Lori - With the brand name, using the default of C in the access dictionary, here is what I get:
1 SINEQUAN 10 MG CAP Doxepin HCl 10 MG CAP DOXE10C 2 SINEQUAN 100 MG CAP Doxepin HCl 100 MG CAP DOXE100C 3 SINEQUAN 25 MG CAP Doxepin HCl 25 MG CAP DOXE25C 4 SINEQUAN 50 MG CAP Doxepin HCl 50 MG CAP DOXE50C 5 SINEQUAN 75 MG CAP Doxepin HCl 75 MG CAP DOXE75C 6 SINEQUAN ORAL CONC 1 ML Doxepin HCl 10 MG/ML ML DOXEL120 Entering the generic name - I get this: 1 DOXEPIN HCL Doxepin HCl 100 MG CAP DOXE100C 2 DOXEPIN HCL Doxepin HCl 10 MG CAP DOXE10C 3 DOXEPIN HCL Doxepin HCl 25 MG CAP DOXE25C 4 DOXEPIN HCL Doxepin HCl 50 MG CAP DOXE50C 5 DOXEPIN HCL Doxepin HCl 75 MG CAP DOXE75C 6 DOXEPIN HCL Doxepin HCl 10 MG/ML ML DOXEL120 So, it doesn't even seem to be consistent as to which is first between a brand name look-up and a generic name look-up. But I do agree that this is a safety issue and makes sense. Furthermore, if Meditech and the formulary service vendors could get their dose range checking working correctly, it would be less of an issue. I've built a lot of my own dose ranges because the ones with FDB give too many worthless alerts. I believe that the bigger issue here is that a dose range check would have caught this. Charlie Charles Downs PharmD Washington County Hospital 251 E. Antietam Street Hagerstown, MD, 21740 301-790-8904 _____ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Howes, Lori Sent: Tuesday, July 03, 2007 4:20 PM To: [email protected] Subject: [MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT TOP MIX Hello, Our Pharmacy department has created a MIX request, and is hoping to get other Meditech PHA users to join us to convince Meditech that this is something we need them to look at. Here is our request; Brief Description/Synopsis of Request When selecting a Drug, we would like the lowest strength to be the first selection. How are you currently handling this now? We have no workaround. What problem will be resolved? Our system has the potential to contribute to a similar error like the one below that happened at another hospital; In an outpatient pharmacy located in a hospital, a prescription for SINEQUAN (doxepin) 100 mg was entered into the computer and dispensed instead of the correct strength of 10 mg. Neither the technician who pulled the 100 mg strength from the shelf nor the verifying pharmacist caught the error. The patient took 500 mg of doxepin daily for one month before the error was corrected. The error was discovered when the prescription was transferred to another pharmacy and the receiving pharmacist expressed concern about the high dosage. Since the error, the patient has been experiencing residual drowsiness and fatigue. The physician is now slowly decreasing the dosage. The pharmacy software system may have played a role in the error. Upon entering Sinequan on the product line, the list of matching results placed Sinequan 100 mg on the first line followed by Sinequan 10 mg. It is believed that the sequential listing of both strengths, with a ten-fold difference, contributed to the selection of the wrong strength, as did the listing of the higher strength first. Proposed Solution Describe in detail how you think the system could be changed, considering Dictionaries Parameters, Input and Output Screens, and Reports. When selecting a Drug, we would like the lowest strength to be the first selection. System Impact Describe why this enhancement is important. How does it improve the MEDITECH system? What impact will it have on users? It will lessen the impact of user error. Although neither is acceptable, user error is inevitable and the thought process is that underdosing is less dangerous than overdosing. Lori Howes Business Systems Analyst - Clinical Support Niagara Health System - Cecil G Shaver Data Centre 541 Glenridge Avenue St. Catharines, ON L2T 4C2 905-378-4647 X44857 _____ Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. ***** CONFIDENTIALITY NOTICE ***** This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system.
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