Technology continues to play a pivotal role in healthcare and the shift from paper-based prescriptions to electronic formats has improved efficiency, safety and convenience for patients and healthcare providers. However, with these benefits come potential challenges and risks for pharmacists and their patients.
Incidents reported to PDL involving an electronic prescription (e-script) are generally attributed to lapses in the dispensing process or if checks during the dispensing process are not followed. PDL recommends using the Guide to Good Dispensing for dispensing protocol.
A recent example
A software vendor coding error has recently caused incorrect data transfer when an e-script token is scanned. PDL understands the vendor supports a very small number of prescribers and the number of potential e-scripts affected is minor in proportion to the overall number of e-scripts generated nationally.
The scanned token prepopulates the drug field in the dispensing software with cyproterone, rather than the prescribed medicine. The electronic copy of the prescription displayed in the software accurately reflects the prescribed medicine. However, if the displayed copy of the original prescription is not properly checked against the item being processed in the dispensing software, there is the potential for a cyproterone label and repeat form to be generated instead of a label and repeat for the prescribed medicine – causing an inadvertent wrong drug selection error with supply of the wrong medicine.
Concerns from PDL
While appreciating that lapses can sometimes occur, PDL has concerns for pharmacists and patients when the checking process has not identified the difference between the e-script and the labelled medicine.
PDL encourages pharmacists to check the dispensing records for cyproterone in the past 12 months and cross check the e-script to ensure the medicine supplied is as prescribed.
Any events relating to this technical issue should be discussed with the prescriber and patient through open disclosure process, reported to pharmacy owners and their business insurer and to PDL. Any cases identified should also be reported to the Australian Digital Health Authority (ADHA) via the contact form.
Reminder of dispensing process for e-scripts
PDL strongly urges pharmacists to ensure that e-scripts are checked on every occasion against the legal original prescription in its electronic form, as thoroughly and systematically as you would a paper prescription.
To avoid dispensing errors with e-scripts, consider the following:
- Confirm patient details including full name, address, date of birth, contact information, Medicare number and any entitlement details.
- Confirm patient’s preferred method of receiving the repeat token and verify the mobile number or email address is up to date.
- Be aware of pop-ups in dispensing software that flag differences between the patient details on file and those on the downloaded script, at the scanning step and when dispensing the token.
- Do not override these details unless you have checked with the patient before proceeding. Points of identification from the downloaded prescription including full name, address and Medicare number should be utilised to ensure the correct patient is selected and the details are confirmed confidentially and professionally.
- Confirm that medication selection in the dispense software matches the full legal version of the downloaded e-script.
- Confirm the directions match those on the downloaded prescription, and that they make sense. Note that prescriber shorthand may be different to the dispense software shorthand (sig) in your dispense system. Any discrepancies with drug details or directions should be clarified with the prescriber.
- Check labelled product against the full legal version of the downloaded e-script. A printed token is not a legal prescription and does not include essential information required to adequately check the prescription.
- Check downloaded e-script for annotations. Check with your dispensing software provider if annotations are not visible in your software (e.g. sometimes staged supply directions have been missed as the annotation field of the e-script was not checked).
- Conduct a final clinical assessment of the labelled product. This may detect prescribing or dispensing errors. Review patient history to determine if it is a new medication or if the strength, dose or directions have changed.
- Check with the patient that the e-script token has been received at their email address or phone number. If the token has been sent incorrectly, cancel the dispensing and re-dispense to generate a new e-script repeat token and confirm its receipt (this may not apply in some jurisdictions for S8 repeat tokens if they must remain under the control of the pharmacy).
This is the last opportunity to ensure the correct medication is being supplied to the correct patient and pharmacist counselling can help to confirm the drug dispensed matches the expected indication.
How to ensure a safe and effective workflow
Most pharmacies now successfully operate a hybrid dispensing workflow that incorporates electronic and paper-based prescriptions. It is important to maintain adequate resources and staff levels to support the pharmacist with the time and concentration needed to ensure safe dispensing.
PDL Professional Officers recommend the following tips to assist with a hybrid workflow:
- At the final check, ensure pharmacists have easy access to a screen to check the labelled medication against the original downloaded e-script. If a technician is completing data entry, another screen may be needed.
- Refer to the Pharmacy Board of Australia ‘Guidelines for dispensing of medicines’ for guidance on sufficient staffing levels to ensure pharmacists can safely oversee accurate and safe dispensing of medicines. Consideration of the provision of other services in the practice setting and capability of staff are essential to ensure adequate staffing.
- Implement protocols to minimise distractions and interruptions in the dispensary.
- Identify realistic wait times and communicate these to patients, to reduce workload pressure.
PDL supports the opportunities that technology offers to improve workflow efficiency, reduce medication errors and enhance patient safety. It is hoped that this alert encourages practitioner awareness of potential risks and the need to maintain best practice processes to deliver an efficient and safe patient experience.
For immediate advice and incident support, call PDL on 1300 854 838 to speak to one of our Professional Officers. We are here to support our pharmacist members 24/7, Australia-wide.
