Safety Nets: Gabapentin

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

Melanie Reinhardt, Pharm.D. Eddie Dunn, Pharm.D.

Gabapentin

This issue of Safety Nets illustrates the potential hazards associated with poorly handwritten prescriptions. Thank you for your continued support of this column.

The electronic prescription illustrated in Figure One was transmitted from a prescriber’s office to a community pharmacy in Northwest Arkansas. The technician entered the gabapentin patient directions into the pharmacy computer as “take one capsule by mouth two times a day and two capsules at bedtime.” This information and the prescription image were then transmitted to the pharmacist verification queue.

While verifying the accuracy of this order, the pharmacist noticed two additional sig’s – “take one tab in a.m. and 2 in pm” in the Comments section of the order, and “2 tablets at bedtime” in the Admin Instructions section. The pharmacist immediately telephoned the prescriber’s office for clarification about the multiple patient directions contained in the order. The prescriber’s nurse confirmed the patient was to follow the sig. listed in the Comments section – “take one capsule in the morning and two in the evening.” After this, the prescription was correctly filled and place in the will-call bin for patient pick up.

Figure 1

This case clearly demonstrates the hazards associated with electronic prescriptions. While this type of medication order may have certain advantages over handwritten prescriptions, their use does not guarantee error-free medication orders. In this case, the electronic prescription itself is the problem – not just one part of it – because it actually contains three separate, different instructions to the patient in a single medication order. This E-prescription might be the gold standard for a confusing, hazardous, and ultimately dangerous medication order. Whoever devised sections on medication orders such as Comments and Admin Instructions in addition to the traditional “Sig:” section familiar to all pharmacists, has never heard of USP requirements for a valid, safe prescription. It is clearly not in the interest of patient safety to create this type of software.

Electronic prescriptions are not guaranteed to completely free from errors. In fact, the legibility and neatness of E-Prescriptions may actually increase the likelihood of error compared to handwritten orders which may be more carefully examined by pharmacy staff. The days of traditional handwritten prescriptions are rapidly coming to an end. Pharmacists must realize that many individuals – prescribers, nurses, even office staff – could be involved in “writing” an electronic prescription before transmission to the pharmacy. Legibility and neatness do not mean error-free. Electronic prescriptions must be carefully examined – perhaps even more so – than handwritten prescriptions of the past. §

STUDENT SPOTLIGHT

Isn't a Migraine Just a Bad Headache?

- Sydney Zotti

The short answer is “no”. I suffer from migraines and I want to give insight about what it’s like living with them.

I have migraine symptoms every day. Did you know that eye floaters are a symptom of migraines? These are spots in my vision that move with every eye movement. My migraines are also trigged by weather. I check the forecast daily to plan around the likelihood of a migraine.

It’s discouraging to wake up and KNOW I’m going to have a migraine that day. On these mornings, I have a stiff neck and a mild headache. Throughout the day, the pain radiates up my neck into the base of my skull and into my eye. Unless you suffer migraines, the pain is impossible to describe. It’s like having knives slowly pushed into your skull, which becomes unbearable if you try to walk or even sit up.

My migraines are also associated with visual problems. I lose vision in one eye and peripheral vision in the other making it impossible to see clearly. This is compounded by nausea which for me is the worst part of it all. I vomit with every migraine. It’s frustrating for me to have to lay in a dark room for hours until my migraine passes.

Pharmacists interact with migraine sufferers daily. I hope my story increases your empathy for these patients. Migraines are debilitating and detrimental to one’s life. Let your migraine sufferers know you care about their wellbeing. They will appreciate it – I would.