DrugDescription

drugdescription best practices customers should work with their drug compendia vendors to utilize the compendia's e prescribing preferred name as mentioned in the drugdescription field (see the medication elements docid\ t j0gupe16bjjbyq3fnbg ) section use e prescribing preferred name ✅ quality check use the e prescribing preferred name the drug segment of the script standard allows up to 105 characters within the drugdescription field the content of the drugdescription field most accurately conveys prescriber intent when using the e prescribing preferred name (epn) as published by a commercial compendium source, or the rxnorm prescribable name (psn) rxnorm is a normalized naming system with unique identifiers for generic and branded drugs maintained by the national library of medicine for more information, see https //www nlm nih gov/research/umls/rxnorm/ https //www nlm nih gov/research/umls/rxnorm/ clinical relevance/rationale incomplete or inaccurate drug descriptions create workflow disruptions on both sides of the network and may introduce risks to patient health and safety entering drug descriptions as free text into the note field rather than using the designated field may result in higher rates of dispensing or processing errors ncpdp recommends that software providers only use the epn from the drug database provided by either the drug compendium source or the national library of medicine rxnorm data the use of standardized drug naming methodology reduces variation, thereby improving operational quality and optimizing e prescribing processes best practices for technology partners display the epn to end users in the final summary screen even if additional alternate names are displayed to end users within the application limit the ability for end users to create or use personalized content (free text) in the drugdescription field best practices for prescribers only enter the drug description into the designated drugdescription field ensure drug descriptions are not entered into the note field if unable to find a specific medication or product within the drug database, work through internal support channels to request that the product be added prior to e prescribing do not add other extraneous information to the drug description such as medication changes, dosage increase, etc optional inclusion of a reference name ✅ quality check optional inclusion of a reference name a standardized reference drug name sourced from the compendia may be conditionally included in parentheses after the epn to help with drug selection and patient safety it is not intended to be interpreted as the specific product prescribed while the epn should exactly correspond with the product identifiers (e g , representative ndc, rxnorm code and qualifier) example standardized format “epn (reference drug name)” example “diltiazem er 120 mg capsule, extended release 12hr (cardizem sr)” in addition, for the implementation of drug descriptions that include a parenthetical reference drug name, follow the recommended implementation guidance below if the prescribed drug is a brand/single source brand, send the trade name as the epn note, a reference generic name may be sent in parenthesis at the end a align the representative ndc, rxnorm code and rxnorm qualifier to that branded trade epn b do not send truncated names if brand and generic names do not both fit within the 105 character limit of the field, only send the epn in all other non brand scenarios, send format of generic epn + (branded trade name) a for old products where the branded trade name is no longer available, the drug description may be sent without the reference branded trade name b align all reference names and product indicators with the epn per orange book and compendia guidelines for patient safety, it is recommended that the e prescription drug description that is sent to the pharmacy match what was displayed to the prescriber communicate only one concept in the epn, either the proprietary “brand” name of the product or the chemical “generic” name of the product when there is no generic product commercially available, use the proprietary “brand” name as the epn clinical relevance/rationale for certain products, the compendium’s epn alone may not always provide enough clarity to distinguish between similar multi ingredient products or products with slightly different formulations – e g , the generic extended release metformin equivalents for fortamet, glumetza, or glucophage xr (none of which are freely interchangeable or ab rated by the fda) furthermore, ismp also recommends the inclusion of an additional drug name to help distinguish between look alike sound alike (lasa) medications as an additional safety check hence, appropriately placed generic or reference brand names can provide supplemental information that may help drive improved product selection, clarity, and dispensing accuracy pharmacies are limited by each state’s board of pharmacy regulations and scope of practice rules many states have specific regulations regarding the use of generic products in place of brand name products that may take into account the u s food and drug administration (fda) bioequivalence ratings, the pharmacokinetic/pharmacodynamic properties or the therapeutic outcome of the medication (e g , narrow therapeutic index medications, biosimilars, etc ) it is important that the drug description clearly references either a brand or a generic product, so the pharmacy can determine the single prescribed medication this helps the pharmacist interpret the “dispense as written (daw)” intentions indicated by the prescriber to determine if a substitution may occur examples use “proair 90 mcg/actuation solution for inhalation” or “albuterol sulfate hfa 90 mcg/actuation aerosol inhaler (proair hfa)” instead of “albuterol (proair, ventolin hfa) 90 mcg/actuation ” use “harvoni 90 400 mg tablet” instead of “ledipasvir sofosbuvir (harvoni) 90 400 mg tablet” or “ledipasvir sofosbuvir 90 400 mg tablet ” e prescribing drug name sequence ✅ quality check e prescribing drug name sequence at a minimum, ensure the epn is in the following sequence product name, strength, strength unit and dosage form best practices for non medications, transmit the complete product name non medications (e g , test strips, insulin pump machine) rarely have an applicable strength or dosage form, thus all elements may not be available the epn may also include a dosage route or drug delivery device examples use “hydroxyzine hydrochloride 100 mg tablet” or “hydroxyzine hcl 100 mg tablet” instead of “hydroxyzine hcl tablet 100 mg ” lancets 31 gauge proper use of punctuation ✅ quality check proper use of punctuation best practices and examples use hyphens (i e , “ “) instead of forward slashes, back slashes, or pipes (i e , “/”, ”\”, “|”) to separate similar elements use “augmentin 875 125 mg tablet” instead of “augmentin 875/125 mg tablet ” when large numbers are required, use commas to separate groups of three digits in numbers of 1,000+ use “heparin 10,000 unit subcutaneous injection” instead of “heparin 10000 unit subcutaneous injection ” use a forward slash to write a concentration or proportion per unit of volume use “fluticasone 50 mcg/actuation nasal spray” instead of “fluticasone, 50 mcg per actuation, nasal spray ” ensure a space is used between numbers and the units to which they refer use “simvastatin 80 mg tablet” instead of “simvastatin 80mg tablet ” multiple salts ✅ quality check multiple salts when there are multiple drug formulations with different salts, include the specific salt name in the drug description clinical relevance/rationale providing complete and accurate salt form names is a critical method of avoiding confusion or misinterpretation, especially for medications that come in similar formulations best practices only use united states pharmacopeia convention (usp) approved abbreviations, including, but not limited to, k, na, hbr and hcl may be used otherwise, spell the salt name out in its entirety examples use “hydroxyzine hydrochloride 100 mg tablet” or “hydroxyzine hcl 100 mg tablet” instead of “hydroxyzine 100 mg tablet ” use “metoprolol tartrate 50 mg tablet” instead of “metoprolol 50 mg tablet ” use “hydroxyzine pamoate 25 mg capsule” instead of “hydroxyzine pam 25 mg capsule ” dosage strength values ✅ quality check dosage strength values for dosage strength, use only arabic (decimal) numbers rather than roman numerals or abbreviations such as “m” for thousands or millions always use a leading zero when a decimal point is required do not use trailing zeroes clinical relevance/rationale the clear identification of numbers, including the proper use of zeroes and decimals, prevents ten or hundred fold dosing errors and reduces risks to patient safety best practices for technology partners when appropriate, develop mechanisms to identify non numeric values and implement logic to identify decimals without a leading or trailing zero(s) when appropriate, also implement decision support or default values to reduce manual entry best practices for prescribers when possible, avoid the use of zeroes by employing alternative units of measure (e g , use 30 mcg instead of 0 03 mg) examples use “aspirin 325 mg tablet” instead of “aspirin v grains ” use “pancrelipase 12,000 38,000 60,000 units delayed release capsules” instead of “pancrelipase 12m 38m 60m delayed release capsules ” use “digoxin 0 25 mg tablet” instead of “digoxin 25 mg tablet ” use “warfarin 5 mg tablet” instead of “warfarin 5 0 mg tablet strengths for active ingredients ✅ quality check dosage strengths for active ingredients provide the dosage strength(s) of each active ingredient for drugs with three or fewer active ingredients and group them together after the drug name the proprietary name alone, without accompanying strength and strength units, is only acceptable when the list of active ingredients is too lengthy to be entered into the field however, include the dose strengths of all active ingredients on prescriptions for controlled substances, particularly narcotic combinations for oral contraceptive prescriptions, include dosage strengths (for estrogen, progestin, and iron) to assist with decision making and clinical support for these drugs it is acceptable to either include or exclude any inert or placebo ingredients a number of drug categories do not require a listing of all active ingredients, including multivitamins, hydration solutions, bowel preparation therapies and other medications with four or more active ingredients clinical relevance/rationale sound medication therapy management requires that healthcare team members be given access to a complete list of the patient’s current medication(s), including all active ingredients an incomplete list of medications or active ingredients increases the risk of misinterpretation examples use “augmentin 875 mg 125 mg tablet” instead of “augmentin 875 mg tablet " use “norel sr 325 mg 8 mg 40 mg 50 mg sustained release tablet” or “norel sr tablet " both are acceptable note norel sr contains four active ingredients use “ortho tri cyclen lo 28 day 0 18 0 215 0 25 mg 25 mcg tablets " do not use “ortho tri cyclen lo 28 day tablets,” as there are two active ingredients whose strengths change by phase use “prenatal plus iron tablet” instead of listing the strengths for the 10 vitamins and four minerals in the drug use “peg 3350 and electrolytes for oral solution” or “nulytely powder for solution” instead of a complete or partial strengths list use “fioricet with codeine 325 50 40 30 mg capsule” to include all active ingredient strengths, especially the essential narcotic dose strength include route of administration ✅ quality checks include route of administration it is critical to include the route of administration for e prescriptions when the drug name and strength combination can be administered via different routes clinical relevance/rationale a drug may have multiple forms in which it is delivered for different clinical indications (e g , ofloxacin otic versus ophthalmic solution) despite having the same drug name and active ingredients, it is clinically important to identify which medication is to be dispensed to the patient one medication formulation may have different physical, chemical, or pharmacokinetic/pharmacodynamic properties and may therefore produce significantly different clinical outcomes in patients than another formulation best practices ensure the identified dosage route is specific and not abbreviated list the route after the dosage strength and strength unit, and before the dosage form in the epn examples use “ofloxacin 0 3% ophthalmic solution” instead of “ofloxacin 0 3% solution ” use “flovent 50 mcg/actuation nasal suspension” instead of “flovent 50 mcg/actuation suspension ” use the complete dosage form ✅ quality checks use the complete dosage form include the complete dosage form for all medications ensure the dosage form indicates any modified release forms of a drug it is particularly important to include modified release forms when a drug is described as any of the following sustained, controlled, extended, timed, or continuous release clinical relevance/rationale when applicable, it is essential to know the modified release forms so they can identify the time period over which a drug is released this bioavailability information is crucial for issues such as dosing intervals and drug drug interactions some compounds that are described as “24 hour” may have ingredients that slowly absorb into the bloodstream due to their chemical properties, but do not actually require any special time release delivery mechanisms best practices do not abbreviate the dosage form, even in the case of a modified release dosage form though a brand name may include an abbreviation, acronym, symbol, or code to indicate a modified release form, there is no industry standard for such extensions; specify the type of release with the dosage form the use of “24 hour” or similar indicators is not recommended to fully convey the modified release form of a drug, and instead, use this in conjunction with a more specific indicator (e g , “24 hour extended release”) or not at all examples use “toprol xl 100 mg extended release tablet” instead of “toprol xl 100 mg tablet ” use “allegra d 24 hour 180 mg 240 mg extended release tablet” instead of “allegra d 24 hour tablet ” include drug delivery mechanism or device ✅ quality checks include drug delivery mechanism or device when a drug is available in multiple variants of the same dosage strength and dosage form, communicate the drug delivery mechanism or device in conjunction with either the drug name or the dosage form do not modify or eliminate the drug name and/or dosage form due to the addition of the delivery method or device clinical relevance/rationale the communication of specific drug delivery mechanisms or devices is important for differentiating between multiple drug variants examples lantus (insulin glargine) subcutaneous solution may be dispensed as “lantus 100 units/ml subcutaneous solution” (interpreted as vial) “lantus solostar pen 100 units/ml subcutaneous solution” or “lantus 100 units/ml subcutaneous solution pen ”