The introduction of electronic prescriptions has improved patient accessibility to medication and reduced the administrative burden on pharmacies related to faxed or emailed prescriptions.
Most pharmacies now successfully operate a hybrid dispensing workflow that incorporates both electronic and paper-based prescriptions.
Despite the benefits of electronic prescriptions, mistakes can still be made if the correct dispensing processes are not followed. As such, the PDL Professional Officers continue to see incidents involving electronic prescriptions which generally fall into one of the following three categories:
1. Privacy and confidentiality breaches
This can occur when an electronic prescription repeat token is inadvertently sent to the wrong phone number or email address.
To avoid this:
- Ensure that your prescription intake process includes confirmation of the patient’s preferred method of receiving their repeat token and verifying their mobile number or email address is up to date.
- When scanning and dispensing the electronic prescription token, take note if the dispensing software prompts you of differences between the patient contact details on file and those on the downloaded script. Do not automatically assume or override these details unless you have checked with the patient prior to proceeding.
To mitigate this:
- When handing out and counselling the patient about their medication, check that the electronic prescription token has been received to their email address or phone number. If the token has been sent incorrectly, cancel the dispensing and re-dispense to generate a new electronic prescription repeat token and then send it to the correct phone number/email address. This does not apply in some jurisdictions for S8 repeat tokens as they must remain under the control of a pharmacist.
2. Dispensing errors
Whilst dispensing electronic prescriptions is less likely to lead to an administrative error compared to manual entry of a paper prescription, it is still essential to ensure that electronic prescriptions are checked against the legal prescription thoroughly and systematically as you would a paper prescription.
To avoid dispensing errors with electronic prescriptions:
- Check that the medication selected in the dispense software matches the full legal version of the downloaded electronic prescription. The dispense system may default to the active ingredient format which requires the dispenser to select from a list of medicines containing the active ingredient with a range of strengths.
- Confirm that the directions match those on the downloaded prescription and the prescriber’s intentions and that they make sense. Noting that prescriber shorthand may be different to the dispense software shorthand (sig) in your dispense system.
- Check the labelled product against the full legal version of the downloaded electronic prescription. Take note that a printed token is not a legal prescription and does not include essential information required to adequately dispense and check the prescription.
- Ensure that the downloaded electronic prescription has been checked for annotations. If you are not sure where to find annotations for electronic prescriptions, check with your dispensing software provider. PDL Professional Officers have seen serious incidents where staged supply directions have been missed as the annotation field of the electronic prescription was not checked. In some instances, the full quantity of medication was supplied, and the patient subsequently overdosed.
- Complete a clinical assessment of the final labelled product. Pharmacists are responsible for ensuring that every medication dispensed is safe and appropriate for the patient. A final clinical assessment may detect prescribing or dispensing errors.
3. Patient complaints
- There have been cases of patient complaints due to pharmacies not issuing repeat tokens of electronic prescription to their patients. Please note that pharmacists should always issue a repeat token to their patient via their chosen method (email, SMS or printed token), unless the prescriber has indicated the medicine is to be supplied in stages from a particular pharmacy, in the case the pharmacist’s assessment determines there is significant risk of harm or consequence from the return of the repeat token, or there is a legislative requirement to retain the repeats at the pharmacy.
- In the case of Active Script List (ASL), the patient does not require a repeat token to be issued, however if the patient specifically requests that you send them one you must oblige with their request. This does not apply in some jurisdictions for S8 repeat tokens as they must remain under the control of a pharmacist. Pharmacists will need to ensure patients understand the legal requirement for retention of the repeat prescription at the pharmacy prior to the initial dispensing occurring, if applicable in their location. A pharmacist may organise transfer of a retained S8 repeat prescription, including a token, directly to another pharmacy as per their jurisdiction’s poisons legislation.
- There are cases reported of pharmacies attempting to register their patients for an ASL without the patients’ knowledge or consent, which is an unacceptable use of the system.
- Patient complaints have resulted when repeat prescriptions on a patient’s ASL were used to mark off an owing prescription without their knowledge. The patient then went to a different pharmacy to try and fill their repeat prescription, without realising that they had no repeats left. The key here is to always communicate with your patients and discuss with them if you need to use repeat tokens from their ASL to mark off an owing prescription.
Further information
If a pharmacy experiences technical issues with electronic prescriptions and their dispensing software, it is recommended that the pharmacy contact their software provider for assistance. However, if the software provider is unable to resolve the technical issues, a pharmacy can contact the Australian Digital Health Agency via the ‘Contact us’ form.
Useful resources
- CPD-accredited webinar ‘Digital Health Update – Responding to issues, incidents and patient queries’, available via the AJP and supported by PDL
- Free CPD-accredited eLearning modules on electronic prescriptions and ASL
- On-demand webinars available via the Australian Digital Health Agency
For immediate advice and incident support, call PDL on 1300 854 838 to speak with one of our Professional Officers. We are here to support our pharmacist members 24/7.
Article last updated on 31 January 2024
