Orders and Prescription Writing

Question 1

Why are there so many errors in prescribing medications?

Answer 1

Large number of drugs available

Lack of precisely defined best practices when it comes to prescription writing.

Drug confusions

Names – often multiple

5 rights

“Look alike and sound alike”

Newly approved drugs weekly from FDA

• Continual updates to approved uses
• Handwriting of scripts

All cause a convoluted medication use system

CPOE (Computerized Physician Order Entry) touted to eliminate approximately 2.1 million ADEs/yr (Adverse Drug Events).

Question 2

What are the responsibilites of the DEA?

Answer 2

Prevent diversion.
Oversee illicit and licit controlled drugs.
Ensure adequate supplies for the country’s legitimate uses.
Maintain and regulate licensure via a “closed system.”

Question 3

Who does the DEA maintain and regulate?

Answer 3

Physicians
PAs
NPs
Researchers
Pharmacists

-All provided a DEA number.

Question 4

What are some personal prescription safeguards?

Answer 4

Hide script pads.
Write the actual amount - ten vs 10 or both to prevent tampering.
Never pre-sign blank scripts.
Clarify appropriate when pharmacy calls.
Contact DEA with suspicious activity.
Do NOT pre-print DEA numbers.
Keep inventory of script pads.
Avoid using your DEA number except when necessary.
Limit access to your DEA number.

Question 5

What type of script pads must be used?

Answer 5

Tamper proof script pads.

Question 6

What are controlled substances?

Answer 6

Agents with pre-determined known likelihood of abuse and abuse causing dependency.

Question 7

What are Schedule I drugs?

Answer 7

No approved medical use.

Question 8

Give an example of a Schedule I drug

Answer 8

LSD

Question 9

Which schedule drugs have the highest potential for abuse?

Answer 9

Schedule I

Question 10

What schedule drugs are approved for medical use?

Answer 10

Schedule II
Schedule III
Schedule IV
Schedule V

Question 11

Give an example of schedule II drugs.

Answer 11

Morphine

Dilaudid

Question 12

Give and example of schedule III drugs.

Answer 12

Vicodin

Question 13

Give an example of schedule IV drugs.

Answer 13

Benzodiazepines

Provigil

Question 14

Which schedule drugs have low abuse potential?

Answer 14

Schedule IV

Schedule V

Question 15

Give an example of schedule V drugs.

Answer 15

Hycodan syrup

Question 16

Which have the lowest abuse potential?

Answer 16

Schedule V

Question 17

Which schedule drugs have some abuse potential?

Answer 17

Schedule III

Question 18

What are the elements of a prescription?

Answer 18

Date of script
Provider ID
Patient ID
Inscription
Subscription
Sig
Indication
Refill information
DAW - if needed
Warnings
Signature

Question 19

What needs to be included for the patient ID on a prescription?

Answer 19

Name and DOB

Question 20

What is the inscription of a prescription?

Answer 20

Name and strength of the drug.

Question 21

What is the subscription of a prescription?

Answer 21

Quantity

Question 22

What is the sig on a prescription?

Answer 22

The instructions on drug use.

ie, take 1 tab PO q 12 h x 7 days

Question 23

How many drugs were prescribed in 2009?

Answer 23

3.9 billion

1 billion went unfilled

Question 24

How many new drugs does the FDA approve each week?

Answer 24

1-2

Question 25

How many lines per order to you write for hospital orders?

Answer 25

One

Question 26

What should you remember for hospital orders?

Answer 26

The 5 rights
Be legible
Sign your orders

Question 27

What do you need to do when changing hospital orders?

Answer 27

Write a new one!!

DO NOT simply cross out the previous order.

Question 28

How do you fix a hospital order that is written in error?

Answer 28

Strike through
Initial
Time
Date
Ensure the order hasn't been validated yet.

Question 29

What must you do if an hospital order that has been written in error has been validated?

Answer 29

Write a D/C order

Question 30

What must you do for hospital orders for labs and diagnostics?

Answer 30

Use one line.
Be specific and legible.
Be reasonable

Question 31

What must you include for imaging orders?

Answer 31

CT a/p with IV/PO contrast - abdominal pain r/o diverticulitis

Help to direct radiology
Specificity helps everyone and prevents errors.

Question 32

What are good practices in prescription writing?

Answer 32

Always review allergies before a new script

Review medication list to check for interactions

Review with risk / benefit ratio

Clearly document, if an interaction possible, why a drug is still being used

Question 33

What are common prescribing errors?

Answer 33

Poor legibility 
Omissions on the script especially patient information
Dose or direction errors
Use of dangerous abbreviations 
Unclear quantity or omitted 
Legal requirements not met
-Spelling out the quantity 
-Reason for the script
-Providing DEA numbers
-Leading or trailing zeros

Question 34

What should you remember about leading and trailing zeros?

Answer 34

Never use trailing zeros. Do use leading zeros.

Question 35

What must qualified e-prescribing systems do?

Answer 35

Must generate a complete med list
Selecting, printing, transmitting, and safety check capabilities
Provide information on lower cost appropriate alternatives
Provide information on formulary issues from the patient’s drug plan

Question 36

What are the benefits of e-scripts?

Answer 36

Decreased medication errors

Point of care provider access to eligibility and formulary issues

Alerts on interactions and allergies

Preventing of tampering

Increased time to provide patient care

• Long term benefit
• Less time on the phone with pharmacies

Better continuity

• All providers can see in real time a patients active med list
• Inclusive of pharmacies

Question 37

What are the pitfalls of e-scripts?

Answer 37

Increased costs

Lack of prescribing standards
-Instructions – sig. Use of drop down menus with inappropriate options

Software problems (system shut down)

Compatibility with DEA requirements for controlled drug e-prescribing
-Will still allow handwritten scripts

Potential for increased errors – early use

• Related to lack of standardized sig
• Overlooking / overriding influx of interaction data

Question 38

What causes the increased cost of e-scripts?

Answer 38

Implementing and purchasing
Training staff

Makes it cost prohibitive for many small practices.

Question 39

What are the main things to remember for e-prescribing?

Answer 39

Challenges and benefits of e-prescribing

Adopted by most major health systems

Cost prohibitive for many small practices

Incentives to adopt now becoming penalties for not

Penalties through reimbursement from Medicare & Medicaid patients

Controlled drugs can still be handwritten

New law allows for e-prescribing of controlled drugs

Question 40

What is the ultimate goal of e-prescribing?

Answer 40

Decreased medication errors and improved continuity

Question 41

Where do the penalties for e-prescribing come from?

Answer 41

Medicare & Medicaid patients