How do community pharmacies recover from e-prescription errors?

Abstract

Background The use of e-prescribing is increasing annually, with over 788 million e-prescriptions received in US pharmacies in 2012. Approximately 9% of e-prescriptions have medication errors. Objective To describe the process used by community pharmacy staff to detect, explain, and correct e-prescription errors. Methods The error recovery conceptual framework was employed for data collection and analysis. 13 pharmacists and 14 technicians from five community pharmacies in Wisconsin participated in the study. A combination of data collection methods were utilized, including direct observations, interviews, and focus groups. The transcription and content analysis of recordings were guided by the three-step error recovery model. Results Most of the e-prescription errors were detected during the entering of information into the pharmacy system. These errors were detected by both pharmacists and technicians using a variety of strategies which included: (1) performing double checks of e-prescription information; (2) printing the e-prescription to paper and confirming the information on the computer screen with information from the paper printout; and (3) using colored pens to highlight important information. Strategies used for explaining errors included: (1) careful review of patient’ medication history; (2) pharmacist consultation with patients; (3) consultation with another pharmacy team member; and (4) use of online resources. In order to correct e-prescription errors, participants made educated guesses of the prescriber’s intent or contacted the prescriber via telephone or fax. When e-prescription errors were encountered in the community pharmacies, the primary goal of participants was to get the order right for patients by verifying the prescriber’s intent. Conclusion Pharmacists and technicians play an important role in preventing e-prescription errors through the detection of errors and the verification of prescribers’ intent. Future studies are needed to examine factors that facilitate or hinder recovery from e-prescription errors.

A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks

“…Pharmacists are supposed to perform additional checks when dealing with certain drugs that come in multiple dosage forms and usually have incorrect dosing directions. 75 Pharmacies are also observed as being responsible for documenting and intercepting errors that originate in e-prescribing systems before they harm patients. 23 They need to intervene in the e-prescribing process quite frequently compared to their intervention in traditional paper prescriptions.…”

“…Most e-prescribing errors can be detected by pharmacists and technicians using several methods, including double checking e-prescription information, printing the e-prescription out on paper to confirm the information, and highlighting important and sensitive information on the printed versions of e-prescriptions. According to Odukoya et al, 75 the majority of errors detected by technicians are related to incorrect quantities or incorrect duration of therapy, and most of the errors detected by pharmacists are wrong dosing directions and incorrect dosage formulation. Pharmacists can also use strategies for explaining errors such as reviewing patients' medication histories, consulting with patients and other team members in the pharmacy, and checking online drug information tools, as well as using manufacturer databases.…”

“…79 One type of error caused by e-prescribing systems is sending the e-prescription to the wrong pharmacy instead of that used by the patient. 75 Better communication among physicians, pharmacists and patients (the 3Ps) can resolve this problem to some extent.…”

Report of the 2013-2014 Professional Affairs Standing Committee: Advancing the Pharmacy Profession Together through Pharmacy Technician and Pharmacy Education Partnerships

“…services (e.g., medication reconciliation, asthma education, smoking cessation, prescription error reduction, telepharmacy, drive-through pharmacy) 31,32,33,34,35,36,37 , importance of pharmacy technician credentialing for successful pharmacy services 38 , pharmacy technician roles to enhance pharmacy clinical and operational capabilities 39,40,41 , versus collaborations with pharmacy technician programs 42,43 or pharmacy technician-to-student pharmacist pathway programs. 44,45 In order to gather more information to address their second charge, the PAC chose to investigate the current relationships and successful practices between schools/ colleges of pharmacy and institutions engaged in pharmacy technician education.…”

Barriers and facilitators to recovering from e-prescribing errors in community pharmacies

“…Error recovery is a patient safety concept that has been used to describe how pharmacists prevent medication errors in clinical practice, and it takes into consideration the specific processes used to detect and correct errors. 9 Little is known about work system factors that facilitate or hinder pharmacists’ error recovery with e-prescribing. Exploring what factors promote or limit e-prescription error recovery will inform the development of interventions, such as technological or educational tools, that aim to promote recovery so as to enhance patient safety.…”