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Electronic Pharmacopoeia: A Missed Opportunity for Safe Opioid Prescribing Information?

  • Toxicology Investigation
  • Published:
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Abstract

Errors in prescribing of dangerous medications, such as extended release or long acting (ER/LA) opioid forlmulations, remain an important cause of patient harm. Prescribing errors often relate to the failure to note warnings regarding contraindications and drug interactions. Many prescribers utilize electronic pharmacopoeia (EP) to improve medication ordering. The purpose of this study is to assess the ability of commonly used apps to provide accurate safety information about the boxed warning for ER/LA opioids. We evaluated a convenience sample of six popular EP apps available for the iPhone and an online reference for the presence of relevant safety warnings. We accessed the dosing information for each of six ER/LA medications and assessed for the presence of an easily identifiable indication that a boxed warning was present, even if the warning itself was not provided. The prominence of precautionary drug information presented to the user was assessed for each app. Provided information was classified based on the presence of the warning in the ordering pathway, located separately but within the prescribers view, or available in a separate screen of the drug information but non-highlighted. Each program provided a consistent level of warning information for each of the six ER/LA medications. Only 2/7 programs placed a warning in line with dosing information (level 1); 3/7 programs offered level 2 warning and 1/7 offered level 3 warning. One program made no mention of a boxed warning. Most EP apps isolate important safety warnings, and this represents a missed opportunity to improve prescribing practices.

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Conflict of interest

The authors have no financial conflicts of interest to report.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Southern California Permanente Medical Group, 4647 Zion Ave., San Diego, CA, 92122, USA

    Jeff Lapoint

  2. Department of Emergency Medicine, Division of Medical Toxicology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19107, USA

    Jeanmarie Perrone

  3. Department of Emergency Medicine, Director, Fellowship in Medical Toxicology, New York University School of Medicine, 455 First Avenue, Room 123, New York, NY, 10016, USA

    Lewis S. Nelson

Authors
  1. Jeff Lapoint
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  2. Jeanmarie Perrone
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  3. Lewis S. Nelson
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Corresponding author

Correspondence to Lewis S. Nelson.

Additional information

This study was presented at the American College of Medical Toxicology Annual Scientific Meeting in San Juan, Puerto Rico, in May 2013.

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Lapoint, J., Perrone, J. & Nelson, L.S. Electronic Pharmacopoeia: A Missed Opportunity for Safe Opioid Prescribing Information?. J. Med. Toxicol. 10, 15–18 (2014). https://doi.org/10.1007/s13181-013-0351-6

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  • DOI: https://doi.org/10.1007/s13181-013-0351-6

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