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Tuesday, July 31, 2018

The Goldilocks Directions Challenge.

Too Much? Too Little?
We have to find the set of directions that are "just right" for the label; the directions that are easiest to understand; that convey the prescriber's intentions clearly; the directions that, hopefully, leave the least amount of room for error and misinterpretation. 

Our job is, and has always been, to interpret what the prescriber wrote and translate it into patient-friendly directions; ones that can be easily understood. (From med-speak to patient-speak. . . so to speak.)

I thought of this after yesterday's Humira picture and could envision all the possible ways pharmacy staff would type this.
For some pharmacists and technicians, verbatim, seems to be the mantra. (My call center loves to type directions word-for-word. They're so bad they even type the typos, and sprinkle in a few new ones that weren't on the e-script. But that's how the call center TRAINS them.)

Should the directions for "Humira 40mg / 0.8ml Pen" be typed on the label as:

A. "Inject the contents of 1 pen subcutaneously every 2 weeks"
B. "Inject 40mg subcutaneously every 2 weeks"
C. "Inject 0.8ml subcutaneously every 2 weeks"
D. "Inject the contents of 1 syringe (40mg) subq every 2 weeks"
E. "Inject the contents of 1 syringe (0.8ml) subq every 2 weeks"

Which direction allows for the least chance of a mistake on the patients' part?

Personally, I believe the MORE information you put on a label, the LESS clear and MORE confusing it becomes for the patient(s).

Answer the question I asked but consider the following examples as my reason for asking: 
Example 1:
Zofran is available as 4mg/5ml solution.
If you put both mg and ml on the label, it can lead to an error. I hate putting on the label verbatim what came through on the e-rx: 
"Give 2mg (2.5ml) by mouth . . . "
That is too much info that can lead to confusion by a tired mother/grandmother/sitter, etc. and the pharmacy staff typing it.

Example 2:
How many times have we filled prescriptions for elderly patients where prescribers don't always use the most logical strength? (Granted, they may be making dose adjustments, but keep it simple for this argument.)

Ativan 0.5mg Tabs : "Take 2 tablets (1mg) by mouth. . . "
or. . . "Take 1mg (2 tablets) by mouth . . . "

Both of these are real-world examples.
Both are confusing.
Both can be read backwards.
Both can lead to errors.
Remember, the more information you provide to help, the less helpful you truly are.

Answer Key: A.
The only correct, not-open-to-interpretation answer is "A".
Why? D complicates the directions with too much information.
B and D? Who measures anything in "mg"? (and patients will ask that exact question.)
E isn't awful BUT, the more information you type, the more likelihood you can make an error while typing. (Accidentally typing "1ml" or reversing the "1" and the "0.8" happens occasionally.)
C? That's the best alternative answer I will allow. If my techs type it, I won't send it back. However, it is still open to questions from patients ("how do I measure 0.8ml?")

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