Evaluating the effect of making the indication field compulsory in electronic prescriptions: A pre-post study in a...

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.

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 8 weeks after introduction of a compulsory indication field to an equivalent 8 weeks in 2022. Secondary outcomes included medication cessation and indication recording before discharge.

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 5557 prescriptions with 'to be determined' initially, 18.1% were ceased and 2.7% had an indication before discharge.

After making the prescription indication field compulsory, the proportion of medicines with an indication increased from 29% to 76%, with only a small increase in 'rubbish text'. Following the system change, the quality of information recording improved but there was no change in medicine use. Compulsory fields should be combined with improvements in other components of care to improve medicine use.