Appendix C Return to the Beginning

National Coordinating Council for Medication Error Reporting and Prevention Recommendations to Reduce Medication Errors Associated with Verbal Medication Orders and Prescriptions

Preamble

Confusion over the similarity of drug names accounts for approximately 25% of all reports to the USP Medication Errors Reporting (MER) Program. To reduce confusion pertaining to verbal orders and to further support the Council's mission to minimize medication errors, the following recommendations have been developed.

In these recommendations, verbal orders are prescriptions or medication orders that are communicated as oral, spoken communications between senders and receivers face to face, by telephone, or by other auditory device.

Recommendations

1. Verbal communication of prescription or medication orders should be limited to urgent situations where immediate written or electronic communication is not feasible.

2. Health care organizations* should establish policies and procedures that:

Describe limitations or prohibitions on use of verbal orders
Provide a mechanism to ensure validity/authenticity of the prescriber
List the elements required for inclusion in a complete verbal order
Describe situations in which verbal orders may be used
List and define the individuals who may send and receive verbal orders
Provide guidelines for clear and effective communication of verbal orders

3. Leaders of health care organizations should promote a culture in which it is acceptable, and strongly encouraged, for staff to question prescribers when there are any questions or disagreements about verbal orders. Questions about verbal orders should be resolved prior to the preparation, or dispensing, or administration of the medication.

4. Verbal orders for antineoplastic agents should NOT be permitted under any circumstances. These medications are not administered in emergency or urgent situations, and they have a narrow margin of safety.

5. Elements that should be included in a verbal order include:

Name of patient
Age and weight of patient
Drug name
Dosage form (e.g., tablets, capsules, inhalants)
Exact strength or concentration
Dose, frequency, and route
Quantity and/or duration
Purpose or indication (unless disclosure is considered inappropriate by the prescriber)
Specific instructions for use
Name of prescriber, and telephone number when appropriate
Name of individual transmitting the order, if different from the prescriber.

6. The content of verbal orders should be clearly communicated:

The name of the drug should be confirmed by any of the following:
Spelling
Providing both the brand and generic names of the medication
Providing the indication for use
In order to avoid confusion with spoken numbers, a dose such as 50 mg should be dictated as "fifty milligrams…five zero milligrams" to distinguish from "fifteen milligrams…one five milligrams."
Instructions for use should be provided without abbreviations. For example, "1 tab tid" should be communicated as "Take/give one tablet three times daily."

7. The entire verbal order should be repeated back to the prescriber, or the individual transmitting the order, using the principles outlined in these recommendations.

8. All verbal orders should be reduced immediately to writing and signed by the individual receiving the order.

9. Verbal orders should be documented in the patient's medical record, reviewed, and countersigned by the prescriber as soon as possible.

*Health care organizations include community pharmacies, physicians' offices, hospitals, nursing homes, home care agencies, etc.

Appendix D

National Coordinating Council for Medication Error Reporting and Prevention Recommendations to Health Care Professionals to Reduce Errors Due to Labeling and Packaging of Drug Products and Related Devices

The Council encourages health care professionals to routinely educate patients and caregivers to enhance understanding and proper use of their medications and related devices. Furthermore, the Council encourages health care professionals to regularly participate in error prevention training programs and, when medication errors do occur, to actively participate in the investigation.

In addition, the Council makes the following recommendations to health care professionals to reduce errors due to labeling and packaging of drug products and related devices:

1.The Council encourages health care professionals to use only properly labeled and stored drug products and to read labels carefully (at least three times - before, during, and after use).

2.The Council encourages collaboration among health care professionals, health care organizations, patients, industry, standard-setters, and regulators to facilitate design of packaging and labeling to help minimize errors.

3.The Council encourages health care professionals to take an active role in reviewing and commenting on proposed regulations and standards that relate to labeling and packaging (i.e. Federal Register, and Pharmacopeial Forum).

4.The Council encourages health care professionals to report actual and potential medication errors to national (e.g. FDA MedWatch Program and/or the USP Practitioners' Reporting Network), internal, and local reporting programs.

5.The Council encourages health care professionals to share error-related experiences, case studies, etc., with their colleagues through newsletters, journals, bulletin boards, and the Internet.