Clinical Indications in Hospital and on Discharge

What did the 2019 UK study find?

That few trusts required an indication for every medicine. Katherine Shemilt and colleagues looked at the impact of including clinical indications on inpatient prescriptions (Clinical Pharmacist, published online 8 January 2019; read the article).

Only 4 of the 64 trusts (6%) required an indication for all medicines, while 15 (23%) did not require one for any medicine.

Pharmacists called indications “helpful” or “useful”. This site’s news item summarised their view: indications would be “helpful and practical to implement on new prescriptions but time consuming and difficult to apply to pre-existing medicines”.

What did the authors warn about?

Forcing prescribers to fill in a field. They conclude that “systems that force prescribers through mandatory fields to document clinical indications may be counterproductive.”

What happened when the field became compulsory?

Recording went up. Pairman, Chin and Doogue compared prescriptions before and after the indication field became compulsory in a hospital electronic prescribing system in Christchurch, New Zealand (Br J Clin Pharmacol 2025; PubMed).

The share of medicines with an indication rose from 29% to 76%, “with only a small increase in ‘rubbish text’”. The authors found “no change in medicine use”.

Do the two studies disagree?

They answer different questions. The 2019 study looked at what UK trusts required and what pharmacists thought; the 2025 study measured what a compulsory field changed in one hospital system in New Zealand.

The first warns against forcing prescribers through mandatory fields. The second found that a compulsory field raised recording, with only a small increase in rubbish text.

What does the wider research say?

In a 2026 review, most of the studies concerned antimicrobials. The systematic review, by the same authors, included 24 studies; 16 covered antimicrobials, and “only one study examined prescriptions for all medicines”. The authors call for “agreed international standards to guide system vendors” (Int J Med Inform 2026; PubMed).

See research for what is and is not known, and system suppliers on indication fields.

Why record the reason in hospital?

Dr Masters compares prescribing with X-ray radiography. In FAQ 7 he notes that in radiography “it is mandatory to explain the clinical indication to justify exposure to a potentially hazardous procedure”, and argues that clinical indications linked to prescriptions may in future be medico-legally essential to justify a medicine’s risk.

A 2016 NEJM commentary by Schiff and colleagues, “Incorporating indications into medication ordering: time to enter the age of reason”, advocates indications-based prescribing coupled with health information technology as a way to improve team communication, medication reconciliation, and patient education and compliance (PubMed).

What happens to the indication at discharge?

It should travel with the patient. Dr Masters’ FAQ 15 (2006) describes the route. The hospital doctor who prescribes records the use in the clinical record, for example an angiogram report with a drug list, and needs to make sure the hospital pharmacy uses clinical indications in the same way.

The information then flows out to primary care: first the practice computer, then the local pharmacy computer, and finally the MAR (medicine administration record) in a care home or the label on the medicine package at home. See care homes and MAR charts.

How can a hospital check?

With two audits. Dr Masters’ audits page (April 2006) describes a departure audit of ward drug charts, and a destination audit of discharged patients’ medicine packets to see whether the clinical indications are listed.