Baltimore, MD—This likely will come as no surprise to pharmacists, but nearly 90% of opioid prescriptions written by hand weren’t in line with “best practice” guidelines, a new study reveals.

The article in the Journal of Opioid Management describes how writing a script, as opposed to transmitting it electronically, leads to many more prescribing and processing errors.

Johns Hopkins Medicine researchers reviewed opioid prescriptions filled at the healthcare system’s outpatient pharmacy to determine whether and how prescription processing methods contribute to variations, inconsistencies, and errors in opioid distribution.

“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,” explained lead author Mark Bicket, MD, assistant professor of anesthesiology and critical care medicine.

The report notes that 92% of handwritten prescriptions either failed to meet ideal practice standards, contained such errors as the absence of at least two patient identifiers, or failed to comply with federal opioid prescription rules.

“There are the normal legibility issues you would suspect with a handwritten prescription, but we also commonly found things like missing patient identification information and errors in abbreviations,” Bicket emphasized.

All prescriptions for opioid medications for patients aged 18 years and older processed at an outpatient pharmacy at The Johns Hopkins Hospital for 15 consecutive days in June 2016 were reviewed for the study.

Evaluation of the 510 prescriptions was based on three criteria:
• Their compliance with best practice guidelines for prescription writing compiled from past studies at the Johns Hopkins Children’s Center, including criteria such as legibility, date, and pill quantity;
• The presence of at least two patient identifiers, including medical record number, Social Security number, and date of birth; and
• Compliance with the U.S. Drug Enforcement Administration’s (DEA) rules regarding prescriptions of controlled substances, which require the patient’s full name and address.

Researchers determined that 42% contained some error. Handwritten prescriptions made up 47% of the total, and, while prescriptions created by the electronic health system failed to properly meet the DEA’s standard at the same rate, all of the scripts that violated best practice or did not include at least two patient identifiers were handwritten.

In fact, 89% of prescriptions written by hand deviated from best practice guidelines or were missing at least two forms of patient identification information, study authors point out. On the other hand, none of the prescriptions created by the hospital’s electronic prescribing system had those errors, primarily because e-prescriptions use a template that aligns with best practices.

Thanks to safety nets such as pharmacists checking the prescription information, such as the drug name, indication, and amount, Bicket says, those errors rarely affect dispensing of the drug. He cautions, however, that the errors increase the risk that something will be missed.

“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 concluded.

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