Medication administration: Should you document generic or brand names?

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, including the basics in “Understanding the Basics of Medication Administration,” and 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 …read more

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