Compulsory indications in hospital prescribing software tested with antibacterial prescriptions

Abstract

Abstract Purpose To assess and visualise how making the indication field compulsory in our electronic prescribing system influenced free text documentation. Methods This was a three-group prospective controlled study. In the intervention group of seven antibacterial medicines, the free text indication field was made compulsory in our electronic prescribing system. Text recorded in the indication field was manually classified as ‘indication present’, ‘other text’, ‘rubbish text’, or ‘blank’. The proportion of prescriptions with an indication for the seven antibacterials was compared with five antibacterials with and 72 without pre-existing compulsory indications for four weeks before and after the field was made compulsory. An interactive report was developed using a live data extract to illustrate indication provision for all medicines prescribed at our tertiary hospital. Results The proportion of prescriptions with an indication increased from 10.6–72.4% (p < 0.01) post-intervention. There was a 17.5% increase in ‘other text’ (p < 0.01), and 0.6% increase in ‘rubbish text’ (p < 0.01). Indications increased 2.7% (p < 0.01) in antibacterials without and 0.5% (p = 0.89) in antibacterials with pre-existing compulsory indications. The interactive report was validated and locally published. Conclusion Introducing a compulsory indication field in electronic prescriptions increased the proportion of indications documented substantially. There was only a small increase in ‘rubbish text’ reducing concern inaccurate information is recorded as a ‘workaround’ to the compulsory field. Interactive reports with live data support audit and quality improvement projects.