Aim To assess the utility of pharmacy technician pre-screening of discharge prescriptions by reviewing the number of straightforward formulation and dosing changes made during the pharmacist led screening process.

Method A retrospective audit of prescriptions dispensed over a one month period covering Acute Receiving (ARU) and Clinical Decision Units (CDU) in a tertiary paediatric hospital. All completed electronic discharge prescriptions (i.e. screened by a pharmacist and dispensed) were compared with the original electronic prescription completed by the prescriber. Two factors were assessed: changes to formulation (e.g. changing to a preferred strength of liquid), and simple changes to dosing instructions (e.g. adding maximum frequencies or changing to standardised instructions).

Results ARU dispensed 400 items from 142 prescriptions. 163 items were modified (41%) during pharmacist screening. 85 prescriptions (59%) required modification (between 1 and 6 changes per prescription). 62 changes were to formulation (38%) and 101 (62%) were to dosing instructions.

CDU dispensed 199 items from 77 prescriptions. 70 items were modified (35%) during pharmacist screening. 41 prescriptions (53%) required modification (between 1 and 4 changes per prescription). 20 changes were to formulation (29%) and 50 (71%) were to dosing instructions.

Conclusion Medication errors in children are associated with significant harm.¹ Lack of appropriate formulations or choice of incorrect formulation on a discharge prescription can lead to potentially fatal incidents.²

Our audit found that more than half of all prescriptions dispensed during a one month period from one dispensing room in a paediatric hospital required simple modification before dispensing. These modifications do not have to be carried out by a pharmacist. Experienced paediatric pharmacy technicians have the knowledge base to make these adjustments.³ Electronic prescribing allows technicians to make password-protected alterations to prescriptions.

Utilising pharmacy technicians to carry out pre-screening of discharge prescriptions could release pharmacist time, and allow for development of clinical services. There is no clinical pharmacy service provided to either of these clinical areas at present.

The results from the two clinical areas audited are similar, suggesting that the results could apply across other acute care areas within the hospital, although further work would be needed to determine this. An audit would be required after implementation of pre-screening to assess how much pharmacist time (if any) is saved by the pre-screening process.

References

1. Wong ICK, Wong LYL, Cranswick NE. Minimising medication errors in children. Archives of Disease in Childhood 2009;94:161–164.

2. Walsh KE, Kaushal R, Chessare JB. How to avoid paediatric medication errors: a user’s guide to the literature. Archives of Disease in Childhood 2005;90:698–702.

3. Smith L. A day in the life of a paediatric palliative care pharmacy technician. Pharmaceutical Journal 2018;Online:DOI:10.1211/PJ.2018.20205467.