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    The Case for Indications on Prescriptions

    Putting indications on all prescriptions may reduce errors.

    The five “rights”— the right patient, right drug, right dose, right time, and right route are essential for safe medication ordering and use. But some medication safety experts assert that the time has come to add a sixth element: the right indication.

    Adding the indication on either print or electronic prescriptions can help prevent medication errors and improve medication use in a variety of ways, says Gordon Schiff, MD, Associate Professor of Medicine, Harvard Medical School, and Associate Director, Center for Patient Safety Research and Practice, Brigham and Women’s Hospital in Boston.

    Currently, less than 10% of prescriptions have the indication listed.

    Table 1

    How close are we to indications-based prescribing being commonplace?

    “In a primitive form, we are already there. Various EMR vendors include options for attaching indications to the prescription. Some VA medical centers are also requiring their clinicians to include indications,” Dr. Schiff told Drug Topics.

    But Schiff said that it will be years before the sort of visionary prototype that he and his team are designing becomes a reality for prescribers. The best case scenario, he said, would be that some enlightened vendors would redesign their CPOE systems in a way that would allow clinicians to start with an indication.

    “People from the patient safety, pharmacy, and health policy communities, along with patients, will need to keep pushing to make indications-based prescribing a reality,” Schiff said.

    Related article: Prescribing Rights: Worth it?

    Schiff and his team at Brigham and Harvard have identified several key areas as to why the indication should be on the prescription and why it will result in better outcomes. He also admits there are some obstacles. The idea, for instance, has not been very popular among physicians or among those concerned about patient confidentiality (Table 1).

    “The indication is something that can really help us know what the right drug is, what the right dosing is, and prevent and spot errors,” said Schiff.

    Up next: Obstacles and challenges

    Anthony Vecchione
    Anthony Vecchione is Executive Editor of Drug Topics.

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    • [email protected]
      Having the indication on the prescription is a great idea for all of the reasons mentioned. However, if this becomes a requirement then any penalties for its absence should be borne by the prescriber, not the pharmacy. Additionally, the PBMs would need to be forbidden from using the absence of an indication or dispensing for an unlabeled indication as grounds for recoupment. Ideally, too, the pharmacy should be paid for any interventions since so many prescriptions now are going out the door for less than an OTC, which I find to be professionally insulting. Too many well intentioned ideas end up costing pharmacies money for things that are not within our control. E-prescribing and tamper resistant prescription pads are 2 examples that come immediately to mind where actions (or failures) by the prescriber are paid for by the pharmacy.