Identifying Preventable and Nonpreventable Prescription Callbacks for Clarification at an Academic Medical Center...

The need for discharge prescription clarification can lead to delays in patient care and possibly medication nonadherence, which can then lead to repeat emergency department (ED) visits and an increased strain on the healthcare system.

This study aims to categorize and quantify the reasons pharmacies request prescription clarification from ED providers.

This is a retrospective analysis of a quality improvement (QI) database containing prescription clarification request data at an urban, 61-bed academic ED in a Level I trauma center with 18 beds dedicated to pediatric patients. The database included de-identified information regarding prescription clarification callbacks populated from prescription clarification forms completed by ED unit clerks. Clarification types were reviewed and classified. Descriptive statistics were used to present the classification types.

Total 2714 clarifications were collected. Of all available clarifications, 63.4% were classified as potentially preventable. The most common preventable clarification was clarification of directions for use (899, 33.1%), followed by a clarification of medication (333, 12.3%), dose (313, 11.5%), concern over a patient allergy or adverse event (135, 5.0%), and duplicate prescriptions (41, 1.5%). Of the nonpreventable clarifications, the most common were insurance issues (397, 14.6%), followed by medication availability (379, 14.0%), delayed patient presentation/lost prescriptions (131, 4.8%), and lastly, patient requests to resend prescriptions to a different pharmacy (86, 3.2%).

Preventable medication clarifications account for the majority of clarification calls, with clarifications for the directions for use accounting for the highest percentage of preventable clarifications, followed by medication clarifications, dosing clarifications, patient allergy or adverse event concerns, and duplicate prescriptions.