Medical Inspection – Health Blog

Update knowledge of therapeutics

Three key factors were listed by the IOM that contribute to prescribing error: 1) using the wrong drug name, 2) incorrect dosage calculations, and 3) atypical or unusual and critical dosage frequency. It is very easy to use the wrong drug name when prescribing, because so many new drugs enter the market every year. The FDA Center for Drug Evaluation and Research (CDER) approved 98 original new drugs in 2000. There are more than 17,000 trade and generic names for pharmaceuticals marketed in North America. Keeping up-to-date and being ready to address drug-related questions posed by patients is becoming increasingly challenging.

Formulary

A useful approach may be for physicians to create their own “personal” formulary of frequently used medications and become familiar with any new information regarding these agents. Numerous sources of drug information are available to physicians. viagra soft

An important criterion for the use of any source is that it should provide unbiased and up-to-date information.

Obtain a personal digital appliance

Interested physicians should point their browser to any one of several Internet-based services that allow physicians to download a database of drug prescribing information onto handheld devices for use at the point of care. These handheld devices allow primary care physicians to look up unfamiliar drugs and review ADR as well as perform checks for drug-drug interactions. All this can be performed before the consultation with the patient is over. Epocrates, a leader in electronic drug databases for the Palm platform, estimates that over 600,000 healthcare providers have used their software. Table 1 provides a partial listing of companies providing electronic drug databases.

Electronic prescribing

This is one way to decrease some of the potential errors associated with prescriptions. A large number of prescription errors arise as a result of mistakes made in attempting to read the handwriting of physicians. A report from the Institute for Safe Medication Practices noted that, each year, pharmacists make approximately 150 million calls to clarify illegible prescriptions. A cardiologist in Texas was ordered to pay $225,000 to the family of a patient who died after receiving Plendil® instead of Isordil®; the pharmacist could not read and did not question the illegible prescription. A 1997 report by the American Medical Association showed that medication errors secondary to misinterpreted physicians’ prescriptions were the second most prevalent and expensive claim listed on 90,000 malpractice claims filed over a seven-year period.
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Table 1. Some Examples of Technology Companies Involved in Drug Databases/ Prescription Writing for Handheld Devices Drug Reference Information

Electronic prescribing, or e-prescribing, reduces inefficiencies in the prescription writing process and eliminates problems associated with illegibility. Computer technology already exists for prescriptions to be sent electronically to community pharmacies. In addition, several companies are attempting to integrate wireless prescription capability and office-based systems. The attempts at integration hopefully will provide access to patient information relevant to prevention of medication errors (i.e., drug allergies and potential drug conflicts). These devices can also be programmed to check to ensure formulary compliance at the point of care. Table 1 provides a partial list of companies currently involved in ventures to provide clinicians with electronic prescription systems.
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Steps to reduce prescription writing errors

Primary care physicians should review the five “rights” of prescription writing with each patient encounter—right patient, right drug, right time, right dose, and right route. If prescriptions are to be handwritten, physicians should take the following specific steps to avoid making any errors:

• clearly state patient’s name
• provide the generic and brand name of the drug whenever possible and avoid abbreviations
• write out the drug strength in metric units and never leave a decimal point “naked” nor use a “trailing” zero (e.g., write “0.1 mg” instead of “.1 mg” and “1 mg” instead of “1.0 mg”)
• state the dosage form and the amount to be dispensed
• directions for use should be clearly stated and lastly,
• if patient confidentiality is not an issue, state the purpose of the medication.

Prescribe medications only when necessary

While this statement may seem obvious, some physicians have prescribed medications because of patient demand. Direct-to-consumer drug advertising, now commonplace, may place undue stress on many physician-patient relationships. Primary care physicians should resist the temptation to prescribe at the insistence of patients and should educate patients about the clinical reasoning behind the use or nonuse of specific agents.
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Related Posts

• Strategies to Reduce Medication Errors in Ambulatory Practice: Prevention Strategies for Primary Care Physicians part 3
• Strategies to Reduce Medication Errors in Ambulatory Practice: Prevention Strategies for Primary Care Physicians part 2
• Strategies to Reduce Medication Errors in Ambulatory Practice
• Improving the Reporting of Medication Errors: PROMOTING A CULTURE OF SAFETY