Consequences of the 1989 New York State triplicate benzodiazepine prescription regulations

Article Abstract:

Since January 1989, all prescriptions for benzodiazepines filled in New York State must be written on special triplicate prescription forms. Benzodiazepines are a group of psychoactive medications, including tranquilizers such as diazepam, which are prescribed to relieve anxiety, and hypnotic medications, which are used to treat insomnia. The triplicate prescription forms are sold to physicians by the state. When the prescription is written, the patient receives two copies for the pharmacist (one of which is forwarded to the state), and the physician must retain his copy for five years. In most cases, prescriptions can only be written for a 30-month supply and are not renewable. Medication specified for treatment of panic disorders or epilepsy may be prescribed in three-month quantities. The main goal of this program was to reduce the amount of these drugs diverted into illegal drug use, reduce inappropriate prescribing, and to educate professionals and the public. A report is presented of psychotropic medication prescribing practices in New York State before and after this regulation went into effect. Information was obtained from three sources: National Prescription Audit (data from retail pharmacies, representing all income and payment groups), Medicaid, and Blue Cross. After the regulation took effect, a 44 percent decrease in prescribing of benzodiazepines was recorded by National Prescription Audit; a 60 percent decrease was noted by Medicaid; and a 30 percent decrease was reported by Blue Cross. Nationally, the prescribing of other sedative-hypnotic drugs has decreased; in New York State it has increased. Prescriptions for meprobamate increased 125 percent in New York State, compared with 9 percent nationwide. Despite this shift in prescribing practices, total Medicaid expenditures for psychoactive medication remained the same. It is concluded that although these regulations have decreased the prescribing of benzodiazepines, less acceptable medications are being prescribed in their place. Before the triplicate prescription requirement for benzodiazepine drugs is extended to other areas, further study should be made of the public health, patient care, and economic implications of this program. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, New York, Prescription writing, Benzodiazepines

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Medication prescribing errors in a teaching hospital

Article Abstract:

Errors made by physicians in prescribing medication may result in serious illness and injury and a study of these errors was performed in a 640-bed teaching hospital. The hospital contained several units (general medical-surgical, intensive care, psychiatric, obstetrics-gynecology as examples) and a medical staff composed of a house staff, fellows, and attending physicians, making a total of 840 physicians. Medication errors committed during a one-year period were analyzed and only those orders written by the physicians themselves were included (289,411 orders). That is, no orders written by nurses or physician assistants were evaluated. Appropriateness of an order was determined by staff pharmacists based on review of computer-entered medication orders and patient identifying information, including allergies and current medication profile. Suspected errors were confirmed by telephone conversations between pharmacist and prescribing physician (or covering physician) and a true error was considered a confirmed order error. Although no erroneous orders were actually implemented, the probable significance of each error was evaluated (its potential to result in adverse consequences), as well as its likelihood of being carried out. Results showed a total of 905 medication prescribing errors during the time period studied, of which approximately 58 percent were considered significant by all investigators. The error rate per 1,000 orders was 3.13 overall, and 1.80 for significant errors. The single greatest number of errors concerned antimicrobial agents, with overdose the greatest kind of error. One hundred eighty-two errors were considered potentially fatal, severe, or serious. Time of day orders were written was important: more total errors and the highest number of significant errors were committed on orders written between noon and 3:59 PM. Finally, obstetrics/gynecology and surgical services had the highest error rates. First-year postgraduate residents and attending physicians had the highest error rates and fourth-year or more residents and fellows had the lowest rates. These results indicate that hospitals and physician training programs should make every effort to reduce prescribing errors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Surveys, Medical errors, Hospitals, Teaching, Teaching hospitals

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Factors related to errors in medication prescribing

Article Abstract:

Several factors appear to contribute to errors in prescribing medication for hospitalized patients. Physicians and pharmacists analyzed significant prescription errors caught and corrected by pharmacists at a large teaching hospital. They found 2,103 errors in a year period for a rate of 4 per 1,000 medication orders. Factors included failing to take declining kidney or liver function into account; ignoring patient history of allergy; using the wrong name, dosage form, or abbreviation; calculating errors; and overdosing. Many of these errors could be eliminated through such strategies as education, computer programs, and dosage standardization.

Demographic aspects, Prescriptions (Drugs)

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