Detecting Potential Medication Selection Errors During Outpatient Pharmacy Processing of Electronic Prescriptions...

Area of Science:

• Health Informatics
• Clinical Pharmacy
• Health Information Technology

Background:

• Medication errors are a significant patient safety concern in outpatient pharmacies.
• Electronic prescriptions (e-prescriptions) require manual transcription and pharmacist double-checks, processes prone to human error due to workload and fatigue.
• Health information technology offers potential solutions for identifying and mitigating medication selection errors.

Purpose of the Study:

• To evaluate the performance of an automated double-check system utilizing the RxNorm application programming interface (API) for identifying medication selection errors in e-prescription processing.
• To assess the accuracy of RxNorm API in matching e-prescription National Drug Codes (NDCs) with dispensing records.

Main Methods:

• A retrospective analysis of 537,710 e-prescription and dispensing record pairs from January 2017 to October 2018 was conducted.
• National Drug Codes (NDCs) were mapped to RxNorm concept unique identifiers (RxCUIs) using the National Library of Medicine's RxNorm API.
• Performance metrics, including sensitivity, specificity, and precision, were calculated by comparing RxCUIs from e-prescriptions and dispensing records.

Main Results:

• Analysis of 527,881 record pairs revealed near-complete matching of RxCUIs (99.67%-99.90%).
• Four clinically significant medication selection errors (3 ingredient, 1 strength) and 546 less significant mismatches were identified.
• The RxNorm API demonstrated high sensitivity (1) and specificity (0.99896–0.99688) in detecting discrepancies.

Conclusions:

• The National Library of Medicine's RxNorm API can effectively perform automated double-checks for medication selection accuracy in outpatient pharmacies.
• RxNorm provides comprehensive drug coverage and can be utilized to detect and correct medication selection errors, enhancing patient safety.
• Automated verification using RxNorm may eventually reduce the need for manual pharmacist double-checks, optimizing workflow and improving efficiency.