Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review...

Area of Science:

• Pharmacoeconomics and Health Policy
• Clinical Pharmacy and Practice
• Health Informatics

Background:

• Routine documentation of medication indications on prescriptions and inpatient orders remains suboptimal despite recommendations.
• Existing systematic reviews primarily focus on antimicrobial indication documentation, necessitating a broader synthesis for general medications.
• This study aims to synthesize literature on interventions for improving medication indication documentation and prescribing, exploring participant perspectives and barriers/facilitators.

Approach:

• Conducted a systematic literature search across Medline, Embase, and CINAHL, focusing on electronic prescribing systems and indication documentation.
• Included qualitative, quantitative, and mixed-methods studies, extracting outcome measures for narrative synthesis.
• Employed the Mixed Methods Appraisal Tool for quality appraisal by two independent reviewers.

Key Points:

• Twenty-one studies evaluated interventions for indication documentation, utilizing free-text, lists, or pre-defined order sentences.
• Positive impacts observed in medication order appropriateness (6/8 studies), prescribing error rates (2/2), and some clinical/workflow outcomes (2/4, 2/3).
• Challenges include accuracy of documentation and unintended consequences on medication use; barriers like long lists and workflow issues contrast with facilitators like improved communication.

Conclusions:

• Indication documentation holds significant potential for enhancing prescribing appropriateness and minimizing errors.
• Realizing broader benefits for prescribers, multidisciplinary teams, and patients requires developing more workflow-efficient indication documentation methods.
• Further research and practice development are needed to optimize indication documentation integration.