Compass Guided Error

[johnep]

Script for Budesonide nebules 500mgm/2ml. dispenser looked on Compass and found only 500mg/ml. ie a 2ml nebule would contain 1mgm. Anyway ordered and I had to check script. Got result same as dispenser. Rechecked BNF to find Pulmicort issued in 250mg/ml nebules so ordered for Monday.

it was Compass which used to guide to qvar when cfc free beclomethasone was ordered. Now corrected to clenil.

Once had similar confusion with a growth hormone (this was on eclipse).

dressings prescribed generically still a nightmare. It would help if everything had a standard generic description instead of something dreamed up by the PMR supplier.
johnep

[Pharmanaut]

Report problems like this ASAP to your supplier.

[LeftArm]

This may be caused by the search terms you entered.

The DM+D lists this generically as:
"Budesonide 250micrograms/ml nebuliser liquid 2ml unit dose vials"
and my proscript system comes up with:
"Budesonide Nebuliser Liquid 0.5mg/2ml 2ml udv"
Your search for "500mcg/2ml" would not return either of these.
If you searched using the term "nebules" then this will also give ambiguous results as it is not (AFAIK) a recognised dosage form and is only associated with Respontin (Ipratropium) and Ventolin (Salbutamol). Pulmicort are branded as "Respules"

When searching any data, less is often more and searching for "Budesonide neb" or even just "Budesonide" and then selecting the correct strength from a list would probably have worked.

Qvar Inhalers 100mcg were the only CFC free Beclometasone inhalers until the introduction of Clenil (again AFAIK) Even now either brand could be supplied.

You are right about the generic names not only for dressings but also for examples like the nebuliser solutions, GTN sprays etc.

The DM+D should resolve some of these issues but the names used are often too long to fit a standard dispensing label.

[Fleegle]

Would I be correct in thinking we are looking at another potentially serious dispensing error just around the corner?

Please correct me if I'm wrong..and I sincerely hope I am.

Fleeg.

[bobbin]

If you searched using the term "nebules" then this will also give ambiguous results as it is not (AFAIK) a recognised dosage form and is only associated with Respontin (Ipratropium) and Ventolin (Salbutamol). Pulmicort are branded as "Respules"

'Nebules' is a registered trademark owned by GlaxoSmithKline (who trade as Allen & Hanburys when selling their respiratory products). 'Respules' is a registered trademark owned by AstraZeneca.

[Pharmanaut]

I'm wondering how the 'scriptswitch' software will work with products that are 1)Not to be prescribed by VMP,and 2)Not recommended to be prescribed by VMP.

Examples of 2) are Tramadol where there is 12 and 24hr release (SR and XL) where these have the same VMP.

[johnep]

Dispensers just enter same description as on script. Until standardisation of generic descriptions this is an accident waiting to happen. With ETP would just go through.
johnep

[Pharmanaut]

Dispensers just enter same description as on script. Until standardisation of generic descriptions this is an accident waiting to happen. With ETP would just go through.
johnep

It shows that we take our (very basic) pharmacist knowledge for granted/second nature.
Not sure if there is anything in dispenser training about converting strengths up and down, eg 125mg/5ml is 250mg/10ml or 25mg/ml etc, as haven't personally been responsible for dispenser training for ages. Might be worth a session if it ever gets quiet enough.

[LeftArm]

Would I be correct in thinking we are looking at another potentially serious dispensing error just around the corner?

Please correct me if I'm wrong..and I sincerely hope I am.

Fleeg.

I don't think so. In this case there is only one product that can be supplied even though it has various names.

The point that Pharmanaut makes is the more dangerous as a patient may receive an XL instead of an SR. In this case there are two products that are therapeutically different but with the same name. AFAIK there is no standardisation of the terms SR,MR,XL.

Of course even if there was standardisation it wouldn't stop the doctor prescribing XL 1bd

[Pharmanaut]

I don't think so. In this case there is only one product that can be supplied even though it has various names.

The point that Pharmanaut makes is the more dangerous as a patient may receive an XL instead of an SR. In this case there are two products that are therapeutically different but with the same name. AFAIK there is no standardisation of the terms SR,MR,XL.

Of course even if there was standardisation it wouldn't stop the doctor prescribing XL 1bd

Thanks for the emphasis - I now have a recruit to my XL/SR cause!

That's probably something for the next generation of systems once the standard dosage syntax has been sorted out, systems can then check dosage ranges appropriately for patients. The risk then is that it will just be another alert to quickly type "Y" to acknowledge to rid it from the screen, so that you can get on with the hundreds of other prescriptions waiting.