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Most Handwritten Opioid Prescriptions Flawed

News  |  By Debra Shute  
   July 07, 2017

Investigators at Johns Hopkins found that 92% of handwritten prescriptions failed to meet ideal practice standards, contained errors, or failed to comply with federal opioid prescription rules.

Electronic prescriptions for opioids aren’t just safer when it comes to legibility.

Because physicians complete them using standard templates, e-prescriptions are also far more likely to comply with Drug Enforcement Agency (DEA) standards and industry best practices, such as date, pill quantity, and inclusion of at least two patient identifiers, according to a study published in the Journal of Opioid Management.

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The study involved 510 prescriptions filled at a Johns Hopkins Medicine outpatient pharmacy, and aimed to contrast prescribing and processing errors that occurred in electronic versus handwritten opioid prescriptions at the time of discharge. Nearly half (47%) of the prescriptions studied were written by hand, while the rest were created by the electronic health system.

Overall, 42% of prescriptions contained some error, researchers found.

While both the handwritten prescriptions and electronic prescriptions failed to meet the DEA’s standard at the same rate (41%), according to the researchers, all prescriptions that violated best practices were handwritten.

Among prescriptions written by hand, 89% deviated from “best practice” guidelines or were missing at least two forms of patient identification information.

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None of the electronic prescriptions—created using a template aligned with best practices—showed these errors.

“Mistakes can be made at any point in the prescribing, transcribing, processing, distribution, use and monitoring of opioids, but research has rarely focused as we have on prescribing at the time of hospital discharge or on written prescriptions prescribed for adults,” said Mark Bicket, MD, assistant professor of anesthesiology and critical care medicine, and the paper’s lead author.

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While safety measures taken at the pharmacy make it unlikely that patients will get the wrong dosage or drug due to the prescribing errors described, problems at any stage compromise overall patient safety Bicket noted.

“What we hope our results do is get more practitioners to adopt electronic prescribing systems because we have a duty to practice in a way that has the lowest chance of harm to our patients,” Bicket said.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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