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      Community pharmacists’ interventions with electronic prescriptions in England: an exploratory study

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          Abstract

          Background Prescribing errors in primary care are problematic. The electronic prescription service (EPS) is an English electronic system linking prescribing, dispensing and reimbursement, designed to rectify some of the problems associated with paper-based prescribing. Objective To document the numbers and types of interventions made by community pharmacists and their staff using EPS release 2 (EPSR2), compare these with those made for other prescription types, and comment on potential effects of EPSR2 on pharmacy practice. Methods We invited staff in 15 community pharmacies to record problems encountered arising from failures in prescribing, dispensing or supply systems for prescribed medication, for a 2 week period. Results Eight pharmacies participated, of which five used EPSR2. These pharmacies reported 69 problems with 68 prescriptions (median 7.5 problems per pharmacy, range 2–22). A total of 33 problems were clinical in nature and 6 were organisational or logistical in origin. Thirty unsigned prescriptions were reported, all non-EPSR2. Of the 69 problems, eight were primarily related to EPSR2 functionality. Conclusion EPSR2 should reduce the number of unsigned prescriptions in circulation. However, prescribers should avoid the use of Latin abbreviations that cannot be interpreted directly by patients, and consider the compatibility of regularly prescribed items with the NHS dictionary of medicines and devices.

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          Clinical pharmacy interventions by community pharmacists during the dispensing process.

          To evaluate the professional contact between the community pharmacist and general practitioner during the dispensing process on issues other than the legality or simple clarification of the prescription. Fourteen community pharmacists from five adjacent localities completed details of each clinical pharmacy intervention during 1 week of each month for a period of 1 year. Each week of the month was randomly selected. When a community pharmacist had to contact the prescriber, during the dispensing of a prescription, the following data were recorded: brief patient details, the prescribed drug therapy, the reason for intervention, the outcome and the time taken. The main outcome measures were the type and nature of each intervention, the BNF category of the drug involved and the time taken. A multidisciplinary clinical panel assessed the potential of each intervention to alter the outcome of the patient's clinical management and to prevent a drug related hospital admission. These assessments were ranked between 0 and 10 (100% confident). During a period covering 1 week per month over 1 year, 1503 clinical pharmacy interventions were made out of 201 000 items dispensed. When normalized for the dispensing volume of each community pharmacy the lower the number of items dispensed then the greater was the percentage of interventions (P=0.013). The clinical panel decided that between 19 (0.01% of the total items dispensed) and 242 (0.12%) interventions may have prevented a drug-related hospital admission, 71 (0.04%) to 483 (0.24%) could have prevented harm whilst 103 (0.05%) to 364 (0.18%) had the potential to improve the efficacy of the intended therapeutic plan. The panel also decided that 748 (0.37%) interventions improved the clinical outcome and could have saved a visit to or by the general practitioner. Conclusion Clinical pharmacy provided by a community pharmacist during the dispensing process has the potential to provide a valuable contribution to health care.
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            Prescribing errors and other problems reported by community pharmacists

            Introduction: Prevention of medication errors is a priority for health services worldwide. Pharmacists routinely screen prescriptions for potential problems, including prescribing errors. This study describes prescribing problems reported by community pharmacists and discusses them from an error prevention perspective. Method For one month, nine community pharmacists documented prescribing problems, interventions made, and the proximal causes of the problems. The results were presented to local GPs and pharmacists at a meeting and feedback was invited. Results For 32 403 items dispensed, pharmacists reported 196 prescribing problems (0.6%). The reporting rates ranged from 0.2%–1.9% between pharmacists and were inversely correlated to dispensing volume. Prescriptions containing incomplete or incorrect information accounted for two-thirds of the problems. Lack of information on the prescriptions and transcribing/typing errors were the most frequently cited proximal causes. A few pitfalls of computerized prescribing were observed. Conclusion Although rates of prescribing problems reported were relatively low, community pharmacists and patients remain important safeguards. This study identified potential causes of prescribing errors, and illustrated areas which could be improved in the design of computerized prescribing systems, and the communication and sharing of information between GPs and pharmacists.
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              A survey of prescription errors in general practice

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                Author and article information

                Contributors
                +44-20-33130503
                +44-20-33130521 , Matthew.reynolds@imperial.nhs.uk
                +44-20-78741295
                +44-115-8837834
                +44-20-85669305
                Journal
                Int J Clin Pharm
                Int J Clin Pharm
                International Journal of Clinical Pharmacy
                Springer Netherlands (Dordrecht )
                2210-7703
                2210-7711
                28 September 2013
                28 September 2013
                2013
                : 35
                : 6
                : 1030-1035
                Affiliations
                [ ]Pharmacy Department, Ground Floor, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
                [ ]Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP UK
                [ ]NHS Rushcliffe Clinical Commissioning Group, Easthorpe House, 165 Loughborough Road, Ruddington, Nottingham, NG11 6LQ UK
                Article
                9853
                10.1007/s11096-013-9853-1
                4514906
                24078302
                41592d0c-7b9f-4350-851b-dec3e2590d10
                © Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013
                History
                : 15 January 2013
                : 12 September 2013
                Categories
                Short Research Report
                Custom metadata
                © Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

                Pharmacology & Pharmaceutical medicine
                community pharmacy,electronic prescribing,pharmacists’ interventions,prescribing errors,united kingdom

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