Newsletter

Reducing Errors in Electronic Prescriptions

A new regulation effective January 2011, Patient-Centered Labels for Prescription Drug Containers (Title 16 Section 1707.5), includes among other provisions a standardized set of patient instructions expected to cover about 90 percent of prescriptions. While the regulation affects labels on drug containers dispensed to patients, the standardized text can also provide a method for reducing discrepancies on other documents such as discharge instructions and prescription slips.

In last month’s CHPSO Patient Safety News we noted that discrepancies between structured and free-text fields in electronic prescriptions are common and can cause patient harm. Standardized instruction text can reduce that risk if an electronic health record is able to generate the free-text instructions field from the structured data.

The standard phrases are (iadf stands for ‘insert appropriate dosage form’):

  • Take 1 iadf at bedtime
  • Take 2 iadf at bedtime
  • Take 3 iadf at bedtime
  • Take 1 iadf in the morning
  • Take 2 iadf in the morning
  • Take 3 iadf in the morning
  • Take 1 iadf in the morning, and Take 1 iadf at bedtime
  • Take 2 iadf in the morning, and Take 2 iadf at bedtime
  • Take 3 iadf in the morning, and Take 3 iadf at bedtime
  • Take 1 iadf in the morning, 1 iadf at noon, and l iadf in the evening
  • Take 2 iadf in the morning, 2 iadf at noon, and 2 iadf in the evening
  • Take 3 iadf in the morning, 3 iadf at noon, and 3 iadf in the evening
  • Take 1 iadf in the morning, 1 iadf at noon, 1 iadf in the evening, and 1 iadf at bedtime
  • Take 2 iadf in the morning, 2 iadf at noon, 2 iadf in the evening, and 2 iadf at bedtime
  • Take 3 iadf in the morning, 3 iadf at noon, 3 iadf in the evening, and 3 iadf at bedtime
  • If you have pain, take __ iadf at a time. Wait at least __ hours before taking again. Do not take more than __ iadf in one day

For example, if pills are dispensed and the physician wrote “sig: i po qhs,” the instructions would read “Take 1 pill at bedtime.”

Note that, even when the instruction specified by regulation basically fits the prescription as issued by the prescriber, it is appropriate to include additional information (such as time increments between doses) on the prescription label, if it is necessary for the safety of the patient.

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