Operation Watchdog

[Pharmanaut]

This is a long post so get a nice hot drink and a biscuit and settle down.
Dispensing Error Reduction

There is an upward pressure on dispensing rate due to the sheer numbers of prescriptions being handled. Is this related to the number of potential dispensing errors? (OK you'll say 'Where's the evidence - reply - come off it!)

One of the key factors in spotting errors is the time needed for the trained eyes and mind to focus on an the drugs etc ordered on a prescription the possible rationale behind them and the dispensing process that has produced the finished work for checking.
A new pressure is about to be unleashed on the profession in the form of the electronic prescription.
Theoretically, this prescription would be perfect when it leaves the Prescribing System and arrives in the pharmacy where it is decoded and presented for dispensing, avoiding a lot of the re-keying of information.
However, the act of handling the information on paper switches the brain into processing mode. Transposing the information from the paper prescription into the pharmacy system is not just a re-keying exercise because the information is being read, passing through someone’s brain and is being typed out again. This is part of, well, let's call it the interpretation phase. Even reading the script as you are walking from the front desk to the dispensing bench gives you time to read and think.
While entering the prescription details the pharmacy staff are checking the PMR, so any inconsistencies if the prescription is a repeat, can be identified. Also if the prescription for an acute medication or a drug that is replacing an existing treatment that can also be identified.
OK, so you know the process and get the idea.

Here’s what I’m getting at.
When the first GP systems were installed, the original patient records were transferred to the computer along with all the subtle problems. These problems are perpetuated in the process and the pharmacy generally sort them out from notes attached to the PMR. The subtle problems are not likely to be removed just because there is a change from a paper prescription to an electronic message. What will happen though is that we will be swept along by the electronic systems to try to work at the same speed as them, which will put pressure on the ‘interpretation phase’ of dispensing. There will be other factors that will put pressure on this. We all know that the public do not think that there should be a moments wait in the pharmacy at any time, etc etc.
At the same time the dynamic of the workforce has changed from proprietors or permanent management who had memory of most of their patients medication, to pharmacies run on locums, or in the case of 100 hour pharmacies, shifts of locums who may despite their good intentions not forge a personal relationship with the patients, their medicines, carers or doctors.

Now to the point (at last!) – here’s where you can help.
There are a lot of things that can be done to reduce medication errors. These can be the prescribing problems that escape from the GP surgery and the errors that can be introduced in the dispensing process itself. Some of the measures are procedural in the pharmacy, but the main ones sought by this posting are related to the computer itself. The idea is that the computer system has a “watchdog” component that is sensible enough to recognise it’s friends but barks when someone else comes along.
What measures could be added to the pharmacy system to reduce the number of prescribing related errors and dispensing related errors?

To get you going - here's one to start.
Ok, so the watchdog analogy is getting a little tedious...
If a drug is entered that a patient has not had before then the dog barks.
Similar with strength and dosage.
If all is correct the dog is trained that this is what to expect in the future, so it does not bark the next time if it sees the same.


Well that's it. If you have any suggestions please pass them on.

[Linnear]

Originally Posted by Pharmanaut

To get you going - here's one to start.
Ok, so the watchdog analogy is getting a little tedious...
If a drug is entered that a patient has not had before then the dog barks.
Similar with strength and dosage.
If all is correct the dog is trained that this is what to expect in the future, so it does not bark the next time if it sees the same.


Well that's it. If you have any suggestions please pass them on.

How about barking if there are children stuck down a well?

Seriously, though. Sounds good. We need something, this whole ETP thing fills me with dread. Hence the letter to the journal several weeks ago.

[admin]

Originally Posted by Linnear

How about barking if there are children stuck down a well?

Seriously, though. Sounds good. We need something, this whole ETP thing fills me with dread. Hence the letter to the journal several weeks ago.

This area also worries me. Some of the pharmacies I work at have scripts just flying by my face all day long, and the typing and labelling of scripts at least slows this process down a little bit. It's already just like working on a production line, except it's your neck on the block, so I hate to think how it will feel when this all gets going.

Thanks for the update Pharmanaut.

[Pharmanaut]

Originally Posted by Linnear

How about barking if there are children stuck down a well?

Seriously, though. Sounds good. We need something, this whole ETP thing fills me with dread. Hence the letter to the journal several weeks ago.

Best Australian 'ocker accent...
Nah mate it's that little roo' from over at the Hammond place called Skippy that comes and tells ya' if there's kids down the well.

[Pharmanaut]

Originally Posted by admin

This area also worries me. Some of the pharmacies I work at have scripts just flying by my face all day long, and the typing and labelling of scripts at least slows this process down a little bit. It's already just like working on a production line, except it's your neck on the block, so I hate to think how it will feel when this all gets going.

Thanks for the update Pharmanaut.

Frightening isn't it.

Please remember to post your suggestions.
I've asked around some colleagues already and the list is growing.
How it works is not as important now. At this stage it's what we want it to do.

I'll put all the collated list of all the suggestions up on the site in a couple of weeks.