UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY
Melanie Reinhardt, Pharm.D. Eddie Dunn, Pharm.D.
Beware the "New" Types of Errors of E-prescribing This issue of Safety Nets illustrates the potential hazards associated with poorly handwritten prescriptions. Thank you for your continued support of this column.
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he e-prescription illustrated in this Safety Net was sent from a prescriber's office to a community pharmacy in Central Arkansas. The pharmacist verified the prescription for Humulin® 70/30, but immediately realized there were two problems with the order: the quantity of Humulin® 70/30 to dispense and the patient directions. The pharmacist realized to fill the order as written, ten vials would be required - an unusually large amount. In addition, there were two separate patient directions in the Sig. field - "30 units twice a day" and "30 units in the morning and 20 units in the evening". The pharmacist telephoned the prescriber's office for clarification. A nurse answered the call and listened to the pharmacist's concerns - along with his frustration - about the order. The nurse addressed the insulin quantity (i.e. 100 mL) by replying "Give him a month supply." When asked about the patient directions the nurse said, "It clearly states 30 units in the morning and 20 units in the evening." When the pharmacist asked why "30 units twice a day" was included in the order, the nurse ended the conversation. After this, the pharmacist entered the prescription information into the computer as Humulin® 70/30, quantity 20 mL (two vials for a month supply), with patients directions of "inject 30 units in the morning and 20 units in the evening. Record fasting and 10 p.m. blood sugar." After the prescription was filled, it was placed in the "will call" bin for patient pickup. Figure 1
Electronic prescriptions are not 100% error-free. In fact, the legibility and neatness of e-prescriptions may increase the risk of error compared to handwritten prescriptions which may be more carefully scrutinized. Pharmacists must continue to carefully examine all prescriptions - both handwritten and electronic. § STUDENT SPOTLIGHT
Breaking the Barrier - David Roberts
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rkansas is home to many Hispanic patients who speak little or no English. This can be a significant barrier to quality patient care. I was in their shoes when I came to the United States from Costa Rica as child. It is intimidating to not understand the language of where you live. Since I can easily identify with these individuals, I am in a unique position to make a difference in their lives. I understand the difficulty when you are trying to ask a question but can’t make the other person understand what you’re trying to say. It took me six years of hard work to become fluent in English. As a result of my efforts, I am now able to serve the Hispanic patients at the pharmacy where I intern.
Over 70% of physicians in the United States currently e-prescribe. The "benefits" of e-prescribing have been touted by many sources including the Health Resources and Services Administration (HRSA) which states "compared to paper prescriptions, e-prescribing improves safety along with prescribing accuracy and efficiency". We agree E-prescriptions do reduce the likelihood of SALAD (sound-alike, look-alike drug) mix-ups and eliminate illegible prescriber handwriting. However, e-prescribing has introduced new types of medication errors into the health care system which would have been extremely unlikely to occur with handwritten prescriptions. What is the likelihood a prescriber would actually write two, separate patient directions in the Sig. field that contradict each other? Clearly, this e-prescription does not "improve safety along with prescribing accuracy and efficiency".
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Frequently I help patients with medical information. I have counseled on a methylprednisolone pack to ensure patients know how to correctly take the six day course of therapy. I have helped patients understand the importance of finishing the entire course of antibiotic medication. Helping people is more than just providing prescription information. I’ve helped patients find the nearest Hispanic church, and directed them to the nearest grocery store. We will all have patients that come into our pharmacies who don’t speak English. I am proud to say I have made a difference in these individuals and so can you. I understand the frustration some pharmacists may feel when dealing with language barriers, but we must remember these are our patients too. They rely on us for help. The next time you encounter a language barrier, try to put yourself in their shoes in order to help.
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