Note To ePrescribing Customers – Appropriate/
Inappropriate Use of Note to Pharmacy Field

Clinical Alert: Use of Note to Pharmacy Field

We are passing along this information from Surescripts® to our valued customers.

The National Council for Prescription Drug Programs (NCPDP) SCRIPT version 10.6 allows the transmission of a free-text Notes to Pharmacy field allowing prescribers to communicate additional non-codified information related to, but not part of, the prescription. In many cases, the free-text Notes field serves as an opportunity for prescribers to enter anything they feel is pertinent to the prescription, but which is often inappropriate. The receipt of inappropriate Notes can cause ambiguity and confusion that may result in pharmacy workflow disruptions, physician callbacks for clarification, and/or potential patient safety risks.

Symptoms: Inappropriate use of the Notes field includes information that already has a structured and codified field within the e-prescription message. The most concerning inappropriate use of this field is for patient directions, either supplemental or conflicting. This can lead to critical information not being conveyed to the patient.

Examples of inappropriate Notes content include:

Type of Inappropriate Notes ContentExample
Patient"PT XXX will pick up - DOB: xx-xx-xx"
Prescriber"Prescribed by: Dr. XYZ NPI: 123456789"
Pharmacy"Send to: ABCXYZ Pharmacy; 123 Easy Street"
Drug Name/ Description"Metroprolol Tartrate 50 mg oral tablet", "Twisthaler"
Directions for the Patient"Take as directed by AC Clinic", "follow up after course"
Diagnosis or Indication"Benign Hypertension", "GOUT", "401.9"
Quantity or Quantity Qualifier/Potency Unit Code"QS for 3 bottle", "Dispense: #5", "C48540"
Days' Supply"#90 days", "Days: 1 month's supply"
Dispense as Written"DAW 1, "Dispense the Brand only"
Refill Quantitiy"Remaining Refills: 2", "Ref: 1+3"

The Notes field should only include information to the pharmacist that does not already have structured fields designated for such information, so long as it does not conflict with information sent in other structured fields.

Examples of appropriate Notes content include:

Type of Appropriate Notes ContentExample(s)
Mail order bridge, vacation, lots, stolen, prelacement supply"This is another 90 tabs for a vacation override." "Additional amount - pills were destroyed."
Label in patient's preferred language"Chineses label please", "Lebel - patient speaks Spanish."
Expedited pick-up time; inform patient when ready"Fill ASAP please - inform patient to pick-up"
Deliver this prescription"Please deliver to patient today.", "Delivery home clinic."
Counsel patient on therapy, indication, use, and other related information"Please advise patient not to drink alcohol while taking this medication. Thanks."
Patient Allergy Notification/Alert to Pharmacy"Ok, has had amoxicillin without reaction", "myalgias with statins"
Place Rx on hold/ do not dispense until later date"DO NOT FILL UNTIL XX-XX-XXXX"
Patient needs appointment/ office visit/labs"ADVISE PT NEEDS CHECKUP"
Change in therapy or Increase/Decrease in dose"changing from capsule to XR tablets", "Change from Simvastatin"
Flavor this medication (with specific flavor)"May add flavoring, preferably bubble gum."
One for home and one for school/other location"Please give 1 for school and 1 for home"
Dispense the medication/quantity/product per patient preference"Patient would like to receive a 90-day supply. Thank you.", "Patient prefers only ABC manufacturer brand."
Number of Prescriptions in Batch"#2 rx", "1 of 3", "Rx #1 of 2"
Other related information intended for the pharmacist without a structured field"Brand Medically Necessary", "SIG calculated with weight: 9.13kg and a terget dose of 1 mg/kg/dose"

Resolution:

Below are the Surescripts® application certification requirements (ACR) that address appropriate use of the Notes field:

On a New Rx, the notes going into the message shall be labeled as “Notes to Pharmacist” or something similar on the user screen. It shall be clear that data passed in the character Notes field will not be shared with the patient. Prescription information that has a designated, standardized data field within the NCPDP script standard shall not be entered into the “Notes to Pharmacist” field. Some examples: SIG, Effective Date, Drug Name, Strength, or Quantity.

In order to optimize workflow efficiency and improve patient care and safety, please ensure your systems and users adopt and adhere to the guidelines explained above.

For Assistance:

If you have further questions or require assistance, please contact AZCOMP Technical Support, or McKesson Technical Support and your questions will be directed to the proper resource.