Analysis of community chain pharmacists' interventions on electronic prescriptions

Objective: To measure the incidence and nature of prescribing errors on electronic prescriptions (e-prescriptions) that required active intervention by dispensing pharmacists to correct. Design: Descriptive, nonexperimental, cross-sectional study. Setting: 122 chain community pharmacies that met a prior minimum dispensing volume of five e-prescriptions per day in five states during July through September 2006. Participants: Pharmacists in participating pharmacies. Intervention: A panel of participating pharmacists reported their medication therapy interventions using a standardized documentation protocol. Main outcome measures: Number, type, and reason for pharmacist interventions on e-prescriptions. Results: Data were reported from 68 participating chain pharmacies in five states during 312 work shifts. During the study pharmacists reviewed 2,690 e-prescription orders (new, 83.0%; refill, 17.0%) and took action 102 times for an intervention rate of 3.8%. The rate at which pharmacists identified problems on new e-prescriptions was found to be nearly twice that of refills (4.1% and 2.2%, respectively). The most common reason for pharmacists' interventions on e-prescriptions was to supplement omitted information (31.9%), especially missing directions. Dosing errors were also quite common (17.7%). The most common response by pharmacists to e-prescription problems was to contact the prescriber (64.1%), consult the patient's profile or medication history (12.8%), or interview the patient or the patient's representative (9.4%). In most cases (56%), the e-prescription order was changed and the prescription was ultimately dispensed. In 15% of cases the e-prescription was dispensed as written following clarification by the prescriber. In 10% of cases the prescription was not dispensed. An additional 12% of prescription issues remained unresolved. Pharmacists required an average of 6.07 minutes to conduct their interventions on problematic e-prescription orders, representing an incremental dispensing cost of $4.74. Conclusion: Electronic prescribing can improve the safety and effectiveness of patient care. As currently implemented in the community practice setting, this still-emerging technology maintains selected threats to both medication safety and effectiveness, although probably less than handwritten prescriptions. The adoption of selected best practice recommendations by prescribers could improve the safety, effectiveness, and efficiency of e-prescribing.