They are known as the “five rights” of safe medication administration: the right patient, right drug, right dose, right time, and right route. For decades, pharmacy and patient safety experts have wanted to add a sixth: right indication. They argue that printing the reason for taking the medication on the individual packaging helps prescribers and pharmacists confirm the right drug has been ordered and helps patients self-administer correctly.
Writing prescriptions has advanced greatly since the days when physicians were urged to write them in Latin to spare patients the effort of even knowing the names of their mediations, not to mention the reason for taking them. But medication processes persist as a leading source of errors and harm, and some experts believe the lack of indication is a contributing factor. Michael Cohen, R.Ph., President of the Institute for Safe Medication Practices, and Gordon Schiff, M.D., Associate Director of Brigham and Women’s Center for Patient Safety Research and Practice, are among those who have been advocating for indications-based prescribing, which involves including the indication at the order-entry phase of the process as well as at the end, with labeling.
“Indications can play a role in signaling to patients that there’s a problem and stopping someone from taking a medication that’s wrong or that they’re confused about,” says Schiff, adding it’s also helpful for pharmacists looking to counsel patients and more respectful to patients themselves. “There’s this guessing game if the pharmacist doesn’t know whether you’re taking this anti-coagulant for a blood clot in your leg or for atrial fibrillation. The pharmacists are very frustrated.”
Cohen, who began advocating for indications-based prescribing in 1975, explains, “It's good for patients to know what the purpose is. If they or the pharmacist sees that it doesn't make sense, because they don't have that diagnosis, then you could pick it up in that way.”
Despite these convincing arguments, including the indication is not the norm. In a recently published study, Schiff and others found that over a five-year period only 7.41% of more than 4.3 million prescriptions at one institution included the indication. Internal medicine prescribers generated the highest number of prescriptions, and they were the least likely to include the indication — only 6.26% of the time.