InterOpNurse Thoughts – Medication Formulary Standards (ISMP)
I was recently involved in a much heated debate over utilizing standards in the roll out of our Computerized Provider Order Entry (CPOE) system. This issue in particular had to do with following a "standard" for drug name nomenclature, such as those recommended by the Institute for Safe Medication Practices (ISMP). Our organization was divided with one camp wanting to utilize their own standard (capitalization of generic names) and another wanting to follow a nationally recognized standard (lower caps). Of course, this decision resides completely with the hospital’s clinical and pharmaceutical leadership. However, the plan to not follow a standard in the EMR system is of real concern since once implemented, this decision will likely persist with the organization.
While I am unaware of specific laws to reference that are against capitalizing generic drug names, although they may exist. I do believe however, it is a community standard not to do so. That is, I believe it is a community standard to use lower case to indicate generic compounds, and capitalization to indicate the Brand or Proprietary names for those compounds. It’s use is ubiquitous. Training books for healthcare workers from transcriptionists to pharmacy techs reference this practice. I have personally never seem an Electronic Medical Record (EMR) or CPOE portion of the system; nor a Pharmacy system to be configured without using lower case for generic names and title case for brand names.
While not as formal as law, ISMP has a set of helpful guidelines for pharmaceutical labels formats that may apply: http://www.ismp.org/Tools/guidelines/labelFormats/default.asp Each of these guidelines recommends to “List all products by generic name using lower-case letters as the primary drug nomenclature (unless employing tall man letters as a safety strategy), ensuring that each matches FDA-approved nomenclature.”
Most importantly, using capitalization on generics may inhibit the effectiveness of the ISMP–recommended tall man lettering. When applied well, the only capitalization would be found on Brand Names and those look-alike and sound-alike areas of the drug names that are accented by this practice. In fact, the only additional thing I would recommend is for our organization to agree to at least adopt ALL the ISMP-recommended tall man recommended matches found at: http://www.ismp.org/tools/tallmanletters.pdf , and then to add more that prove to be useful here.
This issue defies logic for me. Why would someone not want to follow a set of proven standards? Please feel free to chime in and leave your thoughts in the comments!
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