsory fields should be combined with improvements in other components of care to improve medicine use.

Aim Indications for medicines are poorly recorded in prescriptions at our hospitals. Indications are ‘optional’ on paper prescriptions but can be mandated in electronic prescriptions. As part of an initiative to improve indication documentation for antimicrobial medicines, a prospective controlled study of compulsory indications for antibacterial medicines was undertaken. Our aim was to assess the effect of making indications compulsory in an electronic prescribing and administration (ePA) system. Methods Compulsory indications on prescriptions were implemented in our tertiary hospital ePA system for eight antibacterial medicines. The proportion of ‘credible indications’ following the intervention for these medicines was compared with 23 antibacterial medicines with pre-existing (positive control) and 71 without (negative control) compulsory indications. Documented indications for all antibacterial medicines four weeks before and after implementation of compulsory indications were extracted from the ePA system and manually classified as ‘credible indication’, ‘other text’, ‘rubbish text’, or ‘blank’. Results The proportion of ‘credible indications’ for the intervention group had an absolute increase of 64.8%, from 12.5% (270/2166) to 77.3% (1684/2179). In the intervention group ‘rubbish text’ increased by 1.3% (from 0.05% to 1.3%), ‘other text’ increased from 5.4% to 15.3%, and ‘blank’ decreased from 82.1% to 6.1%. For antibacterials with no compulsory indication ‘credible indications’ increased from 22.0% (793/3611) to 46.0% (1667/3621), and in those with pre-existing compulsory indications from 80.3% (191/238) to 83.2% (183/220). Conclusion Implementation of compulsory indications for antibacterial medicines in the ePA system increased ‘credible indications’ substantially with a small increase in ‘rubbish text’.