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Patient information: See related handout on using medicines wiselywritten by the authors of this article. A systematic approach advocated by the World Health Organization can help minimize poor-quality and erroneous prescribing. This six-step approach to prescribing suggests that the physician should 1 evaluate and clearly define the patient's problem; 2 specify the therapeutic objective; 3 select the appropriate drug therapy; 4 initiate therapy with appropriate details and consider nonpharmacologic therapies; 5 give information, instructions, and warnings; and 6 evaluate therapy regularly e.
The authors add two additional steps: 7 consider drug cost when prescribing; and 8 use computers and other tools to reduce prescribing errors. These eight steps, along with ongoing self-directed learning, compose a systematic approach to prescribing that is efficient and practical for the family physician. Using prescribing software and having access to electronic drug references on a desktop or handheld computer can also improve the legibility and accuracy of prescriptions and help physicians avoid errors. Inpersons in the United States younger than 65 purchased a mean of Minimizing such errors through a systematic approach is recommended by national and international authorities 2 — 5 and has drawn the attention of consumer advocates.
All of the scenarios take place during a typical day at a family practice office; scenarios 1 through 4 are phone messages given to you by the nurse and scenario 5 is a patient in the waiting room. Use a systematic approach to prescribing to decrease errors, help patients avoid adverse events, and improve intended outcomes. Discontinue use of abbreviations and non-English characters in prescription writing.
Provide patient education at the time of prescribing to improve patient adherence to pharmacotherapy. Use electronic prescribing tools to prevent errors caused by drug interactions and poor handwriting. Scenario 1 : A five-year-old boy who had pink eye and a clear ocular discharge was started on antibiotic drops four days ago and initially improved, but today the redness and irritation has returned. Scenario 2 : A patient seen yesterday for a sleep-depriving cough was started on antibiotics, Physical description of pills the cough still kept her awake last night.
Scenario 3 : A generally healthy year-old woman who takes nonsteroidal anti-inflammatory drugs NSAIDs for her osteoarthritis now reports ankle edema. In your absence, a colleague had started her on a calcium channel blocker for newly diagnosed hypertension. Scenario 4 : A year-old woman with sinus pain who was prescribed a fluoroquinolone by the overnight call physician called this morning to request a cheaper alternative medication.
Scenario 5 : A year-old woman has presented to the office. She is obese, has type 2 diabetes, and is reporting elevated blood pressures measured at home and at work. You are considering starting her on an angiotensin-converting enzyme inhibitor. In scenario 1, the child treated with antibiotic drops likely had a viral conjunctivitis that did not need specific treatment.
In scenario 4, it is assumed that the woman with sinus pain was diagnosed with a bacterial infection over the telephone on the basis of a symptom, rather than as part of an examination. Prescribing a quinolone to a woman of childbearing age exposes her child to serious teratogenic side effects if she turns out to be pregnant. Specifying the therapeutic objective allows physicians to direct prescribing to a clear goal with expected outcomes.
This can be illustrated using several of the clinical scenarios. In scenario 2, which involves the patient with nocturnal cough, the objective of restoring sleep was not met with the antibiotic prescription; the antibiotic was most likely unneccessary. Other common examples of nonspecific prescribing include using benzodiazepines for insomnia without investigating the cause, and using analgesics without diagnosing the underlying source of pain.
Setting clear therapeutic goals is particularly important in conditions that have treatment objectives that vary depending on risk factors e. The WHO guide suggests that physicians develop a formulary of personal drugs P-drugs. The P-drug and STEPS approaches can be shown using the example of the woman with diabetes and the added diagnosis of hypertension presented in scenario 5. Generic formulations of hydrochlorothiazide Esidrixlisinopril Zestrilmetoprolol succinate Toprol XLand metoprolol tartrate Lopressor are all potential P-drug medications.
Except for metoprolol tartrate, all of these drugs can be administered once daily. Lisinopril offers both blood pressure control and prevention of diabetic complications, 11 but it is contraindicated if the patient is not using a reliable form of birth control. It also is more expensive than hydrochlorothiazide. Metoprolol reduces blood pressure and diabetic complications. Hydrochlorothiazide is the cheapest, but it does not carry the extra benefit of avoidance of diabetic complications. A STEPS assessment Table 1 10 will balance the convenience, effectiveness, and benefit of each drug for a particular patient.
This analysis may lead to different drug selections for different patients. Information from reference In scenario 3, which involves the patient with osteoarthritis, inappropriate prescribing may have been harmful. Her hypertension may be a side effect of the NSAID she was receiving, and her ankle edema could be a side effect of the antihypertensive she was receiving. Perhaps the NSAID should have been discontinued and an adequate dose of acetaminophen, taken three or four times daily, should have been prescribed for her pain rather than adding another medication and inducing a second side effect.
This example illustrates that it is important to consider a patient's age, chronic disease status, and other medications currently being taken before choosing a treatment. Prescriptions should be clear, legible, and written in plain English. The National Coordinating Council on Medication Error Reporting and Prevention recommends eliminating most abbreviations for medication instructions, such as qd dailyqid four times dailyand qod every other day.
They also recommend eliminating abbreviations for drug names, such as MSO 4 morphine sulfate. Prescriptions should include specific indications for anticipated duration of therapy. Physicians should consider reducing transcription errors by prescribing electronically. Nonpharmacologic therapy remains an important treatment option. In scenario 5, the woman with diabetes and the added diagnosis of hypertension may not need medication if she loses weight and exercises. A patient with chronic Physical description of pills may respond to relaxation training, and a patient with insomnia may improve with better sleep hygiene.
However, these perceptions may be inaccurate. Asking a patient directly about therapeutic goals may shed light on his or her willingness to use nonpharmacologic options when available. Physicians should educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication. Physicians must describe how the medication should and should not be administered, including any important relationships to food, time of day, and other medications being taken by the patient.
In scenario 5, the woman with diabetes and the added diagnosis of hypertension should be informed that lisinopril will reduce her blood pressure, protect her kidneys, and could cause a rare but serious reaction called angioedema that demands immediate medical attention.
She should also know that approximately one in 15 patients experiences cough with or without altered taste sensation. When communicating risk, use absolute s e. Physicians also may want to highlight special drug-related information such as avoiding alcohol when taking metronidazole Flagylstaying out of the sun when taking tetracycline, and the possibility of sexual side effects with selective serotonin reuptake inhibitors. Explaining that certain side effects are time-limited can help prevent a patient from discontinuing a needed therapy.
At the end of the visit, the prescriber should ensure that the patient knows when to return for monitoring and whether therapy continues after this single prescription. Systematically reviewing medications at every visit allows the prescriber to monitor treatment effectiveness and reduce problems, particularly in older patients who are most susceptible to polypharmacy.
For example, an antihypertensive may be discontinued after a patient loses weight, or an NSAID for back pain may be stopped after continued exercise and physical therapy. A review also helps avoid the prescribing cascade, which involves a physician adding additional drugs to a patient's regimen to treat side effects of other medications.
The hypertension may be a side effect of her pain medication. Planning regular monitoring for certain medications is important. In scenario 5, if the patient is on lisinopril, she will need follow-up serum chemistries to assess for hyperkalemia or increased serum creatinine.
Physicians often fail to consider cost as an important prescribing factor. Asking about a patient's access to a medical prescription card can help to avoid formulary conflicts and delays in starting therapy. Prescribing and drug reference software can inform physicians and patients about medication costs and coverage on the insurance company's formulary Table 2.
A local pharmacist also can suggest alternatives that decrease cost. Optimal use of the first seven guidelines requires a working knowledge of current medications and keeping up to date on new drugs. The sources described in Table 2 provide more objective, evidence-based data than pharmaceutical representatives or advertisements. Given the pace of change in pharmacotherapeutics, physicians should use continuously updated software for their hand-held or desktop computers and are strongly advised to consider using electronic prescribing programs.
These sources provide clear statements about the strength of evidence supporting their recommendations. Evidence indicates that many new medications offer little or no benefit over drugs that may already be in a personal formulary. More than 10 percent of new drugs on the market in the last 25 years have earned a black box warning or have been withdrawn from the market.
For this reason, physicians should not prescribe new medications until they have been demonstrated to be safer or more effective at improving patient-oriented outcomes than existing drugs. When evaluating new drug studies, physicians should look for evidence that the new drug also improves patient-oriented outcomes more than older drugs, and not just more than placebo.
Physicians should be wary of the influence of the sample closet. Studies Physical description of pills shown that access to samples can influence choices independent of good clinical judgment. Already a member or subscriber?
Log in. Physical description of pills is a board-certified pharmacotherapy specialist and received her doctor of pharmacy degree from the University of oklahoma College of Pharmacy in oklahoma City. Bazaldua completed a primary care specialty residency at the University of Colorado School of Pharmacy and at Kaiser Permanente, both in Denver.
She received her medical degree from the University of Glasgow in Scotland and completed her family medicine residency in Edinburgh, Scotland. Dobbie also completed a fellowship in academic medicine at the Faculty Physical description of pills Center in Waco, Tex. Address correspondence to Madelyn Pollock, M. Reprints are not available from the authors.
Pancholi M, Stagnitti M. Outpatient prescribed medicines: a comparison of use and expenditures, and Statistical Brief Rockville, Md. Guide to good prescribing. A practical manual. Australia Department of Health and Ageing. The national strategy for quality use of medicines. Plain English ed. Canberra, Australia: Health and Ageing, Mottur-Pilson C. Patient safety CME curriculum. Patient safety: the other side of the quality equation. National Prescribing Centre. Medicines partnership. Wolfe SM. Worst pills, best pills: a consumer's guide to avoiding drug-induced death or illness. New York, N.
Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. Shaughnessy AF. STEPS drug updates. Am Fam Physician. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS Council recommendation. Recommendations to enhance accuracy of prescription writing. Santell JP. Confusing abbreviations can lead to drug errors.
Error Watch November ; Prescription writing to maximize patient safety. Fam Pract Manag. Holroyd KA.Physical description of pills
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