HospiceMed is excited to introduce their e-prescribing system to all hospice agencies. The introduction is a good time to have a quick refresher on correct prescription writing. In the U.S., 1.3 million people are injured each year by medication-related errors. Of those injured, approximately 7000 deaths occur. In the U.S., drug-related mortality and morbidity costs over $175 billion annually. E-prescribing helps reduce the number of errors, especially those related to illegible handwriting. However, one of the most difficult items on a prescription for a pharmacist to decipher, whether handwritten or computer-generated, is poorly written directions.
When prescriptions are sent to the pharmacy, the pharmacist is required to interpret the instructions written by the prescriber and translate them onto the prescription label so the patient can easily understand them and take their medication correctly and safely. Often this means shortening long instructions to fit on a small label or lengthening short instructions for clarity. There a few prescription writing rules to remember that help prevent medications errors.
- Follow The Join Commission “Do Not Use” List. This is a list of abbreviations, acronyms, and symbols that should not be used on prescriptions because they can be confused with something else, resulting in an error. While some of these do not translate into e-prescribing, some in fact do. The complete list can be downloaded here.
- Do not use a trailing 0. For example, writing “give 1.0ml of methadone” can be read as 10ml rather than 1ml, resulting in possible death.
- Do not forget a leading 0. For example, writing “give .5ml lorazepam 2mg/ml” can be read as 5ml rather than 0.5ml, resulting in over sedation and possible death.
- Use caution when using both ml dosing and mg dosing in the instructions. It is best to use one or the other. Writing “Morphine 20mg/ml 0.5ml = 10mg – 1ml = 20mg” causes the numbers to be jumbled together, increasing the risk of an error. If both are needed, it is better to be written as “Morphine 20mg/ml give 0.5-1ml (10-20mg)” because there is a clear distinction between measurements.
- Don’t forget the “Why.” There is always a reason why the medication is prescribed. To write “take as needed” is not sufficient. How many? How often? And why? Many medications treat multiple ailments. Pharmacists are required to counsel every patient regarding their medications. For example, the pharmacist does not want to counsel the patient on the antipsychotic chlorpromazine when the patient is taking it for hiccups! The patient should also know why they are taking the medications and having the “why” on the label is a good resource for forgetful patients, family members, nurses, and other healthcare providers to reference.
- Use “quick sigs” or “quick orders” if available on your e-prescribing software. Many medications have standard directions that can be quite long and labor intensive to type over and over. By creating shortcuts, the time spent writing the order will decrease while the clarity and accuracy of the order will increase. HospiceMed’s e-prescribing and ordering software (eRx) has a number of “quick sigs” options that have been pre-loaded to make order writing quicker and safer. Below are a few HospiceMed quick sigs. Client Services is always available to help set up quick sigs/orders in eRx as well.
MIRA DISSOLVE 1 CAPFUL (17 GM) IN 8 OUNCES OF WATER OR JUICE AND DRINK EVERY DAY ZPAK DAY 1: TAKE 2 TABLETS BY MOUTH ; DAY 2-5: TAKE 1 TABLET BY MOUTH UNTIL FINISHED MEDROL TAPER AS DIRECTED ON PACKAGING SCP APPLY 1 PATCH BEHIND EAR EVERY 72 HOURS FENT APPLY 1 PATCH TO SKIN EVERY 72 HOURS (3 DAYS) ATROPINE PLACE 4 DROPS UNDER TONGUE EVERY 2 HOURS AS NEEDED FOR EXCESSIVE SECRETIONS LOPER TAKE 2 CAPSULES AFTER FIRST LOOSE STOOL AND 1 CAPSULE AFTER EACH LOOSE STOOL NOT TO EXCEED 8 * IN 24 HOURS ZOFRAN DISSOLVE 1 TABLET UNDER TONGUE EVERY 6 TO 8 HOURS AS NEEDED FOR NAUSEA UTI10 TAKE 1 TABLET BY MOUTH TWICE DAILY X 10 DAYS FOR UTI ABH MASSAGE 1ML TO INNER WRIST… N1 NEBULIZE 1 VIAL… 1S UNWRAP AND INSERT 1 SUPPOSITORY RECTALLY… MOM TAKE 30ML BY MOUTH DAILY AS NEEDED FOR CONSTIPATION
- When in doubt, write it out. There is nothing wrong with writing instructions out in clear English. This will increase the chance that the pharmacist will understand and effectively communicate the instructions to the patient, resulting in fewer errors.
The use of HospiceMed’s e-prescribing software and following the tips above can help decrease the risk of medications errors and help ensure your patient is receiving the best care possible.