E-prescription errors and their resolution in a community compounding pharmacy.

Despite apparent benefits, electronic prescribing systems still face numerous challenges. Errors associated with electronic prescriptions can often lead to workflow disruptions. This may be particularly disruptive in smaller, independent community pharmacies that may not have the staffing resources to adequately cope with an increase in required correspondence with prescriber offices. The objective of this study was to follow-up on a 2012 quality-improvement project evaluating electronic prescription error type, error rate, and time between error discovery and resolution in an independent compounding pharmacy. The study design was quality improvement with descriptive data. Data were collected over a four-week period during which time the pharmacists completed a data collection form for each electronic prescription received that contained an error. Percentages were calculated for error type, error rate, and error resolution type. Using range, mean, and standard deviation, time until error resolution was reported. In the four-week study period an e-prescribing error rate of 23.2% was identified (32 errors identified in 138 e-prescriptions). The most frequent error was an invalid electronic prescription signature for a controlled substance (31.3%, n = 10). The most commonly used error resolution method was a phone call to the physician (59%, n = 19). The average time to resolve the most frequent error type was 10.30 hours with a standard deviation of 18.18 hours. The results show a 40% decrease in the number of e-prescription errors identified compared to the quality-improvement evaluation done in the same pharmacy one year ago. E-prescription errors continue to disrupt workflow and impede patient care but perhaps at a lower rate. Pharmacies should implement a quality-improvement review process to help identify solutions to systems issues.

E-prescribing errors identified in a compounding pharmacy: a quality-improvement project.

Errors during the prescribing process can cause problems for patients. When the pharmacist intercepts a prescribing error, it can cause a delay, as the patient may not receive the medication until the problem is resolved. Electronic prescriptions are purported to reduce prescribing errors. However, studies have shown that electronic prescriptions can be prone to certain types of errors. Compounding pharmacies may present an additional obstacle for e-prescribing, as the prescribed medications are not commercially available and may not be listed in the e-prescribing software. The objectives of this study were to estimate the electronic prescription error rate in a compounding pharmacy, determine the most common error types, list the most common interventions pharmacists made, and estimate how long it took to resolve these errors. The study design was quality improvement with descriptive data. During the four weeks of data collection, the pharmacists were trained to complete a standardized data collection form when they identified an electronic prescription error. Percentages were calculated for new prescriptions, electronic prescriptions with errors, error types, and error resolution methods. In the four-week period of the study, there were 982 new prescriptions, 111 of which were electronic prescriptions. Of those 111 electronic prescriptions, 70 had errors. The electronic prescriptions error rate was 63%. The most common type of error was wrong entry field (70.3%). For this project, wrong entry field was defined to mean that the drug name was in the wrong field (81%) or that multiple entries were in the wrong field (7%). Pharmacists usually used their own judgment to resolve an error (67%). Many e-prescription errors were identified in this compounding pharmacy. When prescription errors happen, workflow and patient care are disrupted. Our goal is to discuss these findings with Surescripts and e-prescribing software companies to seek systems-based solutions.

Applications and sterility of autologous serum eye drops.

Severe dry eye syndrome can adversely affect a patient's quality of life. When preservative-free artificial tear solutions are not adequate to reduce symptons, the patient's own serum can be compounded into eye drops that improve the ocular surface. The aim of our study was to test the sterility of autologous serum eye drops in refrigerator conditions for up to 30 days and in freezer conditions for up to 180 days. It was determined that sterility was maintained throughout this period.

Prevention of preterm delivery with compounded 17a-hydroxyprogesterone caproate.

17a-hydroxyprogesterone caproate is a naturally occurring metabolite of progesterone that is produced in significant quantities during pregnancy. The demand for 17a-hydroxyprogesterone caproate, the lack of a commercially available manufactured form approved by the US Food And Drug Administration, and publication of the results of a large trial to determine the effectivenss of the drug in the prevention of preterm delivery have spawned an increased interest in compounded formulations of the drug. The demand also has necessitated a review of the available literature and of past clinical studies, and a look at present and planned studies. Owing to the importance of this drug in pregnancy and the need for safety, accuracy in potency, and sterility in an intramuscular injection (the most common route of administration), compounding pharmacies must be in compliance with the United States Pharmacopeia Chapter 797 standards should they wish to compound this formulation.

Patient satisfaction with pharmacist intervention and consultation in hormone replacement therapy: an update.

The purpose of this study was to assess whether the satisfaction of women who took part in the pharmacist-administered bioidentical hormone replacement therapy consultation service at an urban compounding pharmacy has improved since implementation of a follow-up call program. A questionnaire was mailed to 200 randomly selected women who completed hormone replacement therapy consultation and received all three follow-up calls from the pharmacy during the period from July 22, 2003, to April 22, 2004. The returned surveys were tabulated and analyzed, and independent t-tests were used to compare data collected in 2001 with that collected in 2004 on questionnaire items of interest. Of the 200 surveys sent out to patients, 125 were returned completed (a response rate of 62.5%). Over 50% of the respondents heard about the hormone replacement therapy program through referral from their healthcare provider, and 34.4% from a friend or a relative. A large majority (95.9%) of the respondents either agreed or strongly agreed that the follow-up calls were helpful; however, only 73.8% felt comfortable discussing their concerns with student interns, who were responsible for making the follow-up calls. Most (95.2) of the respondents reported no new health conditions since initiation of natural hormone replacement therapy. The t-tests revealed improvement in patient satisfaction items between 2001 and 2004, indicating that patient satisfaction with the consultation service improved from 2001 to 2004, and most of the differences were statistically significant (P less than 0.05). The survey results also showed that participants were happy about the follow-up calls, which perhaps contributed to the increase in satisfaction.