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SGM No. 20-02
TO: Area Directors
FROM: Director, Indian Health Service
SUBJECT: Assuring Appropriate Documentation of Prescriptions

The purpose of this Special General Memorandum (SGM) is to ensure appropriate documentation of all prescriptions written by Indian Health Service (IHS) prescribers, in accordance with the Indian Health Manual, Part 3, Chapter 7 – Pharmacy. The requirements discussed herein apply whether a prescription is filled by an IHS pharmacy or a non-IHS pharmacy.

When medications are not available for any reason at IHS facilities, prescribers often provide patients with a prescription to be filled at a non-IHS pharmacy. Proper prescribing documentation is important for the safety of American Indian and Alaska Native (AI/AN) beneficiaries to prevent adverse drug events. An adverse drug event (ADE) is an injury resulting from medical intervention related to a drug, which may include medication errors, adverse drug reactions, allergic reactions, and overdoses. According to the Centers for Disease Control and Prevention Exit Disclaimer: You Are Leaving , adverse drug events cause approximately 1.3 million emergency department visits each year, including approximately 200,000 visits by children (17 years old or younger). About 350,000 patients each year need to be hospitalized for further treatment after emergency visits for adverse drug events.

Adverse drug events are greatly reduced with proper documentation and medication reconciliation. Entry of prescriptions into the Electronic Health Record (EHR) not only allows prescribers and pharmacists to monitor the prevention of adverse drug events, but allows automatic screening by the system to assist in reducing adverse drug events. This is achieved by ordering the medication on the Medications Tab in the EHR, then either choosing the e-prescribing option (if available) or using the “Outside Pharmacy – print” function to generate a hard copy of the prescription to hand to the patient to physically take to an outside pharmacy.

I am relying on the full support of Area Directors, Area Chief Medical Officers, and Clinical Directors to ensure the safety of AI/AN beneficiaries through the universal entry of all prescriptions into the IHS EHR.

Effective Date

This SGM becomes effective on the date signed.

/Michael D. Weahkee/
RADM Michael D. Weahkee, MBA, MHSA
Assistant Surgeon General, U.S. Public Health Service
Indian Health Service