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Safety Nets: E-Prescriptions: No Guarantee to Be Error-Free
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY
Melanie Reinhardt, Pharm.D. Eddie Dunn, Pharm.D.
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E-Prescriptions: No Guarantee to Be Error-Free
This issue of Safety Nets examines potential hazards associated with electronic prescriptions. Thank you for your continued support of this column.
The E-prescription illustrated in Figure One was transmitted fromaprescriber’sofficetoacommunitypharmacyinNortheast Arkansas. The pharmacy technician entered the gabapentin patient directions into the computer as “take three capsules by mouth three times a day, then two capsules three times a day.” This information, along with the prescription image, was transmitted from the input queue to the pharmacist verification queue. While verifying the accuracy of the prescription, the pharmacist noticed a separate set of directions in the Admin Instructions section of the order instructing the patient to take “two gabapentin three times a day.” Confused by this discrepancy, the pharmacist telephoned the prescriber’s office for clarification. The prescriber’s nurse confirmed the patient was to administer two gabapentin 300 mg capsules three times a day. The nurse remarked “I’m not sure why those other directions were included.” After this, the prescription was correctly filled and the patient appropriately counseled.
Figure 1
This case clearly demonstrates the potential hazards associated with electronic prescriptions. While E-prescriptions may have certain advantages over traditional handwritten prescriptions, their use does not guarantee an error-free order. In this case, the electronic prescription itself is the problem. The order contains two separate, completely different directions to the patient. Whoever devised sections on medication orders such as Admin Instructions in addition to the traditional “Sig” section familiar to all pharmacists, has no knowledge whatsoever about what constitutes a safe prescription.
Electronic prescriptions are not guaranteed to be error-free. In fact, the legibility and neatness of E-Prescriptions may actually increase the risk of error compared to handwritten prescriptions that may be more carefully examined by pharmacy staff. The authors of Safety Nets are not advocating a return to handwritten prescriptions – health care technology has forced them into retirement. Many of these handwritten prescriptions had to be carefully scrutinized for a variety of reasons including poor handwriting. Today’s pharmacists must use the same degree of scrutiny when verifying the accuracy of electronic prescriptions. §
STUDENT SPOTLIGHT
- Abigail Morrow
Healthcare is a basic human right that is disproportionately administered to the different tiers of society: prisoners in the United States Correctional System experience this bias in the quality of care they receive every day. There is a massive amount of prisoners in the United States when compared to other countries, and the quality of care they receive is sub par in comparison. While my father was incarcerated, he experienced this negligence firsthand on multiple occasions. One incident occured when he was bitten by a spider, and was denied healthcare until he had a hole in his leg - on the brink of losing it completely. Another, more serious, incident occurred when he had requested a colonoscopy multiple times for years due to a family history of colon cancer, but it was not approved until his cancer had progressed to a stage IV diagnosisofcoloncancer.Ontheflipside,oncehewas eventually transferred to a prison hospital with more optimal facilities, his team of providers worked with him as best as they could under the circumstances. These examples are indicative of the need to advocate to bring consistent and recommended care across the entire health care system from before diagnosis to end of life care for all patients. As human beings, and more importantly as health professionals, we are driven to help everyone regardless of our biases. My hope is to bring awareness about the sub-par health care that a portion of our citizens receive and that this awareness willleadtoanimprovementthatwillbenefitallpatients. It is time that we as health professionals advocate for prisoners, as every single individual deserves the best healthcare that can be delivered regardless of their circumstances.
