Background: During the 1980s, manual repackaging of multi-dose medications from pharmacies in Sweden was successively substituted with automated multi-dose drug dispensing (MDD). There are few studies evaluating the consequences of automated MDD with regard to patient safety, and those that investigate this issue are not very extensive.

Objectives: To investigate Swedish health care professionals’ perceived experience of automated MDD and its effects on patient adherence and patient safety.

Methods: Three questionnaire forms, one for physicians, nurses, and assistant nurses/nursing assistants, were developed based on reviews of the literature and pilot testing of the questions in the intended target groups. The target groups were health professionals prescribing or administrating MDD to patients. A sample (every sixth municipality) was drawn from the sampling frame of Swedish municipalities, resulting in 40 municipalities, about 14% of all municipalities in Sweden. Email addresses of general practitioners were obtained from county councils, while the municipalities assisted in getting contact details for nurses, assistant nurses and nursing assistants. A total of 915 questionnaires were distributed electronically to physicians, 515 to nurses, and 4,118 to assistant nurses/nursing assistants. The data were collected in September and October 2012.

Results: The response rate among physicians, nurses and assistant nurses/nursing assistants was 31%, 43% and 23%, respectively. The professionals reported that automated MDD reduces duplication of medication, contributes to correct dosages, helps patients take their medication at the right time, and reduces confusion among patients. Fifteen per cent of the physicians and about onethird of the nurses and assistant nurses/nursing assistants reported that generic substitution makes it more difficult for the patient to identify the various medicines available in the sachets. The physicians did, however, note that prescribing medicine to patients with automated MDD is complicated and can be a risk for patient safety. Both physicians and nurses requested more information on and training in automated MDD. They also asked for more medication reviews.

Conclusions: The professionals generally had a positive attitude to automated MDD with regard to improved medication adherence, but said they believed that the electronic prescribing system posed a safety risk for patients.

Background Physicians, patients and others involved need to have accurate information on patients’ current drug prescriptions available, and have that information protected from unauthorized access. During the past decade, many counties in Sweden have implemented regionally shared medication lists within health care. Objective The aim of this study was to describe physicians’ views on changes in accuracy, availability and confidentiality in the transition from local medication lists to a regionally shared medication list. Setting Health care units in four different counties of Sweden after the transition from local medication lists to a regionally shared medication list. The shared medication list was an integrated part of the electronic health record system in the respective counties, but the system and implementation process varied. Methods Physicians (n = 7) with experience of transition from local medication lists to a regionally shared medication list were interviewed in a semi-structured manner. Main outcome measure: Physicians’ views on changes in information risks, focusing on accuracy, availability and confidentiality. Results The transition from local medication lists to a shared medication list increased the availability of information: from being time consuming or not possible to access from other care givers to most information being available in one place. A regionally shared medication list was perceived as having the potential to provide a greater accuracy of information, but not always: the shared medication list was perceived as more complete but with more non-current drugs. On the other hand, a shared medication list implied an increased risk of violating patient privacy, placing greater demands on IT security in order to protect the confidentiality of information. Conclusion Physicians perceived a regionally shared medication list to increase the availability of information about current prescriptions and potentially the accuracy but may decrease the confidentiality of information. To implement a shared medication list, we recommend providing clear description of responsibilities and routines for normal activities as well as back-up routines, consider IT-security and data protection early, involve patients to improve the accuracy of the list as well as to monitor and evaluate the implementation.

Objective To investigate how many patients, with five or more prescriptions in the Swedish National Prescription Repository (NPR) had received (1) the Medication List (ML) from the electronic medical record and (2) the Prescription List (PL) on prescriptions stored in the NPR and how these lists were used.

Methods Patients> 18 years of age, with five or more prescriptions stored electronically in the NPR, collecting medicines on prescription for themselves at nine pharmacies all around Sweden were interviewed about their knowledge of, and if they had received, the ML, the PL and/or the pharmacy record (PR) on medicines purchased on prescription during the last 15 months, and what documentation they used to track their current, prescribed treatment.

Key findings A total of 777 consensual patients (485 women) were interviewed. Of these, 32% were aware of the ML, but only 13% had received the MLat least once a year, and only 9% used the MLto track their current, prescribed medicines. Virtually all patients (99%) had received the PL at every pharmacy dispensing and 68% said they used the PL as documentation on their current, prescribed medicines. 52% used the dispensed packs to track their medication and 10% said they used a handwritten list. Only few patients were aware of the PR.

Conclusion Our study shows that patients’ access to information on their prescribed medicines is not in accordance with intentions in health care. The risk for errors in medicine use at home is substantial.

Purpose To study discrepancies between (i) the prescribed current treatment stated by patients with congestive heart failure (CHF) compared with patients with other chronic diseases, (ii) the data in the medication list (ML) in the electronic medical record and (iii) the data in the prescription list (PL) on the prescriptions stored in the national prescription repository in Sweden, to determine current, noncurrent, duplicate and missing prescriptions.

Methods At one healthcare centre, a random sample of patients 18 years and older with a diagnosis of CHF, diabetes mellitus (DM) or osteoarthritis (OA) provided written informed consent to participate. Participants were interviewed by telephone on the prescribed current treatment.

Results Of 161 invited patients (61 CHF, 50 DM and 50 OA), 66 patients were included. More than 80% of the patients had at least one discrepancy, a noncurrent, a duplicate or a missing prescription, in the ML and PL. The overall congruence for unique prescriptions on current treatment between the ML and the PL was only 55%. Patients with CHF had overall more discrepancies and patients with DM fewer discrepancies in the ML.

Conclusions Prescriptions for noncurrent treatment, duplicates and missing prescriptions are common in both the ML in the electronic medical record and the list on prescriptions stored in the Swedish National Prescription Repository. Patients with CHF had more discrepancies in the ML. The risk for medication errors in primary care due to incorrect information on prescribed treatment may be substantial.

Background

Evidence suggests that prescription intervention frequencies have been found to vary as much as 10-fold among Norwegian pharmacies and among pharmacists within the same pharmacy.

Objective

To explore community pharmacists' perceptions of how their prescription intervention practices were influenced by their working environment, their technological resources, the physical and social structures of the pharmacies, their relations with colleagues, and to the individual pharmacist's professional skills.

Methods

Two focus groups consisting of 14 community pharmacists in total, from urban and rural areas in Norway, discussed their working procedures and professional judgments related to prescription interventions. Organizational theories were used as theoretical and analytical frameworks in the study. A framework based on Leavitt's organizational model was to structure our interview guide. The study units were the statements of the individual pharmacists. Recurrent themes were identified and condensed.

Results

Two processes describing variations in the dispensing workflow including prescription interventions were derived—an active dispensing process extracting information about the patient's medication from several sources and a fast dispensing process focusing mainly on the information available on the prescription. Both workflow processes were used in the same pharmacies and by the same pharmacist but on different occasions. A pharmacy layout allowing interactions between pharmacist and patients and a convenient organization of technology, layout, pharmacist-patient and pharmacist-coworker transactions at the workplace was essential for detecting and solving prescription problems. Pharmacists limited their contact with general practitioners when they considered the problem a formality and/or when they knew the answers themselves. The combined use of dispensing software and the Internet was a driving force toward more independent and cognitively advanced prescription interventions.

Conclusion

Implementation of a general organizational model made it easier to analyze and interpret the pharmacists' intervention practices. Working environment, technology, management and professional skills may all contribute to variations in pharmacists' prescription intervention practices in and between community pharmacies.

Thirty percent of the prescriptions in the EMR and one fourth of all prescriptions in the NPR were either non-current treatment or prescription duplicates. The present data show that printouts of the prescriptions in both the EMR and the NPR contain many errors. Printouts may be confusing and if patients are not fully aware of their prescribed present treatment, medical errors may occur. The problem may be aggravated by generic substitution

Background and objective Patient adherence to prescribed treatmentfor chronic conditions has been estimated to be on average about 50%(1), drug related problems may cause as much as 30% of acuteadmittances to hospital care (2), and the costs have been estimated tobe of the same magnitude as the direct costs for pharmaceutical drugs.A reason for lack of adherence to the treatment and medication errorsmay be that patients with many drugs, especially when changes in thetreatment have occurred, may have knowledge gaps on the drugsrepresenting the actual prescribed treatment.

E-prescribing, from the physicians’ electronic medical record(EMR) directly to the pharmacies, constitute[75% of all prescriptionsin Sweden and [70% of patients in Sweden store theirprescriptions electronically at the national prescription repository(NPR), accessible from any pharmacy in Sweden. Any new e-prescriptionwill automatically be stored in the NPR.However, the NPR may contain both prescriptions for the present,actual treatment, prescription duplicates, and prescriptions for previous,terminated or changed treatment. For patients with manymedications and/or many changes in the treatment it is obvious thatthe risk for medication errors is increased.The objective of the present study was to compare the prescribedtreatment in the EMR, the prescriptions in the NPR, and patient’sknowledge of her/his present prescribed treatment.Design Compare prescribed treatment in the EMR with the prescriptionsin the NPR, and patients knowledge of her/his presentprescribed treatment with regard to prescriptions; prescribed drug,strength; formula and dosing.Setting Ten HCCs in four cities in Sweden, February 2010.Main outcome measures Differences between the computerisedpatients health care journal record and the prescriptions in the NPR,and patients view of her/his actual present prescribed treatment withregard to prescriptions; prescribed drug, strength; formula and dosing.Results The results are available in March 2010.Conclusions Conclusion.

References1. Adherence to long-term therapies: evidence for action. WHO,2003.2. Fryckstedt J, Asker-Hagelberg C. Drug-related problems commonat the medical acute care clinic—the cause of admission foralmost one-third of patients. [Läkemedelsrelaterade problemvanliga på medicinakuten - Orsak till inläggning hos nästan vartredje patient, enligt kvalitetsuppföljning] Läkartidningen 2008;105(12–13): 894–898.