Difference between revisions of "Impact of a warning CPOE system on the inappropriate pill splitting of prescribed medications in outpatients"

From Clinfowiki
Jump to: navigation, search
(Results)
(Conclusion)
Line 11: Line 11:
  
 
==Conclusion==
 
==Conclusion==
 +
The study demonstrated that the warning system for prescriptions had a clear learning effect on physician prescribing behavior. After the introduction of the system, the rates of the inappropriate pill splitting were significantly reduced. The authors recommend developing and implementation of interruptive warning system.
 +
 
==Comments==
 
==Comments==
 
This study was conducted in Taiwan. In the USA, FDA does not have a clear policy on pill splitting bit advises against such practice.  
 
This study was conducted in Taiwan. In the USA, FDA does not have a clear policy on pill splitting bit advises against such practice.  

Revision as of 13:00, 31 October 2015

The article was published in 2014 in PLOS ONE, the world’s first multidisciplinary Open Access journal.

Background

Splitting of extended-release (ER) or enteric-coated (EC) oral drugs can lead to adverse drug events (ADE). To reduce inappropriate pill splitting, the authors developed an automatic warning system within CPOE in an outpatient setting of a hospital. The study assessed the impact of the system and physicians responses. [1]

Methods

The authors designed a real time pop up on the CPOE screen. The message was “Drug should not be split. Please revise the prescription.” Physicians had to change the prescription or select another medication. The study compared inappropriate splitting before and after the implementation of the warning system.

Results

In the late intervention period, the rate of pill splitting was lower than that in the baseline period (0.61% vs 0.16%). The physician' responses to the warning message were changing to the whole pill by adjusting dose or frequency (72.9%), switching to same-ingredient with different formulation(11.8%), switching to an alternative (10.3%), and cancelling the drug.

Conclusion

The study demonstrated that the warning system for prescriptions had a clear learning effect on physician prescribing behavior. After the introduction of the system, the rates of the inappropriate pill splitting were significantly reduced. The authors recommend developing and implementation of interruptive warning system.

Comments

This study was conducted in Taiwan. In the USA, FDA does not have a clear policy on pill splitting bit advises against such practice. "Not all pills are safe to split. Patients may mistakenly think that any pill can be split. But some pills, such as capsules and time-released drugs, should always be taken whole. For example, some tablets are coated with a substance that helps to release the medicine slowly. Splitting these tablets destroys the coating, which means you might absorb the medicine too fast or not at all." [2]


References

  1. Hsu C-C, Chou C-Y, Chou C-L, et al. Impact of a Warning CPOE System on the Inappropriate Pill Splitting of Prescribed Medications in Outpatients. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC4257670/
  2. FDA. Tablet Splitting: A Risky Practice.