2. DEFINITION:
Duplication prescribing is the practice of prescribing multiple
medications for the same indication without a clear distinction of
when one agent should be administered over another.
example for pain, nausea and vomiting, and constipation.
Misuse of medicine is using of medicine in way other then the
intended use is medicine.
3. EPIDEMIOLOGY
.
In the USA 800 patients a year and
accounts for nearly 1 in 100 hospital admissions
death occur by duplication of prescribing.
In the UK, the incidence and consequences of
duplication prescribing similar to USA.
In the India 5000 patient death occurs
by duplication prescribing in year.
Survey:
4. Millions of people world wide addicted by
misuse of drugs.
3,782,000, 60%
1,612,000, 26%
868,000, 14%
Opioid Analgesics
Sedative Hypnotics
Stimulants
5. Risk factors:
Adverse drug reactions,
Drug drug interaction,
High dose toxicity
Health problems,
Addiction, Accidents,
Poor academic
performance , Legal
trouble
Duplication in prescribing Misuse of medicine
It is harmful for patient, it can cause death.
6. Hand written prescription.
and
Mostly in PRN medication
for Pain, Nausea, Vomiting,
Constipation.
Sedative hypnotics,
Stimulants,
Pain relief
Opioid analgesics
(Self medication)
Multiple visit to different
doctor or pharmacist.
By doctor
By patient
7. Let's look at some examples of
duplication in prescribing
88 y/o Female:
Bisacodyl 5mg po daily PRN constipation
Docusate-senna 2 tabs po qHS PRN constipation
Magnesium hydroxide 30ml po Daily PRN constipation
27 y/o Male:
Fentanyl 25 mcg IV q4hr PRN pain
Oxycodone 5mg po PRN moderate pain
8. Misuse of medication sources:
Sources misuse drugs used for illicit purposes include:
Pill mills or illegal pain clinics;
Prescription fraud;
Pharmacy theft;
Illegal online pharmacies;
Doctor shopping - the practice of visiting several different
physicians to obtain multiple prescriptions.
The biggest source misused prescription drugs got them from a
friend or relative, either for free, by purchasing them, or stealing.
9. Risk - Benefits ratio:
Side effects
Toxicity
Unintended consequences
Relief of symptoms
Improved function
Restored quality of life
Benefits Risks
10. Effect on Risk – Benefits:
Relief of pain
Improved function
Restored quality of life
11. IT IS NESSASARY TO FOLLOW SOME STRATERGIES TO REDUCE THIS
RISK OF DUPLICATION OF PRESCRBING AND MISUSE OF MEDICINE
12. Reduction in duplication of
prescribing:
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CPOE
Computerized provider order entry systems are designed to
replace a hospital's paper-based ordering system. They allow users
to electronically write the full range of orders, maintain an online
medication administration record to minimize the duplication
error, dose, frequency or any type of medication error.
14. 3
EHR
Electronic Health Record is an electronic version of a patients
medical history, that is maintained by the provider over time, and
may include all of the key administrative clinical data relevant to
that persons care under a particular provider. It is helpful to check
patient past medical history to reduce therapeutic duplication.
16. • care-plan
development and
communication
physicians,
pharmacists
and nurses
• order
planning
physicians,
pharmacists
and nurses
• order entry
physicians
• order review,
modification,
and fulfillment
physicians,
pharmacists
and nurses
• order review
and
administration
physicians,
pharmacists
and nurses
To be safe and effective, this order-management system must support
the patient's by health care team as it cooperates in performing the
processes:
Before starting of order management system ask patient about home
medication, self medication, diet plan etc.
17. 5
Patient education:
Avoid multidoctors visit
Avoid visiting to different pharmacy
Avoid self medication
Inform your doctor about last prescription, home
medication or any other herb treatment.
If any problem to recognize medication ask pharmacist
before taking.
18. Reduction strategies to reduce
misuse of medicine:
Developing an effective strategy will require balancing the
needs and concerns of patients, public health, law
enforcement, and the medical community.
19. Make better use of prescription
drug monitoring programs
PDMPs are centralized databases where authorized users
can access prescribing and dispensing data submitted by
prescribers and pharmacies.
States can ensure that prescribers and pharmacists have
access to accurate, real-time prescription histories to help
them make clinical decisions about whether to prescribe or
dispense prescription drugs.
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20. Enhance enforcement by coordinating operations,
providing specialized training,
and strengthening existing laws
States can improve their law enforcement and regulatory
oversight activities by ensuring a coordinated approach to
investigating and prosecuting cases of misuse of medicine.
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21. Ensure proper disposal of
prescription drugs
The majority of people who misuse prescription drugs get them from friends and
family, many of those drugs are leftover medicines.
One of the challenges to ensuring proper disposal is a lack of patient education
on proper disposal procedures.
In general, people do not know how to dispose of medications safely and
responsibly.
The Drug Enforcement Administration (DEA) is expected to release regulations
on prescription drug disposal but in the meantime states can act to address the
problem of leftover prescription drugs.
States can help ensure the proper disposal of expired, unwanted, or unused
medication by educating the public, health care providers, law enforcement,
consumers, and policymakers about safe and effective drug disposal methods.
States can consider collaborating with local coalitions, pharmacies, health
professional boards, and the DEA in take-back activities, such as designating times
and places where the public can safely dispose of unused prescription medication.
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22. State’s role as regulator
and purchaser of services
Strategies that states can adopt are increasing educational
opportunities and requirements for health care providers,
adopting guidelines on appropriate prescribing practices, and
restricting when and how patients access drugs misuse.
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23. To promote public education
about drug misuse
Much of the public remains unaware of the dangers of drugs misuse.
A common perception persists that prescription drugs are safer than illegal drugs, and
less likely to lead to misuse, because they are prescribed by a health care provider.
Along with public and private sector partners, states can launch public awareness
campaigns spearheaded by governors to educate the public, providers, public officials,
and state policymakers about the risks associated with drugs misuse.
Many tools and resources already exist that states can use as a foundation for
developing statewide campaigns.
For example, governors can help promote “Medicine Misuse Project,” a national
education effort and call to action to inform people about the dangers of drug misuse,
safeguard and properly dispose of unused medicine, and eliminate improper prescribing
and dispensing practices.
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