Note

note requirements fields that cannot be codified are sent in this free text field military \[prescriber] personnel using their social security number for epcs are also required to report their branch of service here note element best practices on occasion a need may arise for the initiator of the transaction to send additional patient specific information that is relevant to the prescription, but for which a dedicated field does not currently exist in the standard as a discrete element this need should be exceedingly rare, but when necessary, the ncpdp script standard allows for the transmission of the information in two ways first, the patientcodifiednote field is able to relay a set of pre defined notes using a standardized code system second, the optional 210 character free text note field reference ncpdp script implementation guide, v2023011 (may 2024 republication) sec 8 1 6 19 pages 196 197 send codified notes ✅ quality check send codified notes ensure when a note can be sent in a codified fashion it is done so using the patientcodifiednote field an extensive list can be found in the ncpdp script implementation guide referenced above clinical relevance/rationale sending information in a clear, codified fashion reduces the potential for error by reducing the reliance on a human to identify, transcribe, and respond to the information further, systems can be developed to systematically respond to codified notes, reducing the amount of clinician time spent reading notes and ensuring all notes are processed examples in order to relay the need for the patient to make an appointment or schedule labs, send “al” in the patient codified note element and leave the note field null/empty in order to relay the information that this prescription is a vacation supply, send “an” in the patient codified note element and leave the note field null/empty in order to relay information for incrementation dispensing or partial fills, send “ak” in the patient codified note element and leave the note field null/empty best practices – for technology partners develop systems to have the ability to send and receive patientcodifiednote using the current named version of the ncpdp external code list (ecl) ensure end users have a means to quickly populate codified note information without the need to populate free text into the note field submit a data element request form (derf) to ncpdp for any note concepts which are frequently utilized but for which the ecl does not currently support appropriate use of notes ✅ quality check appropriate use of notes any information that has a designated field (e g , patient identifiers, prescriber name, drug description, quantity, etc ) is not to be written in the note field in addition, ensure information in the note field does not conflict with information in any other fields of the e prescription examples of information that have their own discrete fields and therefore are not to be transmitted through the note field includes, but is not limited to example appropriate field “pt needs an appointment for further refills ” “partial fills allowed” patient codified note “dob 12 12 1989" patient segment “prescribed by dr xzy npi 123456789” prescriber segment “daw” or “ok to substitute” substitution “dispense 30 tablets” quantity “take 1 tablet by mouth twice daily” "for acute pain” sig “metoprolol tartrate 50 mg oral tablet” drug “dx 401 9” diagnosis discount card or coupon information benefits coordination “90 day supply” days supply “allergic to amoxicillin” allergy “please label in spanish” language “blood pressure 140/90” observation 340b information office of pharmacy affairs id “please dispense 15 grams” quantity “patient on hospice” hospice “do not fill before ccyy mm dd" other medication date “give 3 refills” number of refills “follow up with pcp” follow up prescriber type clinical relevance/rationale the note field of a transaction is intended to allow prescribers and pharmacists to communicate information that is relevant to the transaction but is not contained in another designated field due to the free text nature of the \<note> field, it is not automatically or systematically reviewed by the receiving technology system, and therefore requires manual review it is crucial that all key prescription information be entered into the designated fields this helps improve patient safety by reducing the amount of unnecessary information healthcare providers review, reduces human touchpoints, and helps leverage e prescribing technology to increase efficiency in the dispensing workflow labeling of the note field ✅ quality check labeling of the note field label the note field as “notes to pharmacy” or “notes to prescriber” to clearly convey the purpose of the field, and display near the end of the prescription workflow to encourage discrete field use early on clinical relevance/rationale use of the free text note field by prescribers and pharmacies are often unnecessary and/or inappropriate instruct users on the appropriate use of this field; the label name and field description are a passive, yet crucial part of this process the position of the field within the workflow of the application can also have an impact on its use and can affect behavior placement of the note field near the end of the workflow (after drug selection and the input of directions, quantity information and days supply) can help deter the entry of information that has a designated field elsewhere in the e prescription best practices – for technology partners in addition to altering the name of the field, include an explanatory watermark (i e , an embedded overlay reminder statement) in the note field that briefly describes the intent of the field (e g , “this field is for additional non structured information needed for the pharmacist to dispense the prescription ”) studies demonstrate this approach to be successful at decreasing the incidence of inappropriate sig related information in the note field provide default selections for commonly written notes to help prescribers save time and standardize such notes (e g , "prescription #1 of #3”, “dose changed,” etc ) consider implementing an additional step or click to access the \<note> field to discourage use of the field when it is not needed distinction between directions and notes ✅ quality check distinction between directions and notes ensure the note field is free of any and all patient directions patient directions are only to be written in the sigtext field alone or along with the structured and codified sig information populated examples use sig “take 1 tablet orally twice daily ” notes “null” instead of sig “take 1 orally ” notes “twice daily ” use sig “take 1 tablet by mouth once a day with breakfast ” notes “null” instead of sig “take 1 tablet by mouth once a day ” notes “take at breakfast ” clinical relevance/rationale the inclusion of patient directions in the note field can result in patient harm depending on when the content of the field is reviewed during the dispensing workflow at the pharmacy, it can result in a change in process for example, if the content of the note field is not reviewed during data entry in the pharmacy, it may require the prescription to be edited later in the workflow or missed altogether due to such a deviation from normal pharmacy workflow, there is an increased risk that the directions will not be captured on the patient label best practices – for technology partners to reduce the likelihood an end user will enter patient directions in the note field, enhance the sig builder tool to include all discrete parts of a prescription accommodate complex directions default to or suggest common directions for frequently prescribed medications allow the end user to append free text instructions to the structured sig created by the sig builder tool if free text must be used for complex directions, consider clearing out the pre populated sig to avoid possible conflicting information if the prescriber is unable to convey complete instructions with appended free text, allow them to disable the sig builder and write entirely free text patient directions best practices – for prescribers if you are not able to construct patient directions in the sig builder tool or sig free text (sigtext field), do not attempt to send the prescription electronically use handwritten, fax or phone prescribing instead avoid programmed insertion of information into the note field ✅ quality check avoid programmed insertion of information into note field ensure information is not automatically inserted into the note field of a new transaction best practices – for technology partners ensure that default information is consistently applied to the designated field for example, transmit any patient benefit or pharmacy discount card information in the benefits coordination segment, not the note field best practices – for prescriber s if given the functionality to save prescription orders for future use, omit any notes from the saved prescription and reconsider the need for a patient specific note each time a new e prescription is transmitted