PREVENTING ERR 0 R S
Purpose of Medication Will Reduce Errors by Neil M. Davis, PharmD, and Michael R. Cohen, MS
Prescribers sometimes think of prescribing one medication but mistakenly prescribe another. At other times, pharmacists misread prescriptions and dispense the wrong dnlg. Sometimes patients forget which medication they are supposed to take and choose the wrong one from their array of prescription containers. There is a simple way to greatly lower the chance of these three errors: prescribers should indicate the purpose of the medication on the prescription order and pharmacists should place this information on the label. Having the purpose for which the medication was prescribed also gives the pharmacist another way (besides the dosage form, strength, and directions), to check whether they have read the prescription order correctly. If the stated purpose does not coincide with what the medication is believed to be, the pharmacist can clarify the situation as either being an unfamiliar but correct use, or as a prescriber error. Knowing the physician'S reason for prescribing the drug also will allow the pharmacist to better counsel the patient and ensure proper patient usage. Everyone gains. AMERICANPHARMACY
Although some physicians now place the medication's purpose on the prescription order, it is not yet standard practice. Recommending this procedure was considered by the American Pharmaceutical Association (APllA) in 1991 at its Annual Meeting, referred for consideration to the 1992 Policy Committee on Public Affairs, and will be considered again at the 1993 Annual Meeting. A recommendation from APhA to the organizations that represent prescribing professionals would start an important educational process. Those who teach medical students and residents how to write prescriptions can foster this practice. Pharmacists can talk to physicians with whom they work and encourage them to provide this valuable information. No new procedure is ever initiated without some problems. One problem that will undoubtedly surface is that some drugs are prescribed for off-label uses-indications that are not listed in the product insert but are backed up by a large body of journal articles ~nd textbooks. Off-label uses sometimes become incorporated into a revised product insert, as
happened with propranolol for headaches. There are many off-label dnlg uses, such as tricylic antidepressants for treatment of headache, ACE inhibitors for congestive heart failure, calcium channel blockers for n1igraines, antibiotics for recurring gastric ulcers, erythromycin for diabetic gastroparesis, cimetidine to stimulate the immune system, to name a few. Pharmacists must keep current and know about these off-label uses-they can never assume that an unusual usage is correct. When pharn1acists encounter such an off-label
use, they should refer to the asp DI, contact a drug information center at a local hospital pharmacy for assistance, or ask a colleague. Pharmacists should also not assume that a physician never makes a mistake. If the dnlg usage cannot be verified, the pharmacist should contact the prescriber. Prescribers may educate you or change the order because you have called a problen1 to their attention. We also suggest that prescribers inform their patients that a certain medication is being prescribed for an offlabel use. TIns is important because the patient may
1021 Park Avenue, Box 9003
Community Hospital
Pharmacy Hospital
A LifeQuest Group Member
Patient _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ __ Address _ _ _ _ _ _ _ _ _ _ _ _ Age _ _ __ (required tor controlled substances)
(required tor geriatric and pediatrics)
Purpose _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (
) Place purpose on container label
SUBSTITUTION PERMISSIBLE _ _ _ _ _ _ _ _ _ _ _ M.D.O.
DEA# _ _ __
IN ORDER FOR A BRAND NAME PRODUCT TO BE DISPENSED, THE PRESCRIBER MUST HAND WRITE "BRAND NECESSARY" OR "BRAND MEDICALLY NECESSARY" IN SPACE BELOW
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Purpose of Medication Will Reduce Errors by Neil M. Davis, PharmD, and Michael R. Cohen, MS
Prescribers sometimes think of prescribing one medication but mistakenly prescribe another. At other times, pharmacists misread prescriptions and dispense the wrong dnlg. Sometimes patients forget which medication they are supposed to take and choose the wrong one from their array of prescription containers. There is a simple way to greatly lower the chance of these three errors: prescribers should indicate the purpose of the medication on the prescription order and pharmacists should place this information on the label. Having the purpose for which the medication was prescribed also gives the pharmacist another way (besides the dosage form, strength, and directions), to check whether they have read the prescription order correctly. If the stated purpose does not coincide with what the medication is believed to be, the pharmacist can clarify the situation as either being an unfamiliar but correct use, or as a prescriber error. Knowing the physician'S reason for prescribing the drug also will allow the pharmacist to better counsel the patient and ensure proper patient usage. Everyone gains. AMERICANPHARMACY
Although some physicians now place the medication's purpose on the prescription order, it is not yet standard practice. Recommending this procedure was considered by the American Pharmaceutical Association (APllA) in 1991 at its Annual Meeting, referred for consideration to the 1992 Policy Committee on Public Affairs, and will be considered again at the 1993 Annual Meeting. A recommendation from APhA to the organizations that represent prescribing professionals would start an important educational process. Those who teach medical students and residents how to write prescriptions can foster this practice. Pharmacists can talk to physicians with whom they work and encourage them to provide this valuable information. No new procedure is ever initiated without some problems. One problem that will undoubtedly surface is that some drugs are prescribed for off-label uses-indications that are not listed in the product insert but are backed up by a large body of journal articles ~nd textbooks. Off-label uses sometimes become incorporated into a revised product insert, as
happened with propranolol for headaches. There are many off-label dnlg uses, such as tricylic antidepressants for treatment of headache, ACE inhibitors for congestive heart failure, calcium channel blockers for n1igraines, antibiotics for recurring gastric ulcers, erythromycin for diabetic gastroparesis, cimetidine to stimulate the immune system, to name a few. Pharmacists must keep current and know about these off-label uses-they can never assume that an unusual usage is correct. When pharn1acists encounter such an off-label
use, they should refer to the asp DI, contact a drug information center at a local hospital pharmacy for assistance, or ask a colleague. Pharmacists should also not assume that a physician never makes a mistake. If the dnlg usage cannot be verified, the pharmacist should contact the prescriber. Prescribers may educate you or change the order because you have called a problen1 to their attention. We also suggest that prescribers inform their patients that a certain medication is being prescribed for an offlabel use. TIns is important because the patient may
1021 Park Avenue, Box 9003
Community Hospital
Pharmacy Hospital
A LifeQuest Group Member
Patient _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ __ Address _ _ _ _ _ _ _ _ _ _ _ _ Age _ _ __ (required tor controlled substances)
(required tor geriatric and pediatrics)
Purpose _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (
) Place purpose on container label
SUBSTITUTION PERMISSIBLE _ _ _ _ _ _ _ _ _ _ _ M.D.O.
DEA# _ _ __
IN ORDER FOR A BRAND NAME PRODUCT TO BE DISPENSED, THE PRESCRIBER MUST HAND WRITE "BRAND NECESSARY" OR "BRAND MEDICALLY NECESSARY" IN SPACE BELOW
N
