The five “rights”— the right patient, right drug, right dose, right time, and right route are essential for safe medication ordering and use. But some medication safety experts assert that the time has come to add a sixth element: the right indication.
Adding the indication on either print or electronic prescriptions can help prevent medication errors and improve medication use in a variety of ways, says Gordon Schiff, MD, Associate Professor of Medicine, Harvard Medical School, and Associate Director, Center for Patient Safety Research and Practice, Brigham and Women’s Hospital in Boston.
Currently, less than 10% of prescriptions have the indication listed.
How close are we to indications-based prescribing being commonplace?
“In a primitive form, we are already there. Various EMR vendors include options for attaching indications to the prescription. Some VA medical centers are also requiring their clinicians to include indications,” Dr. Schiff told Drug Topics.
But Schiff said that it will be years before the sort of visionary prototype that he and his team are designing becomes a reality for prescribers. The best case scenario, he said, would be that some enlightened vendors would redesign their CPOE systems in a way that would allow clinicians to start with an indication.
“People from the patient safety, pharmacy, and health policy communities, along with patients, will need to keep pushing to make indications-based prescribing a reality,” Schiff said.
Schiff and his team at Brigham and Harvard have identified several key areas as to why the indication should be on the prescription and why it will result in better outcomes. He also admits there are some obstacles. The idea, for instance, has not been very popular among physicians or among those concerned about patient confidentiality (Table 1).
“The indication is something that can really help us know what the right drug is, what the right dosing is, and prevent and spot errors,” said Schiff.
Up next: Obstacles and challenges