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Receptionists help keep repeat prescribing safe

Louise Prime

Friday, 4 November 2011

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Generating repeat prescriptions through electronic prescribing systems can lead to dangerous errors, but general practice receptionists often intervene to improve patient safety, shows research published today on bmj.com.

Researchers investigated in detail, repeat prescribing systems in four very different UK general practices, aiming to identify potential threats to patient safety and characteristics of good practice.

Over several months they shadowed 25 doctors, 16 nurses, four healthcare assistants, six managers and 56 reception or administrative staff, for a total of 395 hours. They compared the practices’ formal protocols for repeat prescribing, with how staff understood how it ought to be done, and with how they actually acted.

The study authors found that gaps often existed between how repeat prescribing ‘should’ have been done according to protocols, and how it worked in practice.

They found that over-reliance on electronic health records for repeat prescribing could affect its quality and safety – but that reception staff often drew on their own knowledge and experience to make ‘practical judgements’ to get over disparities between protocols and reality, which helped to protect patients from errors. However, the prescribing clinicians were often unaware of such interventions by staff.

The researchers concluded: “Reception and administrative staff make important ‘hidden’ contributions to repeat prescribing in general practice. Although not formally accountable for prescriptions signed by doctors, these staff consider themselves informally accountable to patients for the quality and safety of these contributions.”

Anthony Avery, professor of primary healthcare at the University of Nottingham Medical School, said in his linked editorial: “It seems reasonable to encourage well trained receptionists to use their initiative in repeat prescribing, but practices need to ensure that members of staff do not step beyond their levels of knowledge and competence.

“A major worry is that any mistake made by a receptionist when issuing an unauthorised prescription is at risk of being signed off by the general practitioner. However, despite concerns raised in the literature, there is little evidence that the high levels of autonomy and engagement shown by some receptionists is a cause for concern.”

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