DONE BY: SHAHINBANU GHORI

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.

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:

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

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.

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

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

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.

Risk - Benefits ratio:

Side effects

Toxicity

Unintended consequences

Relief of symptoms

Improved function

Restored quality of life

Benefits Risks

Effect on Risk – Benefits:

Relief of pain

Improved function

Restored quality of life

IT IS NESSASARY TO FOLLOW SOME STRATERGIES TO REDUCE THIS RISK OF DUPLICATION OF PRESCRBING AND MISUSE OF MEDICINE

Reduction in duplication of prescribing:

1

CPOEComputerized 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.

2

CDSClinical decision support, discuss with clinical team and then

manage treatment plan.

3

EHRElectronic 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.

OMSOrder-management system is helpful to reduce risk of

medication problem after using these electronic system.

4

• 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.

5

Patient education:Avoid multidoctors visit

Avoid visiting to different pharmacyAvoid 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.

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.

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.

1

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.

2

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.

3

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.

4

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.

5

References:

https://www.nga.org/cms/home/nga

https://www.drugabuse.gov

https://www.ncbi.nlm.nih.gov

www.managedcaremag.com