By HANS DUVEFELT
It occurs in eClinicalworks, I noticed it in Intergy, and I now need to maneuver round it in Epic. These EMRs, and I believe many others, insert a cease date on what their programmers assume (or have been advised) are scary medication.
In my present system all opioid drug prescriptions fall into this class. For a brief time period prescription that may maybe be a good suggestion however for a longer-term or sometimes wanted prescription it creates the danger 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 medicine falls off the record after 10 days. This protects me the difficulty of periodically cleansing up the record.
But when I prescribe three oxycodone tablets a day for a affected person with inoperable again ache and observe 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 tablets 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 truly suggests they’d higher hurry up and end it and never have any tablets left over. The opposite consequence is that if my affected person doesn’t name for a refill till day 32, the medicine has already disappeared from their medicine record and can’t simply be “restarted”. I’ve sometimes restarted/re-issued a medicine from reminiscence and gotten the dosage flawed. After all, I can examine the state prescription monitoring program show for the capsule power and dosage frequency, however I nonetheless need to memorize it after which swap 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 go away the “period” field empty. I don’t assume that’s essential: I went to medical college and already know this drug can increase serum potassium ranges and precipitate kidney failure.
Again to the opiates: I believe the plain English printout ought to say “X tablets every day for a minimum of 30 days” so no person will get the thought to take greater than they completely want as a result of the physician needs them to.
Hans Duvefelt is a Swedish-born rural Household Doctor in Maine. This submit initially appeared on his weblog, A Nation Physician Writes, right here.