Sunday, 19 March 2017

Write drug names in capital letters to avoid prescription errors

Write drug names in capital letters to avoid prescription errors Doctors are known to have poor handwriting and they also use abbreviations in their prescriptions. As a result, quite often, prescriptions may be unreadable and it is often said that only chemists could decipher a doctor’s prescription. This is an area that needs to be addressed by doctors as illegible prescriptions may be misread and wrongly dispensed, often with disastrous consequences. A report ‘Preventing Medication Errors’ from the Institute of Medicine (IOM) published in 2006 said, “In hospitals, errors are common during every step of the medication process—procuring the drug, prescribing it, dispensing it, administering it, and monitoring its impact—but they occur most frequently during the prescribing and administering stages.” Beneficence and nonmaleficence along with patient autonomy and justice constitute the four guiding tenets of medical ethics. Patients come to us when they are sick and as clinicians, we are trained to use our skills and knowledge to diagnose and treat them. This is the principle of beneficence ‘do good’ complemented by that of 'non-maleficence' i.e. to do no harm. The fiduciary nature of the doctor-patient relationship places an ethical obligation on the doctor to always put the interests of the patient first. To reduce prescription errors, the Medical Council of India (MCI) has issued guidelines that require doctors to write in capital letters to that the writing is legible. In September 2016, MCI revised its code of ethics notified as Indian Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations, 2016 – Part – I. this revision required doctors to write the generic names of drugs and in capital letters so that the drugs prescribed could be easily read and dispensed. The notification read as follows: In Chapter 1-B-Duties and responsibilities of the Physician in general, Clause – 1.5 under the heading – Use of Generic names of drugs, the following shall be substituted: “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.” IMA welcomes the new MCI gazette notification asking doctors to prescribe generic medicine in capital letters but clarifies it further. “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs”. Here are some examples of common prescription errors and how to avoid them. • Always spell the drug: Always spell the drug if you are giving telephonic instructions. Sound-alike drugs can cause confusion. o E.g. the patient received Isoprin IV in place of Isoptin and nearly died. o E.g. Amlopress AT/80mg; a hypertensive called up his family physician who asked him to take amlopress AT but the patient took amlopress 80 mg. After sometime he developed dizziness, flushing, palpitation, nausea, abdominal pain. • Never write ‘U’ to abbreviate the word ‘units’: Do not write ‘U’ for units when writing prescription. Always write the complete word ‘units’. It may be mistaken as zero. E.g. never write 4U insulin. The patient may be given 40 units of insulin when the doctor meant 4 U (4 units). • Never write the numeric after a decimal point: The use of a trailing zero after a decimal point when writing prescription may lead to medication errors. E.g. do not write 3.0 mg. There are chances that the patient may get 50 mg; 5.0 mistaken as 50 mg if the decimal point is not seen. • Always write the numeric 0 before the decimal point: Always add a leading zero when writing dose of a drug, which is less than one. Lack of a leading zero may lead to a decimal point being missed. For example, never write .25 mg; instead write 0.25 mg. Otherwise there are chances the patient may take 25 mg in the first instance itself. • 8-2-8 mistake: The time interval should be written more clearly as 8am 2pm 8pm. Or, the patient may consider it to be the number of tablets to be taken 8 in the morning, 2 in the afternoon and again 8 at night

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