Abstract
BackgroundMedication errors are pervasive. Electronic prescriptions (e-prescriptions) convey secure and computer-readable prescriptions from clinics to outpatient pharmacies for dispensing. Once received, pharmacy staff perform a transcription task to select the medications needed to process e-prescriptions within their dispensing software. Later, pharmacists manually double-check medications selected to fulfill e-prescriptions before dispensing to the patient. Although pharmacist double-checks are mostly effective for catching medication selection mistakes, the cognitive process of medication selection in the computer is still prone to error because of heavy workload, inattention, and fatigue. Leveraging health information technology to identify and recover from medication selection errors can improve patient safety.ObjectiveThis study aimed to determine the performance of an automated double-check of pharmacy prescription records to identify potential medication selection errors made in outpatient pharmacies with the RxNorm application programming interface (API).MethodsWe conducted a retrospective observational analysis of 537,710 pairs of e-prescription and dispensing records from a mail-order pharmacy for the period January 2017 to October 2018. National Drug Codes (NDCs) for each pair were obtained from the National Library of Medicine’s (NLM’s) RxNorm API. The API returned RxNorm concept unique identifier (RxCUI) semantic clinical drug (SCD) identifiers associated with every NDC. The SCD identifiers returned for the e-prescription NDC were matched against the corresponding SCD identifiers from the pharmacy dispensing record NDC. An error matrix was created based on the hand-labeling of mismatched SCD pairs. Performance metrics were calculated for the e-prescription-to-dispensing record matching algorithm for both total pairs and unique pairs of NDCs in these data.ResultsWe analyzed 527,881 e-prescription and pharmacy dispensing record pairs. Four clinically significant cases of mismatched RxCUI identifiers were detected (ie, three different ingredient selections and one different strength selection). A total of 546 less significant cases of mismatched RxCUIs were found. Nearly all of the NDC pairs had matching RxCUIs (28,787/28,817, 99.90%-525,270/527,009, 99.67%). The RxNorm API had a sensitivity of 1, a false-positive rate of 0.00104 to 0.00312, specificity of 0.99896 to 0.99688, precision of 0.00727 to 0.04255, and F1 score of 0.01444 to 0.08163. We found 872 pairs of records without an RxCUI.ConclusionsThe NLM’s RxNorm API can perform an independent and automatic double-check of correct medication selection to verify e-prescription processing at outpatient pharmacies. RxNorm has near-comprehensive coverage of prescribed medications and can be used to recover from medication selection errors. In the future, tools such as this may be able to perform automated verification of medication selection accurately enough to free pharmacists from having to perform manual double-checks of the medications selected within pharmacy dispensing software to fulfill e-prescriptions.
Highlights
BackgroundMedical error is the third leading cause of death in the United States, and medication errors are the most common type of these errors [1]
The application programming interface (API) returned RxNorm concept unique identifier (RxCUI) semantic clinical drug (SCD) identifiers associated with every National Drug Code (NDC)
We found 872 pairs with 1731 NDCs arising from an e-prescription-dispensing record pair to their where the RxNorm API did not return an RxCUI
Summary
BackgroundMedical error is the third leading cause of death in the United States, and medication errors are the most common type of these errors [1]. One of the medication errors with the greatest potential for harm happens when patients receive a different medication than that prescribed [3,4]. Pharmacy staff members essentially transcribe e-prescription information by using software to select the medication product for dispensing based on the prescribed medication conveyed in an electronic prescription (e-prescription) [6,7,8]. Pharmacy staff perform a transcription task to select the medications needed to process e-prescriptions within their dispensing software. Pharmacists manually double-check medications selected to fulfill e-prescriptions before dispensing to the patient. Leveraging health information technology to identify and recover from medication selection errors can improve patient safety
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