title: Missed drug therapy alerts as a consequence of incomplete electronic patient records in Dutch community pharmacies.
abstract: BACKGROUND
  Complete and up-to-date medical and pharmaceutical information in the electronic patient record (EPR) is a prerequisite for risk management in community pharmacy.
  
  
  OBJECTIVE
  To analyze which information is missing in the EPR and which drug therapy alerts, therefore, fail to appear.
  
  
  METHODS
  Pharmacy students selected patients who were dispensed a prescription drug and enlisted for >3 months in the participating pharmacies. Patients received a questionnaire in which they were asked to verify their medication history, and to provide additional patient information. For each enrolled patient, the students collected all relevant information from the EPR. Self-reported data from the patient were compared with data retrieved from the EPR. Missed information in the EPR was evaluated based on national professional guidelines.
  
  
  RESULTS
  Questionnaires were received from 67% of the selected patients (442/660). Prescription drugs were missing in the EPR of 14% of the 442 patients, nonprescription drugs in 44%, diseases in 83%, and intolerabilities in 16%. In 38% of the patients (166/442), drug therapy alerts failed to appear because of missing information: drug-disease interactions in 34% of the patients, duplicate medications in 4%, drug-drug interactions (DDIs) in 4%, and drug intolerabilities in 2%. Among the (non-)prescription drugs missing, NSAIDs were most frequently responsible for the missed alerts. Diseases most frequently associated with missed alerts were gastroesophageal reflux disease, renal insufficiency, asthma/chronic obstructive pulmonary disease, and heart failure.
  
  
  CONCLUSIONS
  Relevant patient information was frequently missing in the EPRs. The nonappearance of drug therapy alerts may have had clinical consequences for patients.
authors.affiliation: SIR Institute for Pharmacy Practice and Policy, Leiden, Netherlands.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Floor-Schreudering
authors.forename: Mette
authors.initials: M
authors.lastname: Heringa
authors.forename: Henk
authors.initials: H
authors.lastname: Buurma
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Bouvy
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: De Smet
mesh_terms: D004347:Drug Interactions; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D050316:Medical Order Entry Systems; D009426:Netherlands; D061214:Patient Safety; D010594:Pharmacies / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: automated drug alerts; clinical risk management; community pharmacy services; drug safety alerts; electronic patient record; pharmacy information systems