Toxicology Investigation

Journal of Medical Toxicology

, Volume 10, Issue 1, pp 15-18

First online:

Electronic Pharmacopoeia: A Missed Opportunity for Safe Opioid Prescribing Information?

  • Jeff LapointAffiliated withDepartment of Emergency Medicine, Southern California Permanente Medical Group
  • , Jeanmarie PerroneAffiliated withDepartment of Emergency Medicine, Division of Medical Toxicology, Perelman School of Medicine at the University of Pennsylvania
  • , Lewis S. NelsonAffiliated withDepartment of Emergency Medicine, Director, Fellowship in Medical Toxicology, New York University School of Medicine Email author 

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Errors in prescribing of dangerous medications, such as extended release or long acting (ER/LA) opioid forlmulations, remain an important cause of patient harm. Prescribing errors often relate to the failure to note warnings regarding contraindications and drug interactions. Many prescribers utilize electronic pharmacopoeia (EP) to improve medication ordering. The purpose of this study is to assess the ability of commonly used apps to provide accurate safety information about the boxed warning for ER/LA opioids. We evaluated a convenience sample of six popular EP apps available for the iPhone and an online reference for the presence of relevant safety warnings. We accessed the dosing information for each of six ER/LA medications and assessed for the presence of an easily identifiable indication that a boxed warning was present, even if the warning itself was not provided. The prominence of precautionary drug information presented to the user was assessed for each app. Provided information was classified based on the presence of the warning in the ordering pathway, located separately but within the prescribers view, or available in a separate screen of the drug information but non-highlighted. Each program provided a consistent level of warning information for each of the six ER/LA medications. Only 2/7 programs placed a warning in line with dosing information (level 1); 3/7 programs offered level 2 warning and 1/7 offered level 3 warning. One program made no mention of a boxed warning. Most EP apps isolate important safety warnings, and this represents a missed opportunity to improve prescribing practices.


Opioids Medication safety Prescribing Pharmacopoeia Boxed warning