Olufunmilola K. Odukoya

E-prescribing errors in community pharmacies: Exploring consequences and contributing factors

OBJECTIVE To explore types of e-prescribing errors in community pharmacies and their potential consequences, as well as the factors that contribute to e-prescribing errors. METHODS Data collection involved performing 45 total hours of direct observations in five pharmacies. Follow-up interviews were conducted with 20 study participants. Transcripts from observations and interviews were subjected to content analysis using NVivo 10. RESULTS Pharmacy staff detected 75 e-prescription errors during the 45 h observation in pharmacies. The most common e-prescribing errors were wrong drug quantity, wrong dosing directions, wrong duration of therapy, and wrong dosage formulation. Participants estimated that 5 in 100 e-prescriptions have errors. Drug classes that were implicated in e-prescribing errors were antiinfectives, inhalers, ophthalmic, and topical agents. The potential consequences of e-prescribing errors included increased likelihood of the patient receiving incorrect drug therapy, poor disease management for patients, additional work for pharmacy personnel, increased cost for pharmacies and patients, and frustrations for patients and pharmacy staff. Factors that contribute to errors included: technology incompatibility between pharmacy and clinic systems, technology design issues such as use of auto-populate features and dropdown menus, and inadvertently entering incorrect information. CONCLUSION Study findings suggest that a wide range of e-prescribing errors is encountered in community pharmacies. Pharmacists and technicians perceive that causes of e-prescribing errors are multidisciplinary and multifactorial, that is to say e-prescribing errors can originate from technology used in prescriber offices and pharmacies.

Retail pharmacy staff perceptions of design strengths and weaknesses of electronic prescribing

OBJECTIVE This paper explored pharmacy staff perceptions of the strengths and weaknesses of electronic prescribing (e-prescribing) design in retail pharmacies using the sociotechnical systems framework. This study examined how adoption of e-prescribing technology is affecting clinical practice and patient care. MATERIALS AND METHODS Direct observations and think aloud protocols were used to collect data from seven retail pharmacies. RESULTS Pharmacists and pharmacy technicians reported strengths of e-prescribing design that facilitated pharmacy work which included: legibility, ease of archiving, quick access to prescriptions and consistency in the format of electronic prescriptions (e-prescriptions). Design weaknesses and potential hazards to patient care associated with e-prescribing systems were due to differences between pharmacy and prescriber computer systems which resulted in the selection of wrong patient or drug (name, directions, dose, strength, formulation, package sizes). There were unique strengths and weaknesses in the design of e-prescriptions peculiar to the three pharmacy computer systems examined in this study. DISCUSSION Findings from this study can help inform policy on creating e-prescribing design standards for pharmacy. e-Prescribing system developers can use the results of this study to identify and apply the most usable features of the three main pharmacy computer systems to design systems that support dispensing efficiency and safety. CONCLUSIONS This is the first study to highlight design flaws with e-prescribing in retail pharmacies. The sociotechnical systems framework was useful in providing an indepth understanding of the pharmacist and pharmacy technicians interface with e-prescribing technology. This information can be used by policy makers to create e-prescribing standards for pharmacies.

E-prescribing: a focused review and new approach to addressing safety in pharmacies and primary care.

E-prescribing, the health information technology (HIT) that enables prescribers to electronically transmit prescriptions to community pharmacies, has been touted as a solution for improving patient safety and overall quality of care. However, the impact of HIT, such as e-prescribing on medication errors in acute care settings, has been widely studied and shows that if poorly designed or implemented, HIT can pose a risk to patient safety by introducing a source of medication errors. Unlike acute care settings, safety issues related to e-prescribing in primary care settings (where e-prescriptions are generated and transmitted) and pharmacies (where e-prescriptions are received) have not received as much attention in the literature. This paper provides a focused review of patient safety issues related to using e-prescribing systems in primary care and pharmacies. In addition, the paper proposes using human factors engineering concepts to study e-prescribing safety in pharmacies and primary care settings to identify safety problems and possible mechanisms for improvement.

Relationship between e-prescriptions and community pharmacy workflow

OBJECTIVES To understand how community pharmacists use electronic prescribing (e-prescribing) technology and to describe the workflow challenges pharmacy personnel encounter as a result of using e-prescribing technology. DESIGN Cross-sectional qualitative study. SETTING Seven community pharmacies in Wisconsin from December 2010 to March 2011. PARTICIPANTS 16 pharmacists and 14 pharmacy technicians (in three chain and four independent pharmacies). INTERVENTIONS Think-aloud protocols and pharmacy group interviews. MAIN OUTCOME MEASURES Pharmacy staff descriptions of their use of e-prescribing technology and challenges encountered in their daily workflow related to this technology. RESULTS Two contributing factors were perceived to influence e-prescribing workflow: issues stemming from prescribing or transmitting software and issues from within the pharmacy. Pharmacies experienced both delayed and inaccurate e-prescriptions from physician offices. An overwhelming number of e-prescriptions with inaccurate or unclear information resulted in serious time delays for patients as pharmacists contacted physicians to clarify wrong information. In addition, lack of formal training and the disconnect between pharmacy procedures for verifying prescription accuracy and presentation of e-prescription information on the computer screen influenced the speed of processing an e-prescription. CONCLUSION E-prescriptions processing can hinder pharmacy workflow. As the number of e-prescriptions transmitted to pharmacies increases because of legislative mandates, it is essential that the technology supporting e-prescriptions (both on the prescriber and pharmacy operating systems) be redesigned to facilitate pharmacy workflow processes and to prevent unintended increase in medication errors, user frustration, and stress.

e-Prescribing: characterisation of patient safety hazards in community pharmacies using a sociotechnical systems approach

Objective To characterise the safety hazards related to e-prescribing in community pharmacies. Methods The sociotechnical systems framework was used to investigate the e-prescribing technology interface in community pharmacies by taking into consideration the social, technical and environmental work elements of a users interaction with technology. This study focused specifically on aspects of the social subsystem. Study design and setting The study employed a cross-sectional qualitative design and was conducted in seven community pharmacies in Wisconsin. Direct observations, think aloud protocols and group interviews were conducted with 14 pharmacists and 16 technicians, and audio recorded. Recordings were transcribed and subjected to thematic content analysis guided by the sociotechnical systems’ theoretical framework. Results Three major themes that may increase the potential for medication errors with e-prescribing were identified and described. The three themes included: (1) increased cognitive burden on pharmacy staff, such as having to memorise parts of e-prescriptions or having to perform dosage calculations mentally; (2) interruptions during the e-prescription dispensing process; and (3) communication issues with prescribers, patients and among pharmacy staff. Pharmacy staff reported these consequences of e-prescribing increased the likelihood of medication errors. Conclusions This study is the first of its kind to identify patient safety risks related to e-prescribing in community pharmacies using a sociotechnical systems framework. The findings shed light on potential interventions that may enhance patient safety in pharmacies and facilitate improved e-prescribing use. Future studies should confirm patient safety hazards reported and identify ways to use e-prescribing effectively and safely in community pharmacies.

Using a conflict conceptual framework to describe challenges to coordinated patient care from the physicians' and pharmacists' perspective

BACKGROUND In an effort to increase cost-effectiveness of health care and reduce overall costs, patient-centered medical homes have been proposed to spur fundamental changes in the way primary care is delivered. One of the chief principles that describe a patient-centered medical home is that care is organized across all elements of the broader health care system, including community pharmacies. OBJECTIVES To identify and describe challenges derived from a conflict management framework to a physician-pharmacist approach to coordinating patient care. METHODS A descriptive, exploratory, non-experimental study was conducted in Wisconsin (U.S. State) from June to December, 2011. Data were collected through two rounds of face-to-face interviews with physicians and community pharmacists. The first round involved one-on-one interviews with pharmacists and physicians. The second round brought pharmacist-physician dyads together in an open-ended interview exploring issues raised in the first round. Content analysis was guided by a conflict management conceptual framework using NVivo 10 qualitative software. RESULTS A total of four major themes emerged from the conflict analysis of interviews that illustrate challenges to coordinated patient care: Scarce resources, technology design and usability, insurance constraints, and laws and policy governing patient care. The study findings indicate that both groups of health care professionals work within an environment of conflict and have to negotiate the challenges and strains that exist in the current health care system. Their need to work together, or interdependence, is primarily challenged by scarce resources and external interference. CONCLUSIONS Efforts to coordinate patient care through teams of inter-professional health care providers will be more successful if they acknowledge the inherent conflict that exists. Efforts should be made to provide an infrastructure for interdependence and to support interpersonal communication.

Barriers and facilitators to recovering from e-prescribing errors in community pharmacies.

OBJECTIVE To explore barriers and facilitators to recovery from e-prescribing errors in community pharmacies and to explore practical solutions for work system redesign to ensure successful recovery from errors. DESIGN Cross-sectional qualitative design using direct observations, interviews, and focus groups. SETTING Five community pharmacies in Wisconsin. PARTICIPANTS 13 pharmacists and 14 pharmacy technicians. INTERVENTIONS Observational field notes and transcribed interviews and focus groups were subjected to thematic analysis guided by the Systems Engineering Initiative for Patient Safety (SEIPS) work system and patient safety model. MAIN OUTCOME MEASURES Barriers and facilitators to recovering from e-prescription errors in community pharmacies. RESULTS Organizational factors, such as communication, training, teamwork, and staffing levels, play an important role in recovering from e-prescription errors. Other factors that could positively or negatively affect recovery of e-prescription errors include level of experience, knowledge of the pharmacy personnel, availability or usability of tools and technology, interruptions and time pressure when performing tasks, and noise in the physical environment. CONCLUSION The SEIPS model sheds light on key factors that may influence recovery from e-prescribing errors in pharmacies, including the environment, teamwork, communication, technology, tasks, and other organizational variables. To be successful in recovering from e-prescribing errors, pharmacies must provide the appropriate working conditions that support recovery from errors.

Factors influencing quality of patient interaction at community pharmacy drive-through and walk-in counselling areas

To examine factors influencing the amount of time and information pharmacy personnel provide to patients at drive‐through and walk‐in counselling areas.