I might be the only pharmacist in the world saying this, but I don't care. I'm so sick of electronic scripts. I swear I spend more time calling doctors' offices clarifying electronic scripts than I ever did for written ones.
The problem with electronic scripts is that you actually have to know how to use the program in order to send them accurately. Now, I have no idea what the software interface looks like. I just know how they show up on my computer, and often, there's some sort of problem with them.
The most common problem is whoever is inputting the script (medical assistants, RNs, and seemingly rarely the physician) keeps selecting the wrong drug. I can only assume that the interface is similar to our pharmacy computers where you type in at least part of the name of the drug and then choose the correct one from a long list of options. The problem is that while pharmacy employees work with these drugs every single day and are well aware how they're named and supplied, doctors' representatives seem to not really know which is the correct drug to choose.
Here's an example...
Sig: Take 1 teaspoonful q 12h prn
quant: 4 ounces
I don't even know what Tussirex is. Upon looking it up in the PDR, it apparently existed at one time as some sort of cough medicine. I've never seen it, and I'm pretty sure it doesn't exist anymore. Of course, any pharmacist knows that it was supposed to be for Tussionex. However, I can't just assume that. I've seen physicians write for products that are no longer available plenty of times before. Therefore, and especially since Tussionex is a controlled substance, I had to call the office to verify it. As you could have guessed, by the time we got the script, the office was closed and was no longer accepting phone calls. When we finally contacted the office a day later, the nurse confirmed what I already knew; She had selected the wrong drug.
Problems like that are amazingly common. Wellbutrin is another one that drives me crazy. Whenever I see an electronic script for Wellbutrin, there's probably about a 50% chance it was inputted incorrectly. There are 3 different formulations of Wellbutrin. There's just plain old Wellbutrin, the 12 hour Wellbutrin SR, and the once daily Wellbutrin XL. It's not at all uncommon to see scripts that read just like this...
Drug: Wellbutrin SR 12 Hour 150 mg
Sig: Take 1 tablet once daily.
This drives me insane because there are so many things that could be wrong with that script that even after calling the office, it usually takes forever for me to get it resolved. Was it supposed to be for Wellbutrin SR? If so, are they really only taking it once a day? Shouldn't it be twice daily with a quantity of 60? Or did the doctor really mean Wellbutrin XL, and someone just selected the wrong Wellbutrin? AHHHHHH!!!!
Then there's the ones that come across with completely messed up directions...
Drug: Klonopin 0.5 mg
Sig: Take 1 po qd po 1 po HS (30 days)
That's exactly how the script came across. My first thought was that the doctor meant for the patient to take it twice daily. That seemed to make sense. The quantity was for 60, and it said 30 days in the directions. It looked pretty obvious to me, but once again, it was a controlled substance, so I just wanted to double check. Of course, I couldn't get anyone at the office right away, so I had to leave a message. Five hours later the doctor called back to say that it was only supposed to be 1 tablet at bedtime, and he had no idea why the script got messed up like that.
A lot of pharmacists probably would have filled that as twice daily, and it would have been an error (albeit not really the pharmacist's fault) because it wasn't what the doctor intended. That leads me to wonder just how many scripts are filled incorrectly due to someone in the office choosing the wrong drug or inputting the wrong directions? I'm guessing more than a few.
I think that electronic scripts were aimed at solving one prescribing problem: Bad handwriting. However in doing so, they opened up the potential to make plenty of other mistakes. In reality, bad handwriting was never the biggest source of prescription errors. The biggest problem causing incorrectly written (or filled) prescriptions is not double checking them before they go out the door. Prescribers (or whoever is actually writing the scripts, which I know often times is just the medical assistant, and the doctor just scribbles his signature on it) just quickly write out a script without ever giving it a second look. Therefore, careless mistakes are made. Usually the handwriting is at least good enough for pharmacists to figure out. I really don't call offices that much to clarify poor handwriting. Most of my calls for clarification involve the actual content of the prescription. Wrong drug, wrong dosage, wrong directions, wrong or missing quantity, etc. Without making double checking mandatory, these errors will continue to happen whether the scripts be hand written or electronically sent.
What I don't understand is why there's no emphasis on double checking the script before it ever leaves the office. Pharmacists double and triple check every single prescription before it leaves the pharmacy. If I'm the only person working, I will type the script myself. Then once the label prints, I will check what I typed against the hard copy. Then, I will grab the drug from the shelf and check the NDC on the bottle vs. the NDC on the label. Then I'll count it out. If it's a control, I'll double count it. Then, I'll check the name on the bottle vs. the name on the pharmacy receipt that gets stapled to the bag. Finally, I'll verify the patient's address before giving the prescription to them.
Notice that there's a half dozen checks in there for each script I fill. However, prescribers don't seem to even do a single double check. I know decreasing insurance reimbursements have them strapped for time while trying to fit as many patients in as possible. However, I can't imagine that it would take more than 5 seconds to check a prescription one just wrote for accuracy.
There's no excuse for the number of mistakes I see. Absolutely none at all, and since electronic scripts, at least from my observations, aren't doing anything to cut down on these mistakes, what's the point?