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Variations Identified in Free-Text Directions in E-Prescriptions

Variations Identified in Free-Text Directions in E-Prescriptions

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WEDNESDAY, April 4, 2018 — There is considerable variation in the quality of free-text patient directions (Sig) in electronic prescriptions (e-prescriptions), according to a study published online April 2 in the Journal of Managed Care & Specialty Pharmacy.

Yuze Yang, Pharm.D., from Surescripts in Arlington, Va., and colleagues examined the quality and variability of free-text Sig strings in ambulatory e-prescriptions in a retrospective qualitative analysis performed on a sample of 25,000 e-prescriptions issued by 22,152 community-based prescribers using 501 electronic health records or e-prescribing software applications. A Sig classification scheme was used to classify the content of Sig text strings in e-prescriptions.

The researchers identified 3,797 unique Sig concepts in the text strings analyzed; more than half of all Sigs could be classified into 25 unique Sig concepts. Substantial variability was displayed in Sig strings, including in those that expressed apparently simple and straightforward concepts; 832 permutations of words and phrases used to convey the concept of “take one tablet by mouth once daily” were identified. Quality-related events that could pose patient safety risks or workflow disruptions that may necessitate pharmacist callbacks for clarification or other manual interventions were identified in about 10 percent of Sigs.

“More than half of all patient directions sent in the ambulatory setting can be categorized into only 25 Sig concepts,” the authors write. “This suggests an immediate, practical opportunity to improve patient safety and workflow efficiency for both prescribers and pharmacies.”

Several authors are employees of Surescripts.

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Posted: April 2018

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