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Medical Rounds

Patient Safety: Rx for More Accurate Prescriptions

In contrast to opioid prescriptions created electronically, handwritten prescriptions contributed heavily to a trio of prescribing and processing errors, according to a recent study of opioid prescriptions filled at a Johns Hopkins outpatient pharmacy.

The quality improvement study, described in the Journal of Opioid Management, aimed to determine whether and how prescription processing methods contribute to variations, inconsistencies and errors in opioid distribution.

“Mistakes can be made at any point in the prescribing, transcribing, processing, distribution, use and monitoring of opioids, but research has rarely focused, as we have, on prescribing at the time of hospital discharge or on written prescriptions prescribed for adults,” says lead author Mark Bicket, assistant professor of anesthesiology and critical care medicine.

Overall, the investigators found that 92 percent of handwritten prescriptions failed to meet ideal practice standards, contained such errors as the absence of at least two patient identifiers or failed to comply with federal opioid prescription rules.

“There are the normal legibility issues you would suspect with a handwritten prescription, but we also commonly found things like missing patient identification information and errors in abbreviations,” Bicket adds.

Not a single prescription created by the hospital’s electronic prescribing system deviated from best practice guidelines or was missing the required two forms of patient identification information. Because the computer prints prescriptions using a template that aligns with best practices, the only step the prescriber must do after reviewing the prescription is sign the prescription.

Bicket emphasizes that errors in prescriptions rarely result in patients getting the wrong drug or dosage because other safety measures, such as pharmacists double-checking the prescription information, like the drug name, indication and amount, are in place.

However, errors in prescriptions make the holes bigger, increasing the risk for mistakes. “What we hope our results do is get more practitioners to adopt electronic prescribing systems because we have a duty to practice in a way that has the lowest chance of harm to our patients,” says Bicket.