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

Franklin, Bryony Dean; Reynolds, Matthew; Sadler, Stacey; Hibberd, Ralph; Avery, Anthony J.; Armstrong, Sarah J.; Mehta, Rajnikant; Boyd, Matthew J.; Barber, Nick

Authors

Bryony Dean Franklin

Matthew Reynolds

Stacey Sadler

Ralph Hibberd

Anthony J. Avery

Sarah J. Armstrong

Rajnikant Mehta

Matthew J. Boyd

Nick Barber



Abstract

Objectives: To compare prevalence and types of dispensing errors and pharmacists’ labelling enhancements, for prescriptions transmitted electronically versus paper prescriptions.
Design: Naturalistic stepped wedge study.
Setting: 15 English community pharmacies.
Intervention: Electronic transmission of prescriptions between prescriber and pharmacy.
Main outcome measures: Prevalence of labelling errors, content errors and labelling enhancements (beneficial additions to the instructions), as identified by researchers visiting each pharmacy.
Results: Overall, 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.
Conclusions: We 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.

Journal Article Type Article
Publication Date Aug 1, 2014
Journal BMJ Quality & Safety
Print ISSN 2044-5415
Electronic ISSN 2044-5423
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 23
Issue 8
APA6 Citation Franklin, B. D., Reynolds, M., Sadler, S., Hibberd, R., Avery, A. J., Armstrong, S. J., …Barber, N. (2014). The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study. BMJ Quality and Safety, 23(8), doi:10.1136/bmjqs-2013-002776
DOI https://doi.org/10.1136/bmjqs-2013-002776
Publisher URL http://qualitysafety.bmj.com/content/23/8/629
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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