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by Yaneer Bar-Yam
Step V: Improve Communication
Duplication of information entry reduces the likelihood of communication error.

The same principle of redundancy can and should be applied to writing prescriptions.

Why isn’t this done already? The system we use today for writing prescriptions was developed when there were far fewer medications. As the number of possibilities increases we have to be increasingly careful to make sure that enough information is communicated so that the right prescription is delivered.

Thus, whether written or electronic, what matters is how well the system is designed.

The caveat is that every critical piece of a prescription must be written twice, to ensure that few if any errors occur. There are five critical pieces of information on a standard prescription: Patient, Drug, Dose, Route (oral, intravenous, etc.) and Time. Each of these must be written in two ways, or double-checked after electronic entry.

For example, the patient could be designated by both name and ID number. The drug could be doubly specified by writing both the medication and the indication (the condition for which it is prescribed), or both the generic and trade names. Dosage, route of drug delivery, and time of administration could be written out fully and abbreviated, rather than given only in abbreviated form.

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