e-Prescribing: Safety. Quality. Both.

By Michael Hamilton

I’m looking forward to e-prescribing for the convenience and efficiency, but also for the potential enhancements in quality and safety.

Beyond legibility issues, although this is still an important problem, true e-prescribing eliminates the need for a pharmacist to transcribe handwritten or printed prescriptions from the paper version to their own pharmacy system software. Human transcribing is still one of the most error-prone processes that we undertake and if we can eliminate it, we will have come a long way in terms of safety and quality.

Join the discussion on e-prescribing at this year’s Partnership Conference Nov. 14-15 in Calgary.

The development of an e-prescribing service is also an opportunity to engineer out some of the problematic ways physicians write prescriptions. We use short forms that can be misinterpreted and we use acronyms that carry different meanings. Is “HCT” hydrochlorothiazide or hydrocortisone? We use the symbol “U” to mean units and it is easily mistaken for 0 — so 4U of insulin becomes 40 units of insulin. We use trailing zeroes after decimal points — so that 4.0 looks like 40. QOD is confused with QID is confused with QD. This again continues to occur even with computer printed EMR prescriptions. With e-prescribing there is a unique opportunity to standardize the elements required for prescribing and to force input of appropriate parameters, preventing acceptance of error prone, ambiguous, or easily misinterpreted statements.

With a robust and mature e-prescribing system, you can introduce a “safety intelligence” to the system, in particular at the point of prescribing. We do have interaction checking in most EMRs but that assumes we update frequently and we know all the patient’s medications. If an allergy is caught at the emergency room, a family physician may not know about it. A system that automatically communicates this across platforms will trigger a preventive action at the point of prescribing.

There are endless ways that e-prescribing can improve safety, and I, as someone on the ground, who prescribes, and most likely makes mistakes, look forward to these efforts as a way to improve my own work as a doctor. But I also, in my role in medication safety, research, and policy, look forward to the tremendous big picture improvements that can come from e-prescribing — what we prescribe, how we prescribe, and the way in which we communicate instructions.

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About the author
Michael Hamilton

Michael Hamilton

Dr. Michael Hamilton, Physician Lead & Medication Safety Specialist, Institute for Safe Medication Practices Canada (ISMP Canada), is a member of the medication incident analysis team at ISMP Canada, contributing to the investigation of medication errors and collaborating in research projects with the Institute. He has been privileged to be able to advise health care providers, administrators, policymakers, and legislators about issues in medication safety.