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Cancellation Messaging After Discontinuation of Electronic Prescriptions in EHRs

After the implementation of e-prescription cancellation messaging (CancelRx), the proportion of e-prescriptions sold after discontinuation in the electronic health record (EHR) fell immediately and remained low, researchers report. “Widespread implementation of CancelRx may significantly improve medication safety through the reduction of medication dispensing after discontinuation by prescribers,” the authors conclude.

Medications e-prescribed for ambulatory patients in a health-system pharmacy were analyzed from 1 year before to approximately 1 year after CancelRx implementation. Using a primary outcome of the proportion of e-prescribed medications dispensed and sold to patients by pharmacies within 6 months after discontinuation in the EHR, the investigators found the following: “A total of 53,298 qualifying e-prescriptions that were discontinued were identified for 17,451 unique patients (mean [SD] age, 50.6 [18.2] years; 9,332 women [53.5%]). After CancelRx implementation, 22,443 (85.9%) of the 26,127 discontinued e-prescriptions resulted in a CancelRx transaction. In interrupted time series analysis, the proportion of prescriptions dispensed after discontinuation decreased from a baseline of 8.0% (2,162 of 27,171) to 1.4% (369 of 26,127; P < .001), without a significant week-to-week trend (β = 0.000158; P = .37).”

Editorial: “As evidenced by the 1.4% of discontinued prescriptions still dispensed in [this study], even with the adoption of CancelRx, it is clear that we have not yet achieved a perfect system,” editorialists write. “There continue to be limitations, including missed or unsent CancelRx messages or pharmacies not participating in CancelRx. However, [these authors] demonstrated that CancelRx is worth implementing and may improve rates of electronic deprescribing in just 2 years. With states such as California implementing new e-prescription mandates and the continued rise of e-prescriptions, we need to address the issue of electronic deprescribing as quickly as possible and mitigate harm to patients.”

Source: JAMA Internal Medicine