DISPENSING ERROR
Encourage patients to double-check prescriptions
A pediatrician sent an electronic prescription (e-prescription) for a child to a pharmacy for Miralax powder (polyethylene glycol 3350) 3 teaspoonfuls orally mixed with 6 oz of liquid daily for 30 days. However, the label on the bottle said to mix and administer 3 tablespoonfuls daily for 30 days. Fortunately, although the prescriber had sent the prescription electronically, he also gave the child's mother a copy of the prescription. Because of this, she spotted the error. Had she not received a copy of the prescription, she wouldn't have known the correct dose and would have given her daughter more than the required amount for her age and weight.
While e-prescriptions are recommended because they reduce the need for error-prone transcription of handwritten prescriptions or telephone orders, the prescriber should always instruct patients or caregivers as well and provide them with a copy of the prescription (clearly marked as a copy) or an office summary listing the medication and directions for use. This way, the patients can verify the prescription by matching the hard copy to what they receive from the pharmacy. This also gives them time to formulate questions for the pharmacist before picking up the prescription.
MYSTERIOUS "VIAL"
Stabilizing influence
A nurse called the pharmacy with a question about the packaging of the Simplist (Fresenius Kabi) brand prefilled morphine syringe that her hospital had recently begun using. She was unsure what to do with the "vial" in the package. The pharmacist who received the call investigated and found that the nurse was asking about the StabilOx canister contained within the unit-dose syringe packaging (see photo). The round canister contains iron oxide, which absorbs oxygen and reduces oxidative degradation of morphine to improve stability. It's not part of the syringe but is contained within the packaging. It's unusual for unit-dose syringe packaging to contain these canisters, so it's not surprising that the nurse didn't know what to do with the canister. The pharmacist explained the purpose of the canister and instructed the nurse to throw it away upon opening the package.
Both morphine and Dilaudid (HYDROmorphone) Simplist syringes have these canisters contained within the packaging. If you use these products, discard the canister after opening the packaging.
MILLILITERS OR MILLIGRAMS?
Clear up liraglutide dosage confusion
Surescripts, an electronic prescribing network that links clinicians, hospitals, pharmacies, and pharmacy benefit managers, has determined that some new prescriptions for the glucagon-like peptide-1 (GLP-1) receptor agonists Victoza (liraglutide) and Saxenda (liraglutide) pen injectors contain inaccurate dosage information. At issue is the inappropriate use of "mL," "milliliters," or "cc" as dosing units rather than "mg," in the patient directions; for example, "inject 1.2 mL sub-q every day" instead of 1.2 mg. Because the concentration of liraglutide in both products is 6 mg/mL, prescribing 1.2 mL instead of 1.2 mg results in a sixfold overdose (7.2 mg). Although both pen injectors display doses in mg, the mg markings are difficult to see as shown below. (Note: Both Victoza and Saxenda pens allow patients to dial and modify doses, whereas doses are fixed for other GLP-1 receptor agonists.) Surescripts has asked electronic health record vendors to ensure that the dose creation tools provided to end users don't allow "mL" as a dose unit option for Victoza or Saxenda. Should a free-text prescription be necessary, the patient directions should be typed accordingly with the dose unit in "mg"-never in "mL"-to ensure correct labeling, counseling, and administration of the intended dose. Any prescriptions for Victoza or Saxenda with a "mL" dosage amount need to be clarified with the prescriber to verify the dose.