Technology in healthcare is always moving forward. From personal health monitoring to medical tests, technology is here to improve our lives. In medicine and healthcare, digital technology brings more effective solutions for issues happening in any part of the continuum of care.
An excellent example to cite is the introduction of electronic prescribing (e-prescribing) to prevent medication errors secondary to misinterpretation of handwritten prescriptions. E-prescribing is the process of transmitting prescriptions electronically from the prescriber (e.g., doctor, nurse practitioner, etc.) to the pharmacy. It is one of the instructions a provider can send through the computerized provider order entry (CPOE) system. However, research shows that e-prescribing is associated with new errors - both in inpatient and outpatient settings.
A study found out that over one-in-ten e-prescription errors were seen in an outpatient pharmacy chain located in three states. The researchers also noted that a third of the errors could potentially cause harm to the patients.
What Are the Errors Associated With E-Prescribing?
E-prescribing offers an improvement in patient safety over paper-based systems. A good example is alerting clinicians of drug interactions. Although it has been beneficial in many ways, there are still errors associated with e-prescribing. This is why as a pharmacy technician, you must be aware of the following to minimize dispensing a medication prescribed with errors.
1. Missed Allergy
Identifying a patient's allergies is a part of medical history-taking. According to research, the highest error rate in e-prescribing is the failure to enter a patient's allergy information.
2. Medication Name
In a computerized system, you need to choose a medication from a list. Errors such as selecting Augmentin Duo instead of Augmentin Duo Forte would result in prescribing the wrong medication.
3. Dose and Quantity
The wrong dose entered means you could either give a higher or lower dose of the medication than what was prescribed. This error is very risky for the patient.
On the other hand, the quantity and type of unit are required for the provider to enter. If they are unaware, it will lead to guessing what information to enter.
4. Administration Time
Changing the default times for the patient's medication intake is necessary, but failure to do it is common. Let's take Furosemide 40mg PO taken twice daily. If it is prescribed at default times of 0800 and 2000, the patient will take it in the morning and evening. However, the correct time of the second dose intake is midday (1200) to lessen the disruption of sleep.
A provider may have selected the wrong frequency from the CPOE menu. For example, a doctor prescribed Lisinopril 5mg PO daily in the morning. But, the suggested time of the day is in the evening because patients must take this blood pressure-lowering medication at nighttime to avoid the risk of falls.
6. Medication Omissions
Patients prescribed with new medications must have an updated file. Medication omissions happen when the prescriber did not add the new drug to the patient's electronic medication chart.
7. Qualifier Omission
Let's say you have a 76-year-old patient with a groin candida infection who was given Clotrimazole (1%) cream topical three times a day. A qualifier omission occurs when the prescription does not have an instruction for the anti-fungal cream on where it should be applied. In this case, there must be an added text, "to the groin area," for it to be administered properly.
8. Conflicting Information
Incorrect instruction may occur due to the provider's inability to make changes when the computerized system inserts auto-populated information into the prescription. Another possible reason could be that the automated system carried over the information incorrectly from prior prescriptions.
9. Refill Errors
Old refill prescriptions used as a template may generate incorrect information.
10. Transcription Errors
CPOE systems and pharmacy systems are not integrated. This forces a pharmacist or pharmacy technician to print the prescription or memorize the information to enter the data into the pharmacy system.
Recognizing E-Prescribing Errors is Important For Patient Safety
Despite the benefits of e-prescribing, such as improved efficiency between the pharmacy staff and providers, we cannot take the fact that errors are still occurring. Medication errors could potentially harm patients and that is a public health concern. Therefore, one of the pharmacy technician's critical roles as part of the pharmacy staff is to recognize and capture prescription errors before they reach the patient.