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Problems dispensing hospital prescriptions in community pharmacy: a survey of primary-care pharmacists
  1. D R P Terry1,
  2. A G Sinclair1,
  3. J F Marriott2,
  4. K A Wilson2
  1. 1Birmingham Children's Hospital (BCH), Birmingham, UK
  2. 2Aston University, Birmingham, UK

Abstract

Objective To identify the experience, opinions and recommendations of pharmacists when dispensing hospital generated prescriptions in community pharmacy.

Methods Descriptive, cross-sectional, prepiloted, self-administered postal survey sent from Birmingham Children's Hospital (BCH) to community pharmacists known to have dispensed hospital prescriptions (HPs) issued by BCH during June 2008 to May 2009 (n=1282). Survey commenced 22nd September 2009 with two reminders if necessary. The 48 point questionnaire included: demographics; experience and opinions concerning problems when dispensing hospital prescriptions; sources of further information and improving existing arrangements. Responses were entered into SPSS v16 for analysis.

Results Response rate of 47.3% (n=607). Length of experience of the respondents working as community pharmacists ranged from 0 to 44 years with median 14 years. Overall approximately 0.3% of prescriptions dispensed or supervised by respondents were HPs, considerably lower than the national average of 0.6% (personal communication). Time to dispense HPs (mean 8.15 min, SD 9.86, median 5 min) was significantly different (p < 0.001) to GP prescriptions (mean 3.37 min, SD 2.86, median 2 min). There is a significant positive correlation (p = 0.002) between the experience of respondents dispensing HPs and the additional time they take to dispense HPs in comparison to GP prescriptions. When asked the question ‘In comparison to an average GP prescription what is the likelihood of problems when dispensing a HP in a community pharmacy?’ 87.4% (n=528) replied more or much more. Commonly reported problems include: illegible prescriptions, unfamiliar drug and missing information on the prescription, for example, quantity. The problems seem unrelated to unlicensed drugs. 61.1% (n=368) believe that there is more risk of error when dispensing a HP compared to a GP prescription. Pharmacists needing further advice were likely or very likely to consult a standard text (84.7%), the hospital prescriber (84%) or the prescriber's support staff (67.3%). The study estimates the frequency of calls to prescribers made by respondents with 1 call for 923 GP prescriptions compared to 1 call for 10.7 HPs: quantifying observations in a published audit.1 Recommended service improvements are (1) include direct contact details of prescriber on prescription forms and (2) ensure prescriptions are printed.

Conclusion Community pharmacists report frequent problems when dispensing HPs and a higher risk of error in comparison to dispensing GP prescriptions. As a consequence average dispensing time is more than doubled for HPs. Calls to HP prescribers are proportionally much more frequent than to GPs. Greater experience of dispensing HPs prompts longer dispensing times for HPs. Recommended service improvements are print prescriptions and include contact details of prescriber on the prescription form.

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