E-Prescribing: The end of prescription errors? Hardly

Electronic prescribing (e-Rxs) was supposed to be the savior of pharmacy. Things haven’t quite worked out that way.

I have come to the conclusion that in the minds of practitioners -whether MDs, DDSs, NPs, PAs, etc. - the least important thing they do is to issue prescriptions to patients.

For years, everyone in pharmacy has been saying that we must eliminate written prescriptions, because practitioners’ handwriting is so poor that it causes pharmacists to misread prescriptions, which leads to prescription errors. We were told that what we needed was electronic prescriptions, which would eliminate the confusion and time wasted when pharmacists have to call prescribers after trying and failing to interpret badly written prescriptions.

Well, we’ve got the e-Rxs. And boy, they were dead wrong about elimination of calls to prescribers.

While all e-Rxs are now readable, a staggering number of the e-Rxs that a retail pharmacy sees on a daily basis still necessitate a call to the prescriber for some sort of clarification. Questions arise, such as, what drug did the prescriber want dispensed? What are the correct directions for use? Which of the two or three sets of directions on the Rx are correct? What is the correct quantity of medication to be dispensed? How many days’ supply of the Rx is correct?

In order to bill the insurance company accurately, we need to know.

Read ’em and weep

Here are examples drawn from the many bizarre prescriptions that have crossed my screen:

Drugs prescribed:

• Amlodipine besilate powder 100%
• Singular 5-mg chewable (candy)
• Lisinopril/hctz  0 (miscellaneous)

Directions needing clarification:

• For a Medrol dosepak 4 mg: 21 tablets every day as directed
• For an Advair Diskus 250/50 mg: 1 suppository (ies) twice a day
• For an Armour Thyroid 90 mg:1 tablet po every evening before breakfast
• For zolpidem 10 mg: 1 tablet po bid hs prn sleep
• For Ketostix strips: Use as directed, #2500 as a 30-day supply
• Any of the two or more different sets of directions you tend to see on an electronic
  prescription

Quantity ordered:

• For a Biaxin 250mg/5ml, 10 metric drops
• For a Medrol dose pak 4mg,  the usual # 1 tablet dispensed
• For Lidocaine Viscous 2%, 1000000 ml

Who’s minding the Ps and Qs?

These examples show us that no matter who is sending over the e-Rx, whether practitioners or their prescribing agents, no one is taking the time to check to ensure that what they are sending over is 100% correct and makes sense to the person receiving the e-Rx. 

As I said before, it appears that practitioners view the issuing of a prescription as the least important thing they do for their patients. (What do you think?)

As long as this attitude prevails, every day will see the occurrence of prescription errors that easily could have been prevented, if only a little more care had been given to the issuance of each prescription.

The Merriam-Webster dictionary tells us that “to proofread” means “to read and mark corrections in.”

Whether it’s “Oops” or “My finger slipped” or laughter at the other end of the phone - no excuse will ever be acceptable to me.

Tom Hanson is a community staff pharmacist working in Algonquin, Illinois. E-mail him at  rphth@msn.com.