Investigating feasibility of clinical validation of repeat homecare prescriptions by an accredited checking technician (ACT) at Sheffield Teaching Hospitals (STH)
Authors: Shadrokh-Cigari M S F , Hamilton N D , Jogia C , Jamieson H 
Published: November 2024

Introduction

The Hackett report (Hackett, 2011) recommended that all NHS homecare prescriptions are clinically validated by a pharmacist prior to transfer to homecare delivery providers. The recent RPS professional standards for homecare evolved this, such that the validation may be undertaken by any competent healthcare professional (Mulford, 2024). Other regional Trusts have standard operating procedures (SOP) facilitating repeat (defined as a continuation of previous treatment, dose, frequency and formulation) homecare prescription validation by Accredited Pharmacy Technicians (ACT). In 2023, of 4979 of 5790 (86%) dermatology and rheumatology homecare prescriptions were repeats. Validation of these represents a significant workload for pharmacists, whilst not optimising their clinical expertise.

Aim

We aimed to assess the clinical risk and patient safety concerns associated with validation of repeat homecare prescriptions by ACTs, as supported by new RPS standards.

Methods (including an ethical approval statement)

The ACT screened repeat prescriptions in accordance with the STH clinical validation SOP for a 6-week period, between April and May 2023. Anonymised data from all prescriptions was recorded by the ACT, including time taken, number and nature of errors identified. In this study, errors were defined as any omission or discrepancy relating to demographic, clinical or pharmaceutical information. The pharmacist undertook a blinded second validation of each repeat prescription checked by the ACT and findings were compared.

The study did not require ethical approval as ACT validation was an additional step and all prescriptions were subsequently validated by the pharmacist before dispensing , meaning there was no deviation to standard practice.

Results

613 prescriptions were screened, of which 529 (86.3%) were repeats. A total of 33 errors were identified on 33 prescriptions by both the ACT and the pharmacist. The same errors were flagged by both. These errors were categorised as clinical 27 (82%), demographic 3 (9%), and pharmaceutical 3 (9%).

Discussion and Conclusion (including study limitations)

There were no additional errors identified by the clinical pharmacist, showing there was no added benefit from a pharmacist check. The implication is for improved skill mix, more rational and effective use of staffing resources and further development of the ACT role. Freeing pharmacist time to focus on prescribing or other clinical duties could have additional benefits for patients. It should be noted that all homecare prescriptions are generated in Microsoft Word templates, meaning that the utilisation of an electronic prescribing system capable of pre-filling data into fields has the potential to reduce the instances of clerical errors. 15 of the 33 errors (45%) could be rectified by the ACT without seeking input from the prescriber.

Limitations

Not all prescriptions in the 6-week study period could be included due to staff availability; those flagged as clinically urgent were processed outside the project to avoid delay.

References

1. Mulford H. RPS Professional Standards for Homecare Services 2024 [Internet]. O’Sulivan C, editor. Royal Pharmaceutical Society; 2024 [cited 2024 Jun 7]. Available from: https://www.rpharms.com/

2. Hackett M. Homecare Medicines Towards a Vision for the Future [Internet]. www.gov.uk. Michael Howarth; 2011 Nov [cited 2024 Jun 7] p. 111. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213112/111201-Homecare-Medicines-Towards-a-Vision-for-the-Future2.pdf