August 02, 2016
By Marilynn Larkin
NEW YORK - The purpose of using a medication should be included on all prescriptions to enhance transparency and safety, Boston-based experts say.
Currently, patients are often "in the dark" regarding the purposes of their medications, Dr. Gordon D. Schiff of the Brigham Center for Patient Safety Research and Practice at Brigham and Women's Hospital in Boston and colleagues note in a "Perspective" paper online July 28 in the New England Journal of Medicine. However, in an era of transparency and patient-centered medicine, this should no longer be the case, they argue.
"It is said that there are five 'rights' required for safe medication ordering and use: the right patient, the right drug, the right dose, the right time, and the right route," they write. "But there's a sixth element that must be correct - and we believe it's time to add to each prescription an ingredient that's currently conspicuously missing: the right indication."
Dr. Schiff told Reuters Health by email, "There are five key areas where including the indication in the prescription could impact clinical care-first and foremost as a safety feature and check to insure the prescriber/doctor is not making a wrong drug or wrong patient error (e.g., accidentally picking the adjacent medication or patient name from a computer 'pull-down' menu). A patient who goes to the pharmacy and is told to take 'one pill daily for gout' would be able to recognize a potential error and say, 'something is wrong, I don't have gout.'"
Ordering by indication could also narrow the drug choices to those for the specific indication, Dr. Schiff continued. "Electronic drug prescribing systems that incorporate drug indication, if properly designed, would narrow the drug choices to only those appropriate for that patient/indication. This would help to avoid errors such as the one described in the paper, mixing up hydroxyzine 25 mg and hydalazine 25 mg."
"Other clinically important benefits include: patient education and counseling, so patients know which medication is for which health condition; keeping the list of medications better organized . . . to help physicians review and make decisions about medications for each condition; helping guide prescribers to the preferred drugs for a particular condition;" and tracking outcomes based on the reason a drug is prescribed.
Dr. Schiff and colleagues have embarked on a three-year project to build a prototype "ordering-by-indication system," and ultimately will test its safety and efficiency compared with other systems. "We anticipate that vendors who build medication-ordering systems will, in part by building on our work, move to incorporate some of the features or modules we develop," he concluded.
Commenting on the paper, Dr. Paul R. Dexter of the Regenstrief Institute and Eskenazi Health in Indianapolis, Indiana, told Reuters Health by email, "The authors have made a compelling case why every prescription and pill bottle handed to a patient should include a reason for the medication, optimally in terms that the patient can easily understand."
The indication "would need to originate from the prescribing physician, and could easily be a required field in today's electronic prescribing systems. Most pill bottle labels handed to patients do not currently include this, but there is good reason to believe that such a practice would save lives, decreasing medical errors and improving patient medication adherence."
N Engl J Med 2016.
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