A nurse asked if a red flag would be raised when documenting a medication's brand name ordered with its generic name.
Specifically, she is concerned about using the medication's brand name in the nursing narrative notes when the medication administration record also reflects the generic name. In previous blogs, I have presented the legal concerns in medication administration, such as how to prevent medication errors in "Ramifications of Medication Errors and How To Prevent Them." This reader's concern is a realistic one. Studies indicate there is no uniformity in prescribing generic or brand name medications, either by primary care physicians (PCPs) or nurse practitioners (NPs). In the 2017 study "Examining Patterns in Medication Documentation of Trade and Generic Names in an Academic Family Practice Training Centre," which evaluated 9,763 patients prescribed 20 medications:
- 45% of patient charts delineated trade/brand names.
- 32% contained only generic names.
- 23% enclosed a mix of generic and trade/brand names.
In addition, the study disclosed there was large variation in use of generic names among the physicians, varying from 19% to 93%. Another 2017 study examined prescribing practices for NPs and PCPs, with 164,681 patients covered by Medicare Part D. Of the 20 types of medications studied, generic medications were used by both groups at the same rate. The authors point out this result is most likely because of the use of formularies to determine medication choice.
What's in a name?
Every medication has an approved name, which is a generic name. Groups of medications that have similar actions often will have similar-sounding generic names, such as the antibiotic group. Amoxicillin and ampicillin are examples.
If a generic medication is made by several different pharmaceutical companies, it is given a brand or trade name.
In the reader's submitted question, lorazepam is the generic name in the benzodiazepine class of drugs. However, it has several common trade or brand names, including Ativan and Intensol. In addition to the difference in the name of the medication, the color, size or shape of the medication may change, depending on whether a generic or brand name is prescribed.
Why the concern about red flags and medication administration?
As you probably know, raising a red flag is used when an alert to a potential danger or trouble is needed. The reader is correct in stating that a red flag is a realistic concern when an ordered medication by a specific name is not documented as such in the patient record.
Though you might know the generic and brand name of a particular medication, it's possible that not all nursing staff share that knowledge.
In the reader's question, there was no indication that documenting as she described resulted in any patient injury or death. However, it is easy to imagine if you or a fellow nursing staff member do not know the generic and brand name of a particular medication, patient safety could be at risk. The wrong medication unintentionally might be administered. Or, the wrong dose of the medication ordered could be administered because of a change in the shape or size of the brand name tablet as opposed to its generic counterpart.
In addition to the very real concern for patient safety, insurance reimbursement might not be possible because of a difference in what was ordered and what was documented as being given to the patient.
And if the documentation of the medication administration does not correspond with what was ordered and the patient is injured in some way, the question as to what medication was administered by you or your fellow nursing staff member will be scrutinized.
Best practices for documenting medication names
A review of published studies and articles on using generic or brand names in healthcare overwhelming indicate using generic names when ordering medications and documenting medication administration is the best approach. This can be easily accomplished by a policy that requires generic names be used throughout the facility, unless a brand name is required (e.g., those where the bioavailability may be different, such as Lithium). Other published articles and studies take the position that a policy requiring ordered medications, whether oral or written, require the generic and the brand name be used.
In either case, a facility-wide policy and procedure should be in place for you to follow without fail. Substituting one name of the medication with its other name is not in your best interest.
Such substitution can result, for example, in questions about what medication you administered if there is a patient injury or death and allegations of substituting one medication for another when your scope of practice does not allow such a substitution. It is always best to practice with keeping an eye toward that red flag from rising.
Take these courses related to medication administration:
Medication Reconciliation: Avoiding Dangerous Errors (1 contact hr) Medication reconciliation is a comprehensive review of a patient's active medications during care transitions. It is a strategy that enables healthcare providers to make better prescribing decisions for patients. \\"Reconciling Medication Information\\" was added as a Joint Commission National Patient Safety Goal in 2005 with the intent to \\"accurately and completely reconcile medications across the continuum of care.\\" The addition of medication reconciliation as an NPSG created an awareness of the benefits of the service and formalized the process in order to bridge the gap between a patient's medication history and acute treatments. This CE module provides information about the medication reconciliation process and requirements, as well as the importance of medication reconciliation in improving patient safety. Preventing Medication Errors (2 contact hrs) Despite the efforts of healthcare providers, medical error rates in communities, healthcare facilities, and homes remain high. Patients and families pay for errors through disability and death. Preventable medical errors not only affect patients, family members, and healthcare professionals, but also contribute to soaring healthcare costs. This activity will explore approaches to prevent medical errors that are both system-based and human performance-based and describe The Joint Commission National Patient Safety Goals as they pertain to medical errors in hospitals Document It Right: Would Your Charting Stand Up to Scrutiny? (1 contact hr) This course provides nurses with information about the value of laws and standards governing nursing documentation, legal basis for appropriate documentation, and techniques for documenting changes in a patient's condition. It describes the legal definition of nursing negligence, characteristics of legally credible charting, and charting practices that can lead to legal problems.
