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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: CERNER CERNER SOFTWARE
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CERNER CERNER SOFTWARE Back to Search Results
Device Problems Display Difficult to Read (1181); Computer Operating System Problem (2898); Improper Device Output (2953); Application Program Problem: Medication Error (3198)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Type  Other  
Event Description
Description: a prescription was written for norco 325/10mg tablet, but what was dispensed was hydrocodone 5/325.The way the drug is noted in the prescriber's software (b)(4) lists the ingredients in a manner which is backwards from the conventional listing where the hydrocodone dose is listed before the acetaminophen dose.For example, (b)(4) denotes the different hydrocodone products as: norco 325/5mg; norco 325/7.5mg; and norco 325/10mg.We have had several instances where we nearly made an error, and now one confirmed error.In reading the prescription, it is easy to recognize the 325mg and easily overlook the other number, or to expected to see the dose we usually use.There are many instances where the electronically generated prescriptions are misleading.I have two examples: guanfacine 2mg tab 24hr, it is easy to miss the fact that this is the long-acting form of intuniv, not the regular guanfacine 2mg tablet.The same thing is a problem with metoprolol 50mg 24h instead of saying metoprolol "succinate" 50mg.Medication administered to or used by the pt: no.(b)(4).
 
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Brand Name
CERNER SOFTWARE
Type of Device
CERNER SOFTWARE
Manufacturer (Section D)
CERNER
MDR Report Key5728699
MDR Text Key48202096
Report NumberMW5062878
Device Sequence Number1
Product Code JQP
Number of Events Reported1
Summary Report (Y/N)N
Report Source Voluntary
Type of Report Initial
Report Date 04/20/2016
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? No
Device Operator No Information
Initial Date Manufacturer Received Not provided
Initial Date FDA Received06/14/2016
Type of Device Usage N
Patient Sequence Number1
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