{"id":93,"date":"2020-05-28T17:04:03","date_gmt":"2020-05-28T17:04:03","guid":{"rendered":"https:\/\/blogs.bmj.com\/qualitysafety\/?p=93"},"modified":"2020-06-18T22:55:53","modified_gmt":"2020-06-18T22:55:53","slug":"electronic-transmission-of-outpatient-prescriptions-still-requires-significant-pharmacist-oversight","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/qualitysafety\/2020\/05\/28\/electronic-transmission-of-outpatient-prescriptions-still-requires-significant-pharmacist-oversight\/","title":{"rendered":"Electronic transmission of outpatient prescriptions still requires significant pharmacist oversight"},"content":{"rendered":"

\nThe Covid-19 pandemic has led to increasing numbers of patients moving to the use of electronic prescriptions and internet pharmacies in many healthcare systems. For example, there has been a dramatic increase in use of the English electronic prescription service since March 2020, with internet pharmacies in the UK also experiencing large increases in the numbers of patients signing up<\/a>. Rather than requiring a patient to physically take a printed prescription to a pharmacy in person, electronic prescriptions are transmitted directly from the prescriber to an institutional, community-based, or mail-order pharmacy.<\/p>\n

As well as providing greater patient convenience and providing fewer opportunities for a prescription to be lost or forgotten, it might be easy to assume that electronic prescriptions also make life easier for the pharmacist. In theory, pharmacy staff receiving electronic prescriptions don\u2019t have to re-enter information from a paper prescription. And they won\u2019t have to re-type the prescriber\u2019s original directions specifying how the patient is to take the medication.<\/p>\n

But, in practice, it\u2019s not that simple. Zheng and colleagues\u2019 article in the journal<\/a> reports that, in a study of nearly 530,000 prescriptions dispensed by a US mail-order pharmacy, prescribers\u2019 directions are often poor in terms of readability. As an example, the direction \u201c1 po q day\u201d, meaning \u201ctake one tablet by mouth every day\u201d, is unlikely to make sense to the typical patient or carer.\u00a0 Additionally, almost half have other quality problems, such as missing at least one key item of information. The result is that the vast majority of prescription directions end up being edited manually by pharmacy staff to make them more understandable to patients. This is even more important when medications are provided by post, as there is less opportunity for pharmacy staff to check patients\u2019 understanding of how to take their medication, or for the patient to ask questions.<\/p>\n

Making such edits has considerable workload implications for pharmacy staff.\u00a0 Zheng and colleagues estimate this to be 6.6 seconds per prescription; this may not sound like much, but when multiplied by the 6,000 prescriptions processed per week in the pharmacy studied, it amounts to 11 hours of pharmacist time. And this doesn\u2019t include any additional time spent contacting prescribers for clarifications. Even then, pharmacists\u2019 amendments don\u2019t address every quality problem – pharmacy staff corrected around 80% of the quality problems identified, leaving the other fifth uncorrected. All of these issues may be even more challenging in mail-order pharmacies experiencing a rapid surge in workload due to the current Covid-19 pandemic.<\/p>\n

So, what\u2019s the solution?\u00a0 Zheng and colleagues suggest implementing standardised data fields in the electronic prescribing software used by medical staff and other prescribers, rather than relying on free-text fields to enter patient directions. This would be more akin to the structured data used in most inpatient electronic prescribing systems, although a free-text option is always likely to be needed for some cases. Errors can also occur in the selection of options from a standardised menu. This key role for pharmacy staff is therefore likely to be needed for the foreseeable future – and is arguably even more important during the current pandemic.<\/p>\n

-Bryony Dean Franklin<\/em><\/p>\n

Professor Bryony Dean Franklin<\/a> is Executive Lead Pharmacist (Research) and Director of the Centre for Medication Safety and Service Quality at Imperial College Healthcare NHS Trust, Professor of Medication Safety at UCL School of Pharmacy, and a Senior Editor for BMJ Quality & Safety<\/em>.<\/p>\n","protected":false},"excerpt":{"rendered":"

The Covid-19 pandemic has led to increasing numbers of patients moving to the use of electronic prescriptions and internet pharmacies in many healthcare systems. For example, there has been a dramatic increase in use of the English electronic prescription service since March 2020, with internet pharmacies in the UK also experiencing large increases in the […]<\/p>\n

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