In 2000, the Doctor of Pharmacy degree became the entry-level pharmacy degree. This clinical degree gives pharmacists education & patient experience they would be eager to put to work—if only they had enough time to do so.
To Err Is EMR
Traditionally, prescribing errors are the fault of the prescribing physician. A multidisciplinary panel of physicians, surgeons, pharmacists, nurses and risk managers, defined a prescribing error as “when, as a result of a prescribing decision or prescription writing process, there is an unintentional, significant 1) reduction in the probability of treatment being timely and effective or 2) increase in the risk of harm when compared with generally accepted practice.”1
The increasing use of electronic medical records (EMRs) and electronic prescribing has removed a major source of prescribing errors—physician handwriting. I remember as a senior resident doing handwriting consults for interns, helping them interpret the instructions the attending physicians scribbled in the paper chart. I am certain most pharmacists have the same experience. Electronic prescribing has removed the uncertainty that used to come from trying to distinguish the abbreviations for magnesium sulfate and morphine sulfate.
This was no mean feat. On Dec. 1, 1999, the Institute of Medicine released a report on medical errors. The report estimated that 1.5 million adverse events and 7,000 deaths occurred in the U.S. each year as the result of prescribing errors, many of which could be traced back to poor handwriting.2 This report, titled To Err Is Human: Building a Safer Health System, was designed to increase awareness of medical errors and was largely responsible for the push to transition to electronic prescribing.
For the most part, this transition accomplished what it was supposed to. One study demonstrated a 70% reduction in errors following a transition to electronic prescribing, largely attributed to elimination of errors due to illegibility, inappropriate abbreviations, and incomplete prescriptions.3 And were it not for the law of unintended consequences, the transition to electronic prescribing might have been an unequivocal victory. Unfortunately, EMRs, perhaps predictably, gave rise to a new generation of prescribing errors, which include the following:4
- Autopopulation: Most EMRs automatically suggest a list of potential matches as soon as you start to type the first few letters of the drug name. Only a few millimeters of space may separate penicillin from penicillamine, or azithromycin from azathioprine;
- Alert fatigue: Clinicians face a high burden of automatically generated alerts. Some of these are valuable, but are buried under a deluge of nonsensical or repetitive warnings, which dilute the potential of this feature; and
- Default values: EMRs may default to specific quantities or doses, which may be incorrect.
An illegible prescription, while annoying, was easy enough to flag. Who is responsible for catching this new generation of subtle prescribing errors? The pharmacist.
