Diagnosis Code Plus Rx

In a WSJ Blog article about sound alike drugs, they have a potential solution about having the physician add information about why the drug is being used.  Obviously, the low hanging fruit here is to move to electronic prescribing where the clinical information (i.e., diagnosis code) is in the same file as the drug and technology can be utilized to look for potential issues.

In the short-term, adding the diagnosis code (aka ICD-9 code) to the prescription would have lots of benefits.

  • Avoid getting some point-of-sale rejects when a drug is used off label.  Or vice-versa, avoid off-label use by rejecting claims.
  • Avoid getting suggestions you change prescriptions only to find out that you should not do it given your diagnosis.
  • Development of proactive algorithms (e.g., macros) in the technology where whenever a doctor diagnosed diabetes then it would pull up their typical regiment of drugs based on formulary status and other inputs.
  • Better tailor / personalize information based on disease and drug to help the patient and their care team drive successful outcomes.

The issue of sound alike drug names is a real issue.  Obviously, any time you have multiple human handoffs in a process then you increase the likelihood of error.  As I think I have talked about before, I remember my MD prescribing an eye drop.  I picked up a prescription and the pharmacist clearly told me to put one drop in each eye twice a day.  At the end of the second day, I read the label in detail and realized that it said to put the drops in the ear only.  When I called them back, they talked to the MD and realized that they had heard the wrong name when they listened to his voicemail.

2 Responses to “Diagnosis Code Plus Rx”

  1. George Van Antwerp Reply January 31, 2008 at 4:51 am

    There is a good follow-up article on this which a friend sent me.

    http://www.bloomberg.com/apps/news?pid=newsarchive&sid=arOYnPQYgNeM

    “It’s not just health professionals, but also patients and caregivers who get mixed up,” said Cousins. “Sometimes it happens when patients give their drug history to a doctor and mispronounce a complicated drug name, so the doctor hears something else.”

    The agency [Pharmacopeia] received 26,000 reports of drug mix-ups from 2003 to 2006, involving 1,470 different drugs. In 1.4 percent of the cases the patient was harmed, including seven instances that may have caused the person’s death.

  2. As an RN, knowing the importance of checking a medication before administration has been drilled into my knowledge base. The five R’s: The Right medication, the Right dose, the Right time, the Right route, and most important, the Right patient. I do believe we ALL need to take a piece of responsibility for receiving and taking our own medications.Since we have moved into the era of E-Chart many medication errors have diminished. There is, however, still the human component. We do and will make mistakes.
    Using the ICD-9 code will help to decrease many. Then again, who knows what the Doc is ordering a specific drug for unless we ask. Always, always ask. And always check the label of the bottle a little sooner that after 2 days use of a medication.
    Can our elderly do this efficiently? Not always. Pharmacies should use large print on all labels and question the senior prior to departure. Do they understand, can they read the bottle and do they know what it is for.
    If we can barely keep ourselves safe with medications, how do keep or elders safe?

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