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Safety Nets: Beware the "New" Types of
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY
Melanie Reinhardt, Pharm.D. Eddie Dunn, Pharm.D.
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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.
The e-prescription illustrated in this Safety Net was sent from a prescriber's office to a community pharmacy in Central Arkansas.ThepharmacistverifiedtheprescriptionforHumulin® 70/30, but immediately realized there were two problems with theorder: thequantityofHumulin®70/30 todispenseand 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 twiceaday" and "30 units in themorning and 20 units in the evening". The pharmacist telephoned the prescriber'sofficeforclarification. Anurseansweredthecalland listenedtothepharmacist'sconcerns-alongwithhisfrustration - 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." Aftertheprescription wasfilled, itwasplaced in the "will call" bin for patient pickup.
Figure 1
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 prescribingaccuracyandefficiency". WeagreeE-prescriptions doreducethelikelihoodofSALAD(sound-alike,look-alikedrug) 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 directionsintheSig.fieldthatcontradicteachother? Clearly,this e-prescription does not "improve safety along with prescribing accuracyand efficiency". 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
Arkansas is home to many Hispanic patients who speak little or no English. This can be a significant barrierto qualitypatient 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 makeadifferenceintheirlives.Iunderstandthedifficulty 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. Asaresultofmyefforts, Iamnowabletoserve the Hispanic patients at the pharmacy where I intern.
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’vehelpedpatientsfindthenearestHispanic 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.
Honor loved ones, distinguished award winners, new retirees or graduates by purchasing a brick for the Arkansas Pharmacy Foundation Walkway of Honor. The bricks will be featured prominently in the plans for the rebuilding of the Arkansas Pharmacists Association headquarters at 417 South Victory Street in Little Rock.
Purchase a 4”x8” red brick for a $125 tax-deductible contribution to the Arkansas Pharmacy Foundation. Proceeds will provide funds to sponsor, support and conduct educational programs. Personalize your brick by printing the name and other information as you would like it to appear. There is a maximum of 3 lines per brick with up to 18 characters per line, including spaces. Use an ampersand (&) for “and”.
TO ORDER Send order form along with a check for $125 to APF, PO Box 3798, Little Rock, AR 72203.
Name: __________________________________________
Method of Payment: Check Credit Card
Address: ________________________________________
City: ___________________State: _________Zip:_______
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