The Pharmaceutical Journal Vol 267 No 7160 p188
11 August 2001

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Benefits of recording interventions

Community pharmacists regularly identify prescription errors but most do not routinely keep records of their interventions. Keeping electronic records could both enhance the recognition of the pharmacist’s role and assist in patient care. Appropriate computer programmes for recording such information in the community are needed. Zoë Gross investigates

Community pharmacists regularly make interventions during the dispensing process. However, few actually document their interventions, mainly because of time constraints. Documenting their interventions would provide evidence of the extent to which pharmacists are identifying prescription errors. Ideally, this information should be recorded electronically and could, with the appropriate software, be entered on to individual patient medication records.

Professor Alison Blenkinsopp, professor of the practice of pharmacy, department of medicines management, Keele University, told The Journal that recording interventions would lead to a greater recognition of the pharmacist’s role both by doctors and the general public. Current patient medication recording systems, used in the vast majority of community pharmacies, do not make it easy for pharmacists to record their interventions electronically and keeping paper records is not good practice in the long run, she said. Information technology needed to change quickly to enable electronic recording of interventions. In terms of collecting evidence from recording interventions, she said that a computer system, involving patient medication records, was needed which collated a monthly report of the interventions entered during the month.

Electronic communication

Entering interventions on to patient medication records can also be of benefit to GPs. The Government document “Pharmacy in the future — implementing the NHS plan” says that by 2004 electronic prescriptions will be routine in the community, as well as hospitals, and that by 2008 the transfer of prescription data between pharmacies, GPs and the Prescription Pricing Authority will be carried out electronically in most cases using the NHSnet. By using electronic transfer of information to provide a two-way communication system, perhaps via the NHSnet, GPs would be able access patient medication records held by community pharmacies and look at the interventions that pharmacists may have previously made for a particular patient.

Professor Blenkinsopp said that the use of electronic communication between GP surgeries and community pharmacies would also enable pharmacists to check patient details using electronic patient records held at GP surgeries.

Simon Driver, director of sales of NDCHEALTH, a software and hardware supplier, said that no funding was available as yet for software houses to write software for pharmacists to record interventions. However, there was no reason technologically why such software could not be
developed. He also said that the technology was available for GPs to be able to access interventions recorded by pharmacists on patient medication records.

Andrew Burr, chief executive Primary Care Group Holdings Plc, has been involved in developing software for recording interventions. The software is being piloted in a pharmacy in Staffordshire (PJ, 7 July). The system will enable any community pharmacy to be linked within any primary care trust and provide a link between community pharmacy contractors and primary care pharmacists working in GP surgeries. “It also allows a PCT to tailor an intervention and monitoring service for all aspects of medicines management,” he said.

Value of pharmacy interventions

A study led by Dr Gill Hawksworth, community pharmacist, Mirfield, West Yorkshire, evaluated the value of clinical pharmacy interventions and the degree of professional contact made between community pharmacists and general practitioners during the dispensing process, looking at issues other than legality or clarification of the prescription. Data were collected during a period of one week per month for 12 months from 14 community pharmacies dispensing between 2,000 and 8,000 items per month. During this time, 1,503 interventions were made out of a total of 201,000 new and repeat prescribed items dispensed, an incidence of 75 interventions per 10,000 prescribed items.

A multidisciplinary clinical panel assessing the data identified that between 19 (0.01 per cent of the total items dispensed) and 242 (0.12 per cent) of the interventions made may have prevented a drug-related hospital admission, 71 (0.04 per cent) to 483 (0.24 per cent) interventions could have prevented harm to the patient and 103 (0.05 per cent) to 364 (0.18 per cent) had the potential to improve the efficacy of the intended therapeutic plan. The panel also identified that 748 (0.37 per cent) of the interventions made improved the clinical outcome and could have saved a visit to or by the GP.

Dr Hawksworth’s team say that the interventions were made under the current arrangement of the patient not being registered with a particular pharmacy. However, many of the interventions made were possible because of the use of patient medication records during the dispensing of repeat items, many of which are initiated by the patient using a repeat prescribing system at their GP surgery (British Journal of Clinical Pharmacology 1999;47:695).

Dr Hawksworth told The Journal: “As clinical governance develops it is going to become essential for pharmacists to develop documental procedures for recording interventions.” In her pharmacy a procedure has been set up to record the interventions made during the dispensing process, records of which are sent to a particular GP practice, every three months. Currently this information is being recorded on paper. Dr Hawksworth said that it would be useful to have a computer programme that allowed this information to be recorded electronically.

She further commented that after interventions had been made, patients’ notes held by GP surgeries needed to be amended in accordance with what the pharmacist had done. Pharmacists also needed to have access to patients’ notes held in the GP surgery to assist with making interventions.

John D’Arcy, chief executive of the National Pharmaceutical Association, said that the NPA was keen on pharmacists recording interventions. If pharmacists kept a record of the interventions they made it would lead to a better integration of patient care. He commented that it was, however, difficult practically for pharmacists to keep notes of interventions while undertaking other work in the pharmacy.

He said that pharmacy referral forms were a way of recording interventions and passing this information on to GPs. How-ever, a common platform for sharing information electronically, such as using the NHSnet, was needed. He commented that recording the information electronically in the first place would require patients’ permission.

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Zoë Gross is on the staff of The Pharmaceutical Journal