Errors occur in the management of 5-20% of medications ordered in Australian hospitals; and up to 43% of these are preventable. An audit of medication charts in one NSW hospital confirmed these statistics, with “prescribing errors” and “prescription details incomplete” each contributing to around 13% of all clinical interventions.

Many of the “prescribing errors” related to the order not using the generic name. Proper implementation of the National Inpatient Medication Chart, which is mandatory for hospitals seeking accreditation, requires medicine names to be written in full using generic rather than brand names.

Prescribing using the generic drug name assists with:

  • Reducing confusion between medications with names that sound-alike or look-alike
  • Preventing and identifying duplicate orders of the same medication, and
  • Identifying adverse drug reactions and class effects.

It should be noted that brand names vary between distributors, while generic names do not. Furthermore, generic names convey information about the class of medication, allowing staff to identify the indication and cross-check for unintended duplication, drug interactions, and allergies.

There are some exceptions, such as not allowing for interchange between the two brands of warfarin. In this case, medication orders should be written as: “warfarin (Coumadin®)” or “warfarin (Marevan®)”. Including the brand name in the order may also be helpful to avoid confusion; for example fluticasone/salmeterol 500/50micrograms (Seretide®), or oxycodone 10mg (OxyContin®).

Of the “prescription details incomplete” errors, 17% related to the slow release box of the chart not being ticked. This indicated that the standard release form was to be administered, rather than the slow release form supplied. Ticking this box provides additional information that the dose must be swallowed without crushing, and to check carefully before breaking.

References:

  1. Atik A. Adherence to the Australian National Inpatient Medication Chart: the efficacy of a uniform national drug chart on improving prescription error. J Eval Clin Pract. 2013 Oct; 19(5): 769-72.
  2. Department of Health. Medication Administration. Sydney: New South Wales Government; 2014. Available from www.nswhealth.moodle.com.au/DOH/Medication_Administration_1.html. Accessed 5 May 2014.