Problem prescriptions in Sweden necessitating contact with the prescriber before dispensing.

BACKGROUND

Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient.

OBJECTIVES

The aim was to examine prescription problems detected at pharmacies in Sweden, where pharmacists consider it necessary to contact the prescribers for clarification, completion or correction of the prescriptions before dispensing, and to compare the intervention rates at public pharmacies at hospitals (PPHs) with those at city center pharmacies (CCPs).

METHODS

All attempts to contact the prescriber about a prescription problem were recorded by trained observers (pharmacy students). Analyses were made of overall distribution of problem prescriptions, including data from all 14 participating pharmacies, and a comparison between CCPs and PPHs with data from the 5 areas, each consisting of 1 CCP and 1 PPH (10 pharmacies). Chi-square-analyses were used to compare proportions, Spearman's rank-correlation coefficient was used to test correlation between recorded rates and dispensed volume, and Wilcoxon two-sample test was used to test differences between the CCPs and PPHs. P<.05 is regarded as statistically significant.

RESULTS

The pharmacists contacted the prescribers for 1% of all new prescriptions before dispensing. Errors that may compromise patient safety and medication outcome constituted almost 60% of the problems. However, there was an inverse correlation between the intervention rates and the pharmacy's dispensing volume. Significantly lower rates of problem prescriptions were recorded for women than for men. The highest rates were seen for prescriptions to patients younger than 15 years, and the rates decreased with increasing patient age. Pharmacists at PPHs contacted the prescribers about prescription problems twice as often as those at large CCPs. Pharmacists spent an average of 5 minutes on the telephone to solve the problem (median time), but 25% of the prescriptions took 10 minutes or more.

CONCLUSIONS

Computerized physician order entry (CPOE) and electronically transmitted prescriptions (ETP) can not only reduce the total rate of prescription problems, but also introduce new clinically important errors that may compromise patient safety and medication outcome. The prescription problem rates in the present study differed across prescriber groups and patient age and gender, and the inverse correlation to pharmacy size indicates that all problems are not revealed and corrected and may thus reach the patient. CPOE and ETP have been used extensively in Sweden for the past decade, but the present study indicates that there is still a potential and need for improvement for the vision of "no prescribing errors/problems will reach the patient" to come true.