Developing a framework for inappropriate prescribing in a community pharmacy setting : a risk-based approach

Abstract

Risks from inappropriate use of medicines cause patient harm and adverse drug events. Evaluating risk is important before implementing a prescribing process model, to identify significant aspects required for optimum prescribing to ensure patient safety. The aims of this study were to evaluate different types of medication errors in community pharmacies and assess the frequency and the type of errors. An observational study and pharmacist interviews were conducted in seven community pharmacies selected by convenience sampling. A medication error documentation sheet (MedErr) and interview questions were developed and validated by three pharmacists, one general practitioner and one lay person to evaluate different types of medication errors encountered and assess pharmacists’ perspective on medication errors. Data gathered by the MedErr documentation sheet was analysed using SPSS® version 28. Interview responses were thematically analysed. A focus group was set-up to quantify risks of prescription errors and develop a framework for safer prescribing. A risk priority number, which is the product of severity of consequences and probability of occurrence was given to ten of the medication errors identified. Severity and probability were measured on a 5-point Likert scale, anchored by 1 as the lowest score. From 140 prescriptions implemented within the MedErr documentation sheet, 282 medication errors were found. Error in dose (n=101), wrong quantity and frequency of medications (n=79) and error in naming of drug (n= 61) were the most common errors. From the 20 pharmacist interviews, pharmacists (n=17) confirmed that they have encountered prescription errors and the prescriber was contacted for clarification. Lack of communication between healthcare professionals was named by pharmacists (n=18) as one of the main reasons behind prescription errors. Pharmacists (n=19) believed that improved pharmacist accessibility to patient records and to the prescribing process will result in less prescription errors. Suggestions to reduce inappropriate prescribing included access to online patient records (n=6), e-prescribing (n=6) and improved communication between healthcare professionals (n=5). From ten medication errors presented to the focus group, five of the errors were deemed as high risk (RPN >16) by five or more of the twelve participating members. Pharmacists play a role in identifying prescription errors and are aware that lack of communication between healthcare professionals increases inappropriate prescribing. By studying the risk associated with prescribing errors, strategies to reduce inappropriate prescribing may be implemented through the proposed framework, to improve the prescribing process and patient safety.