20 questions to ask yourself as you write that prescription

August 1, 2004

You took a thorough history, performed a solid physical examination, made a reasonably good diagnosis, decided on a proper course of treatment, and wrote a prescription for your young patient. All done? Not so, unless you asked yourself:

You took a thorough history, performed a solid physical examination, made a reasonably good diagnosis, decided on a proper course of treatment, and wrote a prescription for your young patient. All done? Not so, unless you asked yourself:

1. Did I pause to remember that the Institute of Medicine reported 7,000 deaths a year caused by medication errors1 and that MEDMARX2 found 3,361 medication errors in children—including 190 serious ones and two deaths?

2. Did I check on the child's other medications for incompatibility?

3. Did I check on the child's allergies, including not only to the medication I'm prescribing but its analogues?

4. Am I certain that I've chosen the proper drug for the diagnosis and the child?

5. Did I instruct the parents or guardians to report the child's age, weight, and diagnosis to the pharmacist (as a double-check and to protect both me and the child)?

6. Did I tell the parents to call me immediately if the label or the pharmacist says something different from what I told them?

7. Did I tell the parents when to call me with any questions about the medication or any problems?

8. Did I write (or print) the prescription clearly enough so that it is impossible for the pharmacist to misinterpret it, and did I ask the parents to read, or spell, it back to me (and were they able to do so)?

9. Did I order the appropriate dosage for the child's age and weight?

10. If I had to calculate the dosage, did I carefully check (and double-check) decimal points?

11. Did I prescribe the correct frequency of administration and timing (before meals, after meals, without food, etc.) and did I indicate for how long to give the medication?

12. Did I instruct about (and emphasize) the need for the parents to use a calibrated dispensing device if the prescription is for a liquid, explaining to them the great variance in household measures?

13. Did I explain the danger of crushing or cutting pills or tablets or, if the prescription is for scored tablets, did I give specific instructions for doing so?

14. Did I explain the need to keep all medications in their original container, with instructions always visible?

15. Did I provide explicit written or verbal instructions?

16. Did I explain possible side effects and adverse reactions to the medication?

17. Did I explain the risks of not administering the medication?

18. Did I explain the risks of not finishing the medication as I've instructed, or of not stopping it when I told them to?

19. Did I explain the risks of not administering the medication according to instructions?

20. And, last, did I explain the risks of starting any other medication (including over-the-counter therapies, and extending to herbal therapies) while the child is taking this medication?

Remember: You're not playing a game when you ask yourself these 20 questions. You may be saving a life.

Arnold Melnick, DO, MSc
Aventura, Fla.

REFERENCES

1. Kohn LT, Corrigan JM, Donaldson MS (eds): To Err is Human: Building a Safer Health System. Washington, D.C., National Academy Press, 2000

2. Summary of Information Submitted to MEDMARX in the Year 2001: A Human Factors Approach to Medication Errors. Rockville, Md., US Pharmacopeia, 2002

SUGGESTED READING

Tips for Parents: Preventing Medication Errors. Rockville, Md., Center for Advancement of Patient Safety. US Pharmacopeia, 2003