To Err Is Human: Part 5 - "Strikeout" Medication Errors Using Good Documentation Practice, or GDocP

Jubilant Radiopharma, Radiopharmacies Division presents the Part 5 installment of Dr. Laura Bauman’s To Err Is Human, a blog series focused on common errors in nuclear medicine that may occur during the process of writing, ordering and/or dispensing prescriptions. This series also emphasizes the critical importance for organizations to establish error prevention strategies.

This installment chronicles how implementation of Good Documentation Practice can help prevent mistakes when writing prescriptions.

As we have discussed repeatedly throughout this blog series, despite best efforts, nobody’s perfect and errors can occur when writing and communicating prescription orders. In addition to the techniques described in Parts 1-4 of the To Err Is Human series, following generally accepted documentation guidelines when writing prescriptions is another technique to further limit such errors.

Generally accepted Good Documentation Practice (GDocP) is considered part of Good Manufacturing Practices (GMP) and is supported by the World Health Organization (WHO), the U.S. Food and Drug Administration, the U.S. Pharmacopeial Convention, and many others (perhaps including your own organization!).

Some relevant techniques include the following:

  • For all handwritten documents, use indelible ballpoint pen (not pencil, not erasable or water-soluble pen).
  • Strikeout errors by drawing a single line through the incorrect information.
  • Do not obscure the original information with whiteout, marker, scribbles, or new information.
  • Enter the correct information next to the strikeout.
  • Initial and date the change.
  • Use an asterisk to put the reason for the correction in the footer.

Jubilant Radiopharma, Radiopharmacies Division's Online Prescription Ordering System can help your nuclear medicine department avoid many of the common communication mistakes that lead to dispensing errors. Now available through Jubilant Radiopharma, Radiopharmacies Division's pharmacies nationwide, Online Prescription Ordering provides a quick, easy and secure way to transmit your prescription orders directly to your local pharmacy. Contact your Jubilant Radiopharma, Radiopharmacies Division pharmacist to register today.

Take the following scenario: A nuclear medicine technologist called the pharmacy to say he received an extra dose that he did not order. Upon review, the order in question was faint but visible on the fax form. The technologist explained that he had tried to erase the order on the form because he intended to cancel it. Moving forward, the technologist agreed to clearly cross out any cancelled orders on his fax document.

This example reminds us that errors in nuclear medicine are often due to ambiguous communication between technologist and pharmacist. Although these errors can negatively impact our practices and our patients, fearless discussion designed to acknowledge and address those missteps within a “just culture” can lead to error prevention strategies.

Lessons Learned

Throughout this To Err Is Human series we have been reminded time and again that the key to error avoidance is clear communication. Simple steps can and should be taken to eliminate potential confusion and ensure accurate dispensing.

Lets take a quick look back at recommended best practices:

Preparing your own team to learn and grow from mistakes is an essential role of successful leaders. Hopefully, this series has prompted you to ask yourself the following: Has your team experienced other errors? What cultural framework was used to analyze the error afterward? Were error-prevention strategies formed and communicated to the entire team? What more can I do to encourage an error-free environment?

For more information, see Part 1 of our series: How Institution of a “Just Culture” Can Lead to Effective Medication-Error Reporting & Prevention. You may also find the following resources of interest and value: The Joint Comission’s Framework for Conducting a Root Cause Analysis and Action Plan U.S. Nuclear Regulatory Commission's (NRC) list of Risks Associated with Medical Events and the WHO’s Good Documentation & Quality Management Principles.