1. Accurate and legible. Accuracy and legibility for written and EMR-based prescriptions and medication orders are critical. To ensure accuracy, use only approved abbreviations. When using an electronic format, carefully select the appropriate medication using drop-down functionality and be wary when the system auto-completes your request. Be especially careful if you delegate this function to someone who might not be as aware of the exact spelling and dosage of the intended medication. Be sure to double-check your order after itÍs written or typed and do read-backs on verbal orders.
2. Allergies. Check for allergies before prescribing. Allergies should be documented by all providers in a consistent place so that lists are accurate and do not diverge. It is very important to list the medication and the allergy the patient experiences from the drug. Critical allergies such as anaphylaxis or hepatic or renal injury obviously rank higher than reactions such as nausea and vomiting.
3. Drug-drug interactions. Be aware of possible drug-drug interactions. Know the patientÍs current medications. Remember that your EMR or hand-held device may have drug-drug interaction information on different screens, as well as different thresholds of ñalarm.î Be mindful that alarm fatigue can lead to errors.
4. High-risk meds. Understand high-risk medications and those with narrow therapeutic ranges and interactions. For example, warfarin, anti-epileptics, lithium, gentamicin, pitocin, and chemotherapy need additional consideration. You may wish to obtain written consent for long-term anticoagulation, opioid and chronic steroid therapy. Even for medications not deemed high risk, it may be appropriate to discuss and document informed consent.
5. Long-term pain management. Before you recommend a long-term opioid treatment, consult your state's Prescription Drug Monitoring Program Web site. Monitor the patientÍs progress and responses to chronic opioid prescriptions to ensure optimal compliance. Having an opioid agreement with the patient is helpful in the management of long-term pain.
6. Look-alike, sound alike. Cross-check medications for dosages and ñlook alike-sound-alikeî errors - particularly parenterals.
7. Herbals/OTCs. Ask the patient about any herbal or over the counter medications as they may interact with prescriptions. Ask patients if they use medical marijuana as this may interfere with prescriptions„especially opioids, psychiatric medications and medications with sedative properties.
8. Monitor and evaluate. It is important to adequately evaluate and monitor prescriptions. For example, evaluate the patientÍs risk of thrombosis for oral contraceptives and hormone replacement therapy. Monitor the effect of medications like anticoagulants and those that may cause liver or renal compromise.
9. FDA warnings. Stay informed of Food and Drug Administration warnings on medications, especially black-box warnings. Even drugs that have been on the market for a long time can be issued new limitations or be withdrawn.
10. Samples and phone-in prescriptions. Record all samples given to patients. The patientÍs record must include when the samples are distributed, the amount and dosage instructions. A sample log can prevent inappropriate use or diversion by staff or others outside of a physician-patient relationship. Document all phone-in prescriptions, especially those phoned in at night and on weekends.
The Patient Safety Institute is a wholly owned subsidiary of MagMutual, created to enhance the safe delivery of health care. This is a product of our alliance with COPIC in an effort to bring industry leading Patient Safety resources to MagMutual PolicyOwners.