Albert Francis E. Domingo, MD

my flight of ideas

Is your Prescription (Rx) Computerized?

Posted on | November 10, 2008 | No Comments

With the license to practice medicine comes the responsibility of communicating directions (medical orders) to the appropriate health professionals who participate in the care of a patient. These include but are not limited to other physicians, nurses, midwives, physical & occupational therapists, and pharmacists. In outpatient or office clinic practice, the pharmacist (or pharmacy assistant, as the case may be) is the one most communicated with by way of the Prescription Order.

While there is formal training in the subject Pharmacotherapeutics as to how one should write a Prescription, the actual practice of individual physicians do vary somewhat, depending on their clinical experiences while in training, and even in actual medical practice.

When it comes to patients, the Prescription does matter a lot – because it is tangible proof that the doctor cares for the patient, and wants something to be done regarding the illness. Which is why as early as clerkship (4th year Medicine Proper), I took to heart the tip of one of my residents in the Philippine General Hospital. She told me not to use medical shorthand (such as, “1 tab PO BID x 7d”), but to spell out my instructions in plain English (same instruction: “take one tablet by mouth two times a day, for seven days”) or even in Filipino/Tagalog, on a patient-to-patient basis (translation: “uminom ng isang tableta dalawang beses sa isang araw, sa loob ng isang linggo”).

Yes, some colleagues have lightly joked that I’m being too obsessive-compulsive in writing my Prescription instructions in Filipino. But I’m not changing the way I do it – I find that patients comply more when they understand.

Lately I’ve taken on a relatively new trend – issuing computerized/typewritten Prescriptions. I first saw such Prescriptions last May 2006 when I rotated at a Family Practice Clinic in Houston, Texas. Little did I realize that locally, they were also already doing it – at least in the bigger medical centers/hospitals. Now that I am licensed to write my own Prescriptions, I decided to give it a try.

A little academia: in the book Goodman & Gilman’s The Pharmacological Basis of Therapeutics (Hardman and Limbird, Eds., 2001), there is an entire Appendix dedicated to the “Principles of Prescription Order Writing and Patient Compliance”. In it, authors Edwards and Roden stated the obvious: “The clear communication of a prescription order to other members of the healthcare team and to the patient is a vital step in drug therapy.”

Regarding typing Prescriptions, the same authors wrote: “All prescriptions should be written in ink or typed … as erasures on a prescription easily can lead to dispensing errors or diversion of controlled substances” (emphasis supplied).

I set out to write this blog post because earlier today, a patient of mine approached me for a prescription of Phenobarbital, an anti-epileptic drug. In summary, she needed a new Prescription for her previous one was already completely dispensed (Phenobarbital being a controlled substance, the local pharmacy is strict on counting the amount dispensed). After her consultation with me, I decided to give her a computerized Prescription for her medication.

A few minutes later, I received a phone call from the local pharmacy, verifying if I indeed wrote the Prescription. I appreciate the fact that they do conduct such verification, for the drug in question is a controlled substance. However, what perplexed me was when the pharmacist/pharmacy assistant mentioned that his basis for verification was not the drug per se, but the fact that the Prescription was computerized.

As I earlier pointed out, the textbooks are quite clear that Prescriptions should either be written in ink, or typed. Is a computerized Prescription not better than a handwritten one in terms of medical errors avoided, and eye strain? My handwriting is the classic so-called “doctor’s handwriting” – not so clear. Again it was nice of them to call, but I think pharmacists/pharmacy assistants should be oriented that so long as a computerized/typewritten Prescription bears the handwritten signature of the physician, it should be accepted.

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