The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study

Abstract

ObjectivesTo compare prevalence and types of dispensing errors and pharmacists’ labelling enhancements, for prescriptions transmitted electronically versus paper prescriptions.DesignNaturalistic stepped wedge study.Setting15 English community pharmacies.InterventionElectronic transmission of prescriptions between prescriber and pharmacy.Main outcome measuresPrevalence of labelling errors, content errors and labelling enhancements (beneficial additions to the instructions), as identified by researchers visiting each pharmacy.ResultsOverall, we identified labelling errors in 5.4% of 16 357 dispensed items, and content errors in 1.4%; enhancements were made for 13.6%. Pharmacists also edited the label for a further 21.9% of electronically transmitted items. Electronically transmitted prescriptions had a higher prevalence of labelling errors (7.4% of 3733 items) than other prescriptions (4.8% of 12 624); OR 1.46 (95% CI 1.21 to 1.76). There was no difference for content errors or enhancements. The increase in labelling errors was mainly accounted for by errors (mainly at one pharmacy) involving omission of the indication, where specified by the prescriber, from the label. A sensitivity analysis in which these cases (n=158) were not considered errors revealed no remaining difference between prescription types.ConclusionsWe identified a higher prevalence of labelling errors for items transmitted electronically, but this was predominantly accounted for by local practice in a single pharmacy, independent of prescription type. Community pharmacists made labelling enhancements to about one in seven dispensed items, whether electronically transmitted or not. Community pharmacists, prescribers, professional bodies and software providers should work together to agree how items should be dispensed and labelled to best reap the benefits of electronically transmitted prescriptions. Community pharmacists need to ensure their computer systems are promptly updated to help reduce errors.

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

“…Community pharmacy dispensing errors could be reduced through electronic transmission of prescriptions from general practice to the dispensing community pharmacy, as this would prevent errors at the prescriber–dispenser interface [74]. We also recommend implementing a bar coding system for all medications (as is often done in hospital pharmacies), to reduce the potential for human error by acting as an additional safety check prior to medication dispensing [75–77].…”

The need for independent evaluations of government-led health information technology initiatives

“…Then Prime Minister, Tony Blair, championed the project, with the aim of creating a digitised, interoperable, health infrastructure that would transform healthcare delivery, achieve major improvements in health outcomes and, at the same time, substantially reduce government expenditure on healthcare. The study by Franklin et al 2 represents the long-awaited independent academic evaluation of the Electronic Prescription Service (EPS), a core component of NPfIT that aimed to reduce the need for patients to manually transfer paper prescriptions provided by their general practitioners to dispensing pharmacies and, more importantly, diminish medication errors and thereby improve patient outcomes. Franklin et al evaluated the impact of electronic transmission of prescriptions between prescribers and pharmacies, but found no benefit.…”

The impact of electronic prescriptions on medication safety in Finnish community pharmacies: A survey of pharmacists

“…Inexactly or incorrectly entered prescription information probably results from the physician's failure to complete the prescription correctly: for example, entering prescription information in the wrong data fields or incorrectly selecting information from the system. Previous reports have shown that one reason for lack of clarity in dosage instructions is that physicians use abbreviations that may lead to the misinterpretation of instructions in pharmacies [26,37,38]. Moreover, some errors or ambiguities required clarifications from a physician, which delayed dispensing.…”