title: Improving adherence to safe prescription guidelines for Dapsone: harnessing an enhanced electronic medical records system and a team approach.
abstract: BACKGROUND
  Dapsone is a commonly prescribed medication in dermatological practice. Its use is associated with a broad spectrum of adverse effects. Careful selection and monitoring of patients on dapsone are paramount in the prevention and early recognition of adverse effects.
  
  
  OBJECTIVE
  We designed a risk-management program for dapsone at National Skin Centre, Singapore, enhancing an existing electronic medical records system and harnessing a team approach involving the nurses. This includes the performance of key laboratory tests before and after starting dapsone, ensuring adequate counseling before starting dapsone and screening for adverse effects using a questionnaire every visit.
  
  
  RESULTS
  This system of dapsone prescription efficiently improved the adherence to safe prescription and monitoring guidelines. Average adherence rates for key safety parameters improved from 61.4% pre-implementation to 95.3% at six months and were sustained at 12 months at 91.3%. Percentage of follow-up cases in which all three key monitoring parameters were fulfilled increased from 9.5% to 79.6% (p=0.0001) after 12months. The percentage of new patients in which all four key monitoring parameters were met increased from 50% to 80%. It was not statistically significant possibly because of small patient numbers. This project has also translated into enhanced patient safety with dapsone dosages adjusted in 17 patients who experienced mild adverse effects. No severe adverse effects to dapsone were observed in the 12-month period.
  
  
  CONCLUSIONS
  This example of risk management for dapsone may serve as a model for institutions looking at harnessing information technology and a team approach for safer prescription of high-alert medications.
authors.affiliation: Department of Dermatology, National Skin Centre Department of Pharmacy, National Skin Centre, Singapore Department of Nursing, National Skin Centre, Singapore. mailcyneoh@yahoo.com.sg
authors.forename: Ching Yin
authors.initials: CY
authors.lastname: Neoh
authors.forename: Elizabeth A L
authors.initials: EA
authors.lastname: Tian
authors.forename: Cindy
authors.initials: C
authors.lastname: Choi
authors.forename: Hui Hui
authors.initials: HH
authors.lastname: Leong
authors.forename: Audrey W H
authors.initials: AW
authors.lastname: Tan
authors.forename: Roy K W
authors.initials: RK
authors.lastname: Chan
mesh_terms: D003622:Dapsone / Q000009:adverse effects / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000451:nursing; D057286:Electronic Health Records; D019983:Guideline Adherence; D006801:Humans; D055118:Medication Adherence; D010348:Patient Care Team; D017410:Practice Guidelines as Topic
chemical_list: D003879:Dermatologic Agents; D003622:Dapsone