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Tuesday, July 15, 2014

E-Rx Questions

The software a company uses is designed to simplify everyone's jobs. However, it is ultimately only as good as the humans who are using it. You would think with something as critical as electronic-prescribing, the Board-approved companies would have to use better software.
In my pharmacy experiences, pharmacy computers can be pretty smart. If we select a drug and the dosage form is capsules, when we select a sig (directions) from the menu or we type the short code "1bid", the computer is smart enough to translate that into "take 1 capsule by mouth two(2) times a day. If we enter 60 capsules to be dispensed, the computer, usually, will calculate this prescription to have a 30 day supply.
Back to e-Rxs. Why can't they all be smarter? The systems should be set up to not allow you to mix-and-match drugs with salt forms and strength combinations that do not exist. There should be some type of warning that the directions do not match. If I were to design this system, and seriously, they should be required to have pharmacists design and install these systems, I would take out much of the human factor. Keep in mind, most of the errors we see are ones we would never see with a hard copy hand-written by a physician. These are errors that only occur when selecting items from a drop-down menu.

There should be a drop down box for the drug. Once it is selected, there should be one for the strength. This one should only give you options for strengths that match the drug you selected. If the drug you selected does not come in a certain strength, you should not be allowed to enter it. Two errors we saw in the last week:
1. Gabapentin 200mg. It does not come in this strength in an oral dosage form for retail pharmacy.
2. Diclofenac Potassium 75mg. This version is only available as a 25mg or 50mg dose. The 75mg strength is only available as Diclofenac Sodium. The doctor probably knew what he wanted but it wasn't clear so we had to call. But I received this Rx at 6pm on Saturday. No one called back...
The other problem with this issue is what do we do when the doctor only selects "Diclofenac 50mg"? That is available as both salt forms, potassium and sodium. Which did he want? The computer should force him to pick one first, then only present him with the strengths that match. Fewer errors.

Directions: Something has to be done about these too. How many times do we get prescriptions where the directions make no sense, regardless of the drug?
1. Take non-specified once a day.
2. Take one(1) tablet by mouth with the first meal of the day, every morning twice a day (bid).
I have seen doctors select injectables or oral powder dosage forms then select directions for oral tablets or capsules. I have seen them order suppositories with oral directions. Once they have selected a drug, the route of administration should default in the directions. This way, when he only sees IM or SC, or PR, and he wanted Potassium 10mEq capsules PO, he can see something is amiss. Hopefully.

If your software is calculating the day supply for you, it should force you to enter a quantity. How many e-Rxs have we received with "N/A" in the quantity field? Why isn't the computer forcing them to enter an amount to be dispensed? But somehow the field immediately after is populated with "90 day supply". There is also a box to be checked for dosage form. Don't even get me started on the mess created by inhaler and insulin prescriptions...

1 comment:

  1. Our EMR E-RX program blows monkey chunks.
    Just one quick example: I want gentamicin ophthalmic ointment. I know it exists. You know it exists. My EMR does not. We have told the company a dozen times. The only options are PO are solution. However I am allowed to put in a 1/2" of the solution under the SIG. So I always wind up putting a little note that states "yes, I want the ointment, I am aware it says solution, the EMR sucks'