Better patient advice loses out to costly prescription errors

A University of Otago study which shows pharmacists spend too much time seeking clarification for minor prescription errors has prompted a call for greater awareness among doctors and prescribers of this time-wasting problem.

Lead author and School of Pharmacy Senior Lecturer Dr Rhiannon Braund says the study of 20 Dunedin pharmacies found that in most cases unnecessary minor bureaucratic errors were the reason for pharmacists needing to confirm the intent of prescribers - usually doctors.

“This limits the time pharmacists can spend on providing the necessary clinical care they are trained to do,” she says.

Using a series of questions asked over six categories during May 2008, the study recorded activity related to the issuing of over 24,000 prescription items. It was found that time wasted over unnecessary bureaucratic and legal issues occurred at a rate of 52 per 1000 prescription items.

Researchers calculated that this specific type of correcting work took up more than 50 per cent of the time pharmacists spend clarifying prescriptions.

Most of this work involved prescribers using trade-names on the prescription instead of PHARMAC-funded drugs, failing to provide signatures, the wrong authority number, and, to a lesser extent, on altered doses which needed to be checked with the prescriber.

“Doctors are busy and there is never the perfect prescriber. Pharmacists are the safety net and are happy to be in that position. But if they are spending all their time getting bogged down dealing with petty bureaucratic errors on prescriptions, that detracts from the time they could spend talking to patients about the best use of their medicine,” she says.

The most important message for prescribers to come out of the study was to prescribe generic drugs that were Government funded. This was because most of the interventions by pharmacists were to check whether the prescriber had meant to prescribe a generic, funded-drug – which in most cases they did.

The remaining 50 per cent of the total time spent on interventions was considered as more necessary work pharmacists, as a “safety net”, are expected to perform. This work involved clarifying prescribers’ instructions, preventing threats to patient health, such as from allergies or dosing errors, and “other” reasons. The “other” group included medications appearing on the prescription that were intended to be stopped and medications that were required but were missing from the prescription.

Dr Braund decided the time taken to process prescriptions was fertile ground for study after hearing numerous complaints from pharmacists about the amount of bureaucratic work required when dealing with prescriptions.

She decided to conduct a baseline test to look at the amount of time these so-called minor issues were taking and found “it really was as bad as pharmacists were saying.”

The Study has been published in the international pharmacy journal Pharmacy World in Science.

Dr Braund says pharmacists are trained to perform other key primary health-care roles such as blood pressure and cholesterol checks, or to be more closely involved in optimal use of medications, but many seldom had the time to do this necessary preventive work.

“This study shows that pharmacists are under too much pressure spending time on the petty bureaucratic work when they are trained to do other things which could be much more useful to the people they see,” she says.

The study highlights a need to build awareness among doctors and prescribers in general about the requirement to prescribe generically (non-trade names) wherever possible and to double-check prescriptions are correct.