By HANS DUVEFELT
It occurs in eClinicalworks, I noticed it in Intergy, and I now should maneuver round it in Epic. These EMRs, and I believe many others, insert a cease date on what their programmers suppose (or have been instructed) are scary medication.
In my present system all opioid drug prescriptions fall into this class. For a brief time period prescription which may maybe be a good suggestion however for a longer-term or often wanted prescription it creates the chance of medical errors.
In Epic there’s a field for period, which may be very sensible for a ten day course of antibiotics. If I fill within the quantity 10 within the period field, the treatment falls off the listing after 10 days. This protects me the difficulty of periodically cleansing up the listing.
But when I prescribe three oxycodone tablets a day for a affected person with inoperable again ache and comply with the conference of claiming for 30 days or 28 days, that creates an issue: If my affected person is cautious to not take extra ache drugs than completely wanted and the prescription signifies 28 or 30 days period, the textual content on the prescription will learn for as much as 28 days or for as much as 30 days. That language really suggests they’d higher hurry up and end it and never have any drugs left over. The opposite consequence is that if my affected person doesn’t name for a refill till day 32, the treatment has already disappeared from their treatment listing and can’t simply be “restarted”. I’ve often restarted/re-issued a medicine from reminiscence and gotten the dosage incorrect. After all, I can examine the state prescription monitoring program show for the tablet power and dosage frequency, however I nonetheless should memorize it after which change to the prescription display. And the slightest distraction or interruption creates the potential for errors.
Throughout the EMRs I’ve used I’ve additionally seen the diuretic spironolactone get a cease date even when I depart the “period” field empty. I don’t suppose that’s mandatory: I went to medical college and already know this drug can elevate serum potassium ranges and precipitate kidney failure.
Again to the opiates: I believe the plain English printout ought to say “X tablets each day for a minimum of 30 days” so no one will get the concept to take greater than they completely want as a result of the physician desires them to.
Hans Duvefelt is a Swedish-born rural Household Doctor in Maine. This publish initially appeared on his weblog, A Nation Physician Writes, here.
