title: The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study.
abstract: OBJECTIVE
  To compare prevalence and types of dispensing errors and pharmacists' labelling enhancements, for prescriptions transmitted electronically versus paper prescriptions.
  
  
  METHODS
  Naturalistic stepped wedge study.
  
  
  METHODS
  15 English community pharmacies.
  
  
  METHODS
  Electronic transmission of prescriptions between prescriber and pharmacy.
  
  
  METHODS
  Prevalence of labelling errors, content errors and labelling enhancements (beneficial additions to the instructions), as identified by researchers visiting each pharmacy.
  
  
  RESULTS
  Overall, we identified labelling errors in 5.4% of 16,357 dispensed items, and content errors in 1.4%; enhancements were made for 13.6%. Pharmacists also edited the label for a further 21.9% of electronically transmitted items. Electronically transmitted prescriptions had a higher prevalence of labelling errors (7.4% of 3733 items) than other prescriptions (4.8% of 12,624); OR 1.46 (95% CI 1.21 to 1.76). There was no difference for content errors or enhancements. The increase in labelling errors was mainly accounted for by errors (mainly at one pharmacy) involving omission of the indication, where specified by the prescriber, from the label. A sensitivity analysis in which these cases (n=158) were not considered errors revealed no remaining difference between prescription types.
  
  
  CONCLUSIONS
  We identified a higher prevalence of labelling errors for items transmitted electronically, but this was predominantly accounted for by local practice in a single pharmacy, independent of prescription type. Community pharmacists made labelling enhancements to about one in seven dispensed items, whether electronically transmitted or not. Community pharmacists, prescribers, professional bodies and software providers should work together to agree how items should be dispensed and labelled to best reap the benefits of electronically transmitted prescriptions. Community pharmacists need to ensure their computer systems are promptly updated to help reduce errors.
authors.affiliation: Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK Department of Practice and Policy, UCL School of Pharmacy, London, UK.
authors.forename: Bryony Dean
authors.initials: BD
authors.lastname: Franklin
authors.affiliation: Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
authors.forename: Matthew
authors.identifier: http://orcid.org/0000-0002-8152-0870
authors.initials: M
authors.lastname: Reynolds
authors.affiliation: NHS Rushcliffe Clinical Commissioning Group, Easthorpe House, Nottingham, UK.
authors.forename: Stacey
authors.initials: S
authors.lastname: Sadler
authors.affiliation: Department of Practice and Policy, UCL School of Pharmacy, London, UK.
authors.forename: Ralph
authors.initials: R
authors.lastname: Hibberd
authors.affiliation: Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Avery
authors.affiliation: The NIHR Research Design Service for the East Midlands, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Armstrong
authors.affiliation: The NIHR Research Design Service for the East Midlands, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK.
authors.forename: Rajnikant
authors.initials: R
authors.lastname: Mehta
authors.affiliation: Division of Social Research in Medicines and Health, University of Nottingham School of Pharmacy, Nottingham, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Boyd
authors.affiliation: Department of Practice and Policy, UCL School of Pharmacy, London, UK The Health Foundation, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Barber
mesh_terms: D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D004739:England; D006801:Humans; D008508:Medication Errors / Q000706:statistics & numerical data*; D010594:Pharmacies; D013222:State Medicine
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