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.

Aim Indications for medicines are poorly recorded in prescriptions at our hospitals. Indications are ‘optional’ on paper prescriptions but can be mandated in electronic prescriptions. As part of an initiative to improve indication documentation for antimicrobial medicines, a prospective controlled study of compulsory indications for antibacterial medicines was undertaken. Our aim was to assess the effect of making indications compulsory in an electronic prescribing and administration (ePA) system. Methods Compulsory indications on prescriptions were implemented in our tertiary hospital ePA system for eight antibacterial medicines. The proportion of ‘credible indications’ following the intervention for these medicines was compared with 23 antibacterial medicines with pre-existing (positive control) and 71 without (negative control) compulsory indications. Documented indications for all antibacterial medicines four weeks before and after implementation of compulsory indications were extracted from the ePA system and manually classified as ‘credible indication’, ‘other text’, ‘rubbish text’, or ‘blank’. Results The proportion of ‘credible indications’ for the intervention group had an absolute increase of 64.8%, from 12.5% (270/2166) to 77.3% (1684/2179). In the intervention group ‘rubbish text’ increased by 1.3% (from 0.05% to 1.3%), ‘other text’ increased from 5.4% to 15.3%, and ‘blank’ decreased from 82.1% to 6.1%. For antibacterials with no compulsory indication ‘credible indications’ increased from 22.0% (793/3611) to 46.0% (1667/3621), and in those with pre-existing compulsory indications from 80.3% (191/238) to 83.2% (183/220). Conclusion Implementation of compulsory indications for antibacterial medicines in the ePA system increased ‘credible indications’ substantially with a small increase in ‘rubbish text’.