Mail-Order Prescriptions Requiring Clarification Contact With the Prescriber: Prevalence, Reasons, and Implications

Abstract

BACKGROUND: Prescription review by pharmacists prior to dispensing is an important step in an overall strategy for preventing medication errors. Contacts with prescribers may be required to clarify missing, unclear, or inconsistent information. While essential to reduce the likelihood of potential patient harm, clarification contacts are time-consuming for pharmacists and prescribers. The scope of the issue and the factors that contribute to it are not well understood.OBJECTIVE: To quantify the frequency of contacts with prescribers that were necessary to obtain clarification of prescriptions and to identify the factors that made these prescriber contacts necessary.METHODS: An analysis was conducted involving new prescriptions received by a national mail-order pharmacy that required clarification contacts with prescribers for quality reasons (i.e., those potentially impacting the accuracy of dispensing). Excluding refills and renewals, the percentage of new prescriptions requiring clarification contacts was calculated and categorized by incoming delivery channel (mail, fax, telephone, etc.). The quality problems that prompted these contacts were categorized according to the problem identified.RESULTS: Among the total of 295,378 new prescription orders received during the 1-week study period (from April 7 to April 13, 2002), 8.7% contained quality problems that necessitated clarification contact with prescribers. Prescriptions received by fax transmission and mail were most likely to require clarification as compared with direct telephone conversation and miscellaneous (including electronic) channels. Among prescriptions that required a clarification contact for quality problems, an average of 2.4 problems per prescription was observed. The most common problems were: directions unclear or missing (24.3%); refill quantity unclear, missing, or incorrect (24.3%); dosage unclear (20.2%); drug name or strength unclear (13.2%); missing physician or patient data (11.4%); and missing prescriber signature (3.2%).CONCLUSION: Prescriber clarification contacts are frequently needed to reduce the potential for medication error in the current prescription fulfillment process. While these contacts are necessary to clarify data elements essential to accurate medication dispensing, they are time-and resource-intensive. These study results suggest that alternate prescription order channels, including electronic, could reduce the sizable burden of prescription order clarification in mail-order pharmacy.

Assessment of ePrescription quality: an observational study at three mail-order pharmacies

“…The proportion of prescription errors seen in other studies varies between 0.9% and 8.7%. The largest value was detected at a mail-order pharmacy [23,31-35]. The reasons for this wide range of percentage values may include differences in definitions, methodology, culture, legislation and the technical solutions available.…”

“…Pharmacies in Sweden do not have access to automated software for prospective drug utilization reviews (pDUR). For example, drug interactions and contraindications [23-25]. All prescriptions in the present study were manually examined by the pharmacists.…”

Intoxication with Trazodone Caused by Dirty Facsimile Machine

“…Faxing prescriptions is an appreciated service for immobile patients, but this case demonstrates that this may introduce another cause of error in drug delivery. Prescriptions received by facsimile transmission and mail have been shown to be the most likely to require clarification by pharmacists before dispensing 3 . This case illustrates the continued importance of a pharmacist carefully judging whether a (handwritten) prescription is readable and understandable and whether the dose is correct and if not conferring with the prescribing physician to ascertain that the interpretation of the prescription is in accordance with the intentions of the prescriber.…”

A long-term follow-up evaluation of electronic health record prescribing safety

“…2 36 Notably, although the errors targeted by our methodology have lower potential for patient harm, these errors lead to tremendous inefficiencies for providers, patients, and pharmacies and frequently result in clinically significant delays for patients in receiving medications. [37][38][39] For example, a study evaluating pharmacy callbacks found that callbacks for 'acute' medications, defined as medications where administration delays could lead to worsening of a medical condition or cause prolonged pain, were not resolved on the same day 34% of the time. 37 A more recent study focusing exclusively on e-prescriptions from 68 pharmacies found that pharmacists had to intervene on prescriptions 3.8% of the time, resulting in 10% of prescriptions not being dispensed.…”