Receptionists and administrative staff in UK general practices make important 'hidden' contributions to repeat prescribing, concludes a study published on bmj.com today.
It finds that over-reliance on electronic health records can affect the quality and safety of repeat prescribing, but that reception staff often use "practical judgments" to help bridge the gap between formal prescribing protocols and the complex reality of the repeat prescribing process.
The findings highlight the need to ensure that training in repeat prescribing goes beyond technology to help safeguard patients, say the authors.
Repeat prescriptions account for up to three quarters of all medication prescribed and four fifths of medication costs in UK general practice and repeat prescribing has long been recognised as a significant quality and safety concern.
It is often assumed that electronic records make repeat prescribing safer by reducing human error. However, some suggest it may introduce technology-related errors.
So researchers at Queen Mary, University of London analysed how doctors, receptionists and other administrative staff contributed to, and collaborated on, repeat prescribing routines at four UK general practices.
The aim was to identify potential threats to patient safety and characteristics of good practice.
They found repeat prescribing to be a complex, technology-supported social practice, requiring collaboration between clinicians and administrative staff.
They also found that a "model-reality gap" exists between formal prescribing protocols and the real time activity of repeat prescribing, but that staff often bridge this gap by making "practical judgments" which helped to safeguard patients.
This work was creative and demanded both explicit and tacit knowledge, although clinicians were often unaware of this input, say the authors.
In conclusion, reception and administrative staff make important 'hidden' contributions to repeat prescribing in general practice, they write. Although not formally accountable for prescriptions signed by doctors, they consider themselves informally accountable to patients for the quality and safety of these contributions.
Studying technology-supported work routines opens up a relatively unexplored agenda for patient safety research, they add.
"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," writes Professor Anthony Avery from the University of Nottingham Medical School in an accompanying editorial.
There is little evidence that the high levels of autonomy and engagement shown by some receptionists is a cause for concern, he adds. Nevertheless errors do occur in the repeat prescribing process and he calls for further research to find out why.