August 1, 2019

4 Pitfalls of E-Prescriptions

Medication errors are one of the biggest safety issues for patients as there is so much potential for something to go wrong. Medical professionals are trained in the ‘five rights’ of medication safety: The Right Medication, in the Right Dose, at the Right Time, by the Right Route, to the Right Patient. Lawyers specializing in medical malpractice at Cochran, Kroll & Associates, P.C. can assist you in untangling the intricacies of these complex cases.

Up to 1.5 million patients experience a preventable ADE (Adverse Drug Event) annually, leading to 7,000 deaths and costing nearly $21 billion.

What is a Medication Error?

A medication error can be an error of commission or omission at any step from the time the patient registers their medical history, to prescribing up to administration.

What is an Adverse Drug Event (ADE)?

An adverse drug event (ADE) is registered when exposure to medication results in harm to the patient.

Not all ADE’s are due to negligence or error and do not indicate poor quality of care.

  • Preventable ADE: medication error that causes a degree of harm to the patient; this constitutes approximately 50% of all ADEs.
  • Potential ADE: where no harm is caused, due to being picked up in time or luckily did not cause harm.
  • Ameliorable ADE: harm is experienced where it could not have been prevented, but maybe mitigated.
  • Nonpreventable ADE: normally referred to as side-effects, a degree of harm is caused without any inappropriate action.

What is E-Prescribing?

Electronic prescribing (e-prescribing) is a type of Health IT platform that allows medical practitioners to enter prescription information electronically, store it securely, and transmit it to a pharmacy for dispensing. This is done in place of handwritten prescriptions, which are carried by the patient, faxed or called into a pharmacy. E-prescribing has the potential to drastically reduce medication errors and improve patient safety if it is set up thoughtfully and correctly. It is governed by the HIPAA and HITECH regulations and other pharmacy regulations.

Potential Pitfalls in E-Prescribing

Prior to the advent of electronic medical records, medical practitioners and pharmacists took full responsibility for handwritten prescriptions and dispensing records. They had to do manual drug-to-drug or drug-to-disease interaction checking, use bulky MDR books to check the correct dosage, use a calculator to match a dosage that is weight dependant and keep up to date with generic substitutes.

While E-Prescribing is a great way to minimize handwriting interpretation errors and automate many critical tasks in the prescribing of medications, several things can go wrong, depending on the system set-up, the linkages built-in and the provider knowledge and care.

1. System set-up errors

  • Incorrect drug details loaded.
  • Discontinued or recalled drugs still present in the system.
  • Interaction checking not linked properly to generic drug information.
  • Tenuous linkages to the pharmacy, in particular, community pharmacies (as opposed to one system for the entire hospital or health care system).
  • Inventory acquisition entries are done incorrectly (expiration date, batch number, etc).

2. Prescription entries

  • Wrong patient selected (similar names, no DOB or age showing on the prescription screen, no patient photograph on screen).
  • Allergy information not recorded at registration or doctor visit.
  • Prior medical history not recorded (drug-disease interaction checking not done).
  • Wrong drug, format, or dosage selected.
  • Wrong dosage calculated due to weight not being updated or filled incorrectly.
  • Wrong directions entered or selected if pre-entered.
  • Repeat prescription templates out of date and not checked.
  • Disease-specific templates out of date or not checked.
  • Conflicting information between directions and quantity or dosage.
  • If no generic information available, the prescriber may guess the wrong drug.
  • If no information on strength or type of unit available prescriber must guess.
  • Wrong pharmacy selected to send a prescription to.
  • If no dispensing information available (like in a closed system) the prescriber will not know if the patient filled the previous script leading to inappropriate prescribing.
  • If no discontinued information available or wrong prescriptions showing canceled may repeat previous errors.

3. Pharmacy and Transcription errors

  • Wrong information entered by the pharmacist into the pharmacy system if not auto-loaded (interfacing important).
  • All prescription information needed on a single screen to ensure proper dispensing (e.g., drug interaction type, severity, etc.).
  • Prescriptions sent through may be dispensed before the physician can correct an error, which may appear much later in the queue.
  • Additional drugs added to a new prescription may arrive late and not be dispensed.

4. Dispensing errors

  • Duplication of prescriptions if the pharmacy accepts both electronic and fax prescriptions.
  • Dispensing to the wrong patient
  • Dispensing wrong dosage, strength, or type of unit.
  • Dispensing both e and paper prescriptions or missing one or the other.

Potential consequences of E-Prescribing Failures

  • Harm to the patient to due errors.
  • Harm to the patient due to waiting times to resolve errors and issues.
  • Duplicate entry leaves less time for patient counseling, which could lead to harm.
  • Unfilled prescriptions leave the patient not receiving the care prescribed.

If you have suffered harm due to a Preventable Adverse Drug Event, call Eileen Kroll, a Registered Nurse and Personal Injury trial attorney, at Cochran, Kroll & Associates, P.C. at 1-866-MICH-LAW (1-866-642- 4529) for a no obligation case evaluation. Our law firm never charges a fee unless a recovery is made.

Nikole has a special interest in medico-legal issues and holds post-basic degrees in medical law and business. She has developed quality improvement and safety plans for many practices and facilities to prevent medico-legal issues and teaches several courses on data protection and privacy, legal, medical examinations and documentation, and professional ethics. She has been writing professionally on legal, business, ethics, patient advocacy, research and medico-legal issues in articles, white papers, business plans, and training courses for over thirty-five years.

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