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Earlier in 2019, electronic prescribing of Schedule 2 and 3 Controlled Drugs (CDs) was introduced at prescribing and dispensing sites across England. This important step in healthcare technology has raised many issues for community pharmacy teams on the implications of including a group of medicines into the Electronic Prescription Service (EPS), which already pose numerous and significant legislative and patient safety considerations.
An increase in electronic prescribing, to include Schedule 2 and 3 CDs, (also known as EPS Phase 4) results in the obvious environmental advantage of saving paper as well as saving valuable NHS time and resources spent in processing, storing and submitting paper prescriptions. In addition, NHS Digital has anticipated that EPS Phase 4 will improve security, due to fewer “lost prescriptions” and increase patient safety and convenience, particularly for those who had not chosen EPS because they were still receiving paper prescriptions for Schedule 2 and 3 CDs.
However, it is important to consider the wider implications of this significant step – at a practical level, what is the real impact on community pharmacy teams and patient safety?
In general, EPS can improve flexibility for patients obtaining urgent prescriptions; however a face-to face consultation prior to supply of CDs is considered best prescribing practice. The advent of EPS Phase 4 may result in prescribers consulting and prescribing Schedule 2 and 3 CDs remotely, particularly in urgent situations and where there is no personal knowledge of the patient or access to the primary care record. This may present patient safety concerns, especially in clinical areas such as dosing in palliative care and paediatric patients.
"The use of technology in healthcare has the potential to strengthen relationships amongst healthcare professionals and transform patient safety"
The accessibility and convenience of EPS for patients means that the number of patients and/or their representatives collecting their prescription from their nominated pharmacy outside of GP practice hours is likely to increase. This can present notable burdens for community pharmacy teams, for example:
• Legislative –EPS prescribing systems are optimised to ensure prescription writing requirements are met, however, with EPS Phase 4 still in its teething stages and changes in CD classification of certain medicines, prescriptions for Schedule 2 and 3 CDs may not always comply with CD writing requirements. Legally invalid EPS prescriptions cannot be amended by the pharmacist; outside of GP practice hours patients will need to obtain a new prescription. This may present clinical concerns for at-risk patients and issues of workforce pressure for community pharmacy teams facing backlash for a situation that is outside of their control; again, impacting patient safety.
• Operational – EPS Phase 4 is still in its early stages; although organisations are expected to have updated their standard operating procedures, smaller community pharmacies facing workforce issues such as staff shortages and lack of locum pharmacist continuity, may not have completed this step, leaving pharmacy teams dispensing EPS prescriptions for Schedule 2 and 3 CDs in the dark and patient safety at risk.
• Technical – EPS significantly reduces the amount of time pharmacy teams spend in data entry and producing labels, however, in the event of a break in telecommunications systems and/or electricity outage, EPS may not be available. Patients collecting EPS prescriptions for Schedule 2 and 3 CDs will need to obtain a new paper prescription which can be dispensed by alternative methods.
The use of technology in healthcare has the potential to strengthen relationships amongst healthcare professionals and transform patient safety. However, technology systems currently used in health and social care are far behind what is required for this to take shape.
“Open standards, secure identity and interoperability are critical to the safe and successful use of technology, ensuring that systems talk to each other and that the right data gets to the right place at the right time”
As Director of Pharmacy at the NPA and Medication Safety Officer, my aim is to provide the support and practical guidance that community pharmacy teams need to address the issues they face whilst keeping patient safety a priority during these challenging and changing times.