For pharmaceutical manufacturers and life sciences organizations, ensuring patients use medications as intended is central to outcomes, safety, and adherence. But when EHR prescribing workflows introduce ambiguity, especially with patient instructions, those goals become harder to achieve.

While most in the industry focus on clinical effectiveness, market access, or EHR integration, there’s a quiet operational risk undermining patient experience and product performance: unclear or inconsistent patient instructions on prescriptions. As medications become more sophisticated, there is often very detailed instructions for the patient, especially for those that require titration, dosage tapering, or other regimen changes over time.

The Risks of Misplaced Prescription Details?

Recent alerts from the Institute for Safe Medication Practices (ISMP) have highlighted a troubling pattern: prescribers using the "pharmacist notes" or "comments" field in ePrescribing systems to describe patient instructions instead of accurately modeling them in the patient instructions or SIG field.

In one case outlined in the updated guidance, a prescription included vague SIG directions—“Take 5 Tablet By Mouth As Directed – See Instructions”—while the detailed regimen was only noted within the Prescriber’s Note field. The pharmacy software didn’t capture the additional instructions from the Prescriber’s Note field, and during transcription, the data entry technician missed them. As a result, the prescription was filled with incorrect patient instructions.

This isn’t an isolated issue. Another prescription had a simple SIG of “1 tablet PO TID,” but a phased dosing plan—“1 PO BID x7 days, then 1 PO TID thereafter”—was tucked into the notes field. These discrepancies risk patient safety, damage trust, and can result in therapy delays or misaligned outcomes data.

Why Life Sciences Should Pay Attention

From a manufacturer’s perspective, accurate dosing and adherence are foundational. If prescribers are relying on workarounds to convey critical instructions on the electronic prescription, there’s an increased risk of medication errors, off-protocol use, or unnecessary calls to your support center. It can also muddy the waters when it comes to real-world evidence, persistence metrics, and patient support program outcomes.

These issues are especially relevant when:

• A therapy requires titration or phased dosing
• A medication has multiple strengths with different starting vs maintenance regimens
• Prescriptions span across refills and renewals where dosing changes over time
• Patient education relies heavily on accurate instructions
• Ensure prescription quantity matches the number of tablets indicated in the SIG. Some, but not all, EHRs offer tools to help calculate

Structured SIG standards have been in development for years, but most current implementations struggle to adopt the approved technology and accommodate complex dosing scenarios. Until that improves, life sciences companies have an opportunity—and responsibility—to support prescribers by making prescribing instruction examples clear in prescribing materials.

What You Can Do Now

To reduce ambiguity and improve therapy success, manufacturers should:

• Provide clear, modeled SIGs in prescribing guidance and EHR support materials. Include both initiation and maintenance regimens to avoid copy-forward errors.
• Support prescribers to design “favorites” in prescribing workflows. Consider creating separate options for new starts and ongoing prescriptions.
• Educate customer-facing teams and prescribers about the importance of only using the SIG or patient instructions field and risks of using the notes field for critical dosing instructions.
• Ensure patient access programs and hubs have visibility into what patients are actually prescribed—not just what’s expected from the label.
• Support industry efforts to fully adopt structured SIG standards that can handle real-world complexity.

Final Thoughts

Prescribing errors don’t always start with the medication; they often start with how patients are directed to take the medication. For life sciences companies invested in patient outcomes, it’s essential to look beyond the molecule and consider the message. Clarity for prescribers on how to accurately prescribe the medication, in particular, what should be included in the SIG field is a small detail that carries big implications for safety, adherence, and brand performance.

Let’s not leave it up to interpretation. Let’s equip prescribers with the tools and guidance they need to get it right. Do you need help creating education and EHR support materials to improve clarity in accurately prescribing products that have more complex prescribing instructions like those that require titration, dosage tapering, or other regimen changes over time? POCP can help. Reach out to me to set up time to discuss your needs.