Electronic Prescribing Errors

1. Electronic Prescribing Errors Rick Zarek, R. Ph. Gothenburg Discount Pharmacy Anthony Hruska, Pharm. D Candidate 2012 UNMC School of Pharmacy

2. Electronic Prescription Requirements Nebraska Statue 128-014.01 (Same requirements as oral and written prescriptions) - Prescription must contain: 1.) Patients Name 2.) Name of drug, device, or biological 3.) Strength of the drug or biological, if applicable 4.) Dosage form of drug or biological, if applicable 5.) Quantity of drug, device, or biological product 6.) Directions for use 7.) Date of issuance

3. Electronic Prescription Requirements continued • 8.) Prescriber’s name and name of the supervising or collaborating physician, when applicable • 9.) Number of authorized refills • 10.) Additional information required for controlled substances: • a.) Patient’s address • b.) Prescriber’s address • c.) Prescriber’s D.E.A registration number

4. Electronic Prescription Additional Information • Nebraska State Statue 1306.21 • Schedule III, IV, and V Control Substance • Must be a signed written prescription or a facsimile of a signed prescription transmitted by the practitioner or his/her agent to the pharmacy • May also be an oral authorization • Electronic signature is not a valid authorization • Schedule II Control Substance • - Can NOT be filled via electronic prescription • - Must be a signed written prescription with no refills

5. Electronic Prescription Errors • Study published in Journal of the American Medical Informatics Association. (Cortez, Bloomberg, 6/29/11) • 3,850 e-prescriptions from 13 electronic prescribing systems were analyzed • 466 e-prescription errors from 452 e-prescriptions (~12%) • 163 potentially harmful errors • 58% were “significant” (could have caused diarrhea, headaches, or rash) • 42% were “serious” (could have caused low blood sugar, decreased heart rate, or fainting) • None were life-threatening • Most common errors were omitted information • Accounted for 60.7% of total errors (ex. Dosage, strength, date, etc.)

6. Examples of Common Electronic Prescription Errors • Incorrect Quantity

7. Examples of Common Electronic Prescription Errors • Incorrect Directions Was originally written and already filled for Cymbalta 30mg the prior month.

8. Examples of Common Electronic Prescription Errors • Incorrect Directions Maximum dose for Hypertension is 100 mg/day - Usually once a day dosing

9. Examples of Common Electronic Prescription Errors • Incorrect Directions

10. Examples of Common Electronic Prescription Errors • Incorrect Product Selection

11. Examples of Common Electronic Prescription Errors • Incorrect Product Selection Syntest 0.625mg = Esterified Esterogen; Methytestosterone 0.625-1.25 mg Ortho-Est 0.625 mg = Estropipate

12. Examples of Common Electronic Prescription Errors • Incorrect Product Selection

13. Examples of Common Electronic Prescription Errors • Incorrect Product Selection

14. Examples of Common Electronic Prescription Errors • Omitted Information

15. Examples of Common Electronic Prescription Errors • Omitted Information

16. Examples of Common Electronic Prescription Errors • Unfortunately only individuals with prescribing power may prescribe a prescription

17. Future of E-Prescribing • In order to reduce errors due to “omitted data,” mandatory entry may be initiated on electronic prescribing systems. • Medicare E-Prescribing incentives are likely to drive the use of e-scripts forward. • For eligible professionals successfully E-Prescribing , an increase in reimbursement will be implemented: • 1% in 2011-1012 and 0.5% in 2013 • For eligible professionals not successfully E-Prescribing a decrease in reimbursement will be implemented: • 1% in 2011, 1.5% in 2013, and 2% in 2014 and each subsequent year

18. Questions?