Evaluating the effect of making the indication field compulsory in
electronic prescriptions: a pre-post study in a hospital prescribing
system
Abstract
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.