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    Electronic prescriptions: Return to sender

    Life doesn't come with an instruction manual. Fortunately, everything I buy at IKEA does.  

    In the pharmacy world, our assembly instructions come in the form of a prescription. Its singular purpose, the reason for its very existence, is to communicate to the pharmacist the prescribers' intentions. What do we do if the communication system is broken?  

    Years ago, prescriptions were handwritten. If we couldn't read something, we'd call the office for clarification. Today we have electronic prescribing (e-Rxs), the savior of healthcare. It exists to reduce errors.

    When I was first asked about the pure awesomeness of this new technology, the offices and software companies were taken aback by my response: “We do not have fewer errors, we have more legible errors.” Now I can clearly see the mistake that was made on the prescription.

    Pharmacists used to know the handwriting of their local prescribers. We knew what their hieroglyphics meant and often didn’t need to call. Today, the errors are so bad that many e-scripts we receive cannot be filled as sent.

    The Cynical Pharmacist
    Follow The Cynical Pharmacist at www.facebook.com/thecynicalpharmacist and at www.thecynicalpharmacist.blogspot.com.


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    • Anonymous
      I have been so frustrated since the evolution of escripts that I do not have a "Return to Sender" option. The doctors and their agents are so hard to get a hold of by phone or fax anymore. I consistently leave messages that are not returned. Not that I'm a programmer, but it seems that if the escript communication can go in one direction it would be easy to open the channel to communicate in reverse. The other thought I have had about decreasing errors in escripts is the doctors offices should start employing experienced pharmacy technicians to either enter them or review the orders before sending to the pharmacy.
    • Mr. WBidwell
      "Lantus Insulin; dispense 12 teaspoonfuls (60ml) qHS" sent not once, not twice, but 3 times........"Excuse me Mr. Jones, but does your doctor like you?"
    • DebraLawlor
      Great article. This is a hideous problem, are we by law expected to find and solve physcians mistakes? My biggest problem is the physician phone listed on the script! I call to correct thr prescription and the secretary says "I'm sorry this is the billing office, we didn't send you any electronic scripts". Totally ABSURD
    • BruceKiacz
      Good article - but I highly doubt that any of the software providers that write this defective code are willing to hire the team of pharmacists needed to correct and maintain their software. Pharmacists are just too expensive when compared to offshore coding mills. Further, even if an e-script vendor was willing to invest in the necessary resources, the data is coming from a third party "drug database" solution that often contains numerous errors (I keep calling them in and they keep fixing them with the "next release" - whatever happened to "QA"?). One thing that might help is if the FDA would correct their useless NDC system. Every e-script vendor has to "translate" data fields because the FDA allows manufacturers to enter strength, size, quantity every which way then cry about the cost of relabeling if anyone brings up the concept of a real national standard. But then, if these electronic systems actually worked, there would be a lot of pharmacists out of a job as prescriptions flowed automatically to the filling robot who, in Siri's voice would ask: "Would you like to speak to a human about your prescription? Let me get our call center on-line!"
    • VincentKelch
      I understand your frustration. I've worked in both hospital and retail settings for the government for almost 40 years. We had problems with "physician order entry" in the institutional area back in the 1970's and went back to hand written orders. The software providers must use simple directions and provide matching entry fields. Maybe the Affordable Care Act can contribute something since they mandated it.
    • WilliamTarloff
      I have been grousing about this since the advent of electronic prescribing. I see significantly more errors on e-scripts than I ever did on handwritten prescriptions. The fact that the DEA now allows e-prescribing of controlled substances including schedule II drugs is horrifying to me. Why are pharmacists so resistant to banding together to bring about change? It seems that the people who make the decisions are not actually in the field practicing pharmacy.
    • Betty DiannPoret
      Great article. It's nice to know that the errors are more likely to poor e-scribing programs. We have blessed our prescribers more than once for ridiculous e-scripts. Thanks for the article.