How do community pharmacies recover from e-prescription errors?

Area of Science:

• Pharmacy Practice
• Health Informatics
• Medication Safety

Background:

• E-prescribing is increasingly adopted, with millions of electronic prescriptions (e-prescriptions) processed annually in the US.
• A significant percentage of e-prescriptions contain medication errors, posing a risk to patient safety.

Purpose of the Study:

• To investigate and describe the methods community pharmacy staff use to identify, clarify, and resolve errors found in e-prescriptions.
• To understand the error recovery process for e-prescriptions in community pharmacy settings.

Main Methods:

• Utilized the error recovery conceptual framework for data collection and analysis.
• Employed direct observations, interviews, and focus groups with pharmacists and technicians in five community pharmacies.
• Analyzed transcribed data using a three-step error recovery model.

Main Results:

• Most e-prescription errors were detected during data entry into pharmacy systems by both pharmacists and technicians.
• Detection strategies included double-checking, paper printout verification, and highlighting key information.
• Error explanation involved reviewing patient history, patient consultation, team consultation, and online resources.
• Correction involved inferring prescriber intent or contacting the prescriber directly via phone or fax.
• The primary goal during error recovery was to ensure the accuracy of the medication order for the patient.

Conclusions:

• Pharmacists and technicians are crucial in preventing medication errors by detecting e-prescription issues and verifying prescriber intent.
• Further research is necessary to identify factors that influence the successful recovery from e-prescription errors.