Analysis of community chain pharmacists’ interventions on electronic prescriptions
Terri L. Warholak, PhD, BPharm; Michael T. Rupp, PhD, BPharm
J Am Pharm Assoc (2003) 2009;49:59-64. doi:10.1331/JAPhA.2009.08013


Objectives  To measure the incidence and nature of prescribing errors on electronic prescriptions (e-prescriptions) that required active intervention by dispensing pharmacists to correct.

Design  Descriptive, nonexperimental, cross-sectional study.

Setting  122 chain community pharmacies that met a prior minimum dispensing volume of five e-prescriptions per day in five states during July through September 2006.

Participants  Pharmacists in participating pharmacies.

Intervention  A panel of participating pharmacists reported their medication therapy interventions using a standardized documentation protocol.

Main outcome measures  Number, type, and reason for pharmacist interventions on e-prescriptions.

Results  Results: Data were reported from 68 participating chain pharmacies in five states during 312 work shifts. During the study pharmacists reviewed 2,690 e-prescription orders (new, 83.0%; refill, 17.0%) and took action 102 times for an intervention rate of 3.8%. The rate at which pharmacists identified problems on new e-prescriptions was found to be nearly twice that of refills (4.1% and 2.2%, respectively). The most common reason for pharmacists' interventions on e-prescriptions was to supplement omitted information (31.9%), especially missing directions. Dosing errors were also quite common (17.7%). The most common response by pharmacists to e-prescription problems was to contact the prescriber (64.1%), consult the patient's profile or medication history (12.8%), or interview the patient or the patient's representative (9.4%). In most cases (56%), the e-prescription order was changed and the prescription was ultimately dispensed. In 15% of cases the e-prescription was dispensed as written following clarification by the prescriber. In 10% of cases the prescription was not dispensed. An additional 12% of prescription issues remained unresolved. Pharmacists required an average of 6.07 minutes to conduct their interventions on problematic e-prescription orders, representing an incremental dispensing cost of $4.74.

Conclusion  Electronic prescribing can improve the safety and effectiveness of patient care. As currently implemented in the community practice setting, this still-emerging technology maintains selected threats to both medication safety and effectiveness, although probably less than handwritten prescriptions. The adoption of selected best practice recommendations by prescribers could improve the safety, effectiveness, and efficiency of e-prescribing.

Sign In
APhA Members 
Welcome to JAPhA.org! Please log in below using your APhA username and password. Update your APhA profile.
Not a Subscriber
New to JAPhA? Become an APhA member to receive a full subscription to both the print and online editions.


Register for a FREE limited account to benefit from personalization features such as alerts.


Christensen DB, Campbell WH, Madsen S, et al. Documenting outpatient problem intervention activities of pharmacists in an HMO Med Care. 1981;19:104–17.[PubMed][CrossRef]
Rupp MT, Schondelmeyer SW, Wilson GT, Krause JE. Documenting prescribing errors and pharmacist interventions in community pharmacy practice Am Pharm. 1988;NS28:30–7.
Rupp MT. Evaluation of prescribing errors and pharmacist interventions in community practice: An estimate of “value added.” Am Pharm. 1988;NS28:22–6.[PubMed]
Rupp MT, DeYoung M, Schondelmeyer SW, et al. Prescribing problems and pharmacist interventions in community practice Med Care. 1992;30:926–40.[PubMed]
Rupp MT. Value of community pharmacists' interventions to correct prescribing errors Ann Pharmacother. 1992;26:1580–4.[PubMed]
Dobie RL III, Rascati KL. Documenting the value of pharmacist interventions Am Pharm. 1994;NS34:50–4.[PubMed]
Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing JAMA. 1997;277:312–7.[PubMed]
Schiff GD, Rucker D. Building the electronic infrastructure for better medication usage JAMA. 1998;279:1024–9.[PubMed]
Bates DW, Cohen M, Leape LL, et al. Reducing the frequency of errors in medicine using information technology J Am Med Inform Assoc. 2001;8:299–308.[PubMed]
Bates DW, Gawande AA. Improving safety with information technology N Engl J Med. 2003;348:2526–34.[PubMed]
Oren E, Shaffer ER, Guglielmo BJ. Impact of emerging technologies on medication errors and adverse drug events Am J Health Syst Pharm. 2003;60:1447–58.[PubMed]
King WJ, Paice N, Rangrej J, et al. The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients Pediatrics. 2003;112:506–9.[PubMed]
Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention J Am Med Inform Assoc. 1999;6:313–21.[PubMed]
Colpaert K, Claus B, Somers A. Impact of computerized physician order entry on medication prescription errors in the intensive care unit: A controlled cross-sectional trial Crit Care. 2006;10:R21.[PubMed]
Potts AL, Barr FE, Gregory DF, et al. Computerized physician order entry and mediation errors in a pediatric critical care unit Pediatrics. 2004;113(1):59–63.[PubMed]
Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors JAMA. 1998;280:1311–6.[PubMed]
Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: A prospective cohort study of hand-written and computerized physician order entry in the intensive care unit Crit Care. 2005;9:R516–R521.[PubMed]
Tamblyn R, Huang A, Kawasumi Y, et al. The development and evaluation of an integrated electronic prescribing and drug management system for primary care J Am Med Inform Assoc. 2006;13:148–59.[PubMed]
Teich JM, Merchia PR, Schmiz JL, et al. Effects of computerized physician order entry on prescribing practices Arch Intern Med. 2000;160:2741–7.[PubMed]
Schade CP, Sullivan FM, de Lusignan S, Madeley J. E-Prescribing, efficiency, quality: Lessons from the computerization of UK family practice J Am Med Inform Assoc. 2006;13:470–5.[PubMed]
Aspden P, Wolcott JA, Bootman JL, Cronenwett LR, eds.  Preventing medication errors [prepublication copy; uncorrected proofs]. Washington, D.C.:  National Academies Press;  2006.
Gandhi TK, Weingart SN, Seger AC, et al. Outpatient prescribing errors and the impact of computerized prescribing J Gen Intern Med. 2005;20:837–41.[PubMed]
Devine EB, Wilson-Norton JL, Lawless NM, et al. Characterization of prescribing errors in an internal medicine clinic Am J Health Syst Pharm. 2007;64:1062–70.[PubMed]
Lapane KL, Dube C, Schneider KL, Quilliam BJ. Patient perceptions regarding electronic prescriptions: Is the geriatric patient ready? J Am Geriatr Soc. 2007;2:8614.
Lapane KL, Waring ME, Schneider KL, et al. A mixed method study of the merits of e-prescribing drug alerts in primary care J Gen Intern Med. 2008. 23;442–6.[PubMed]
Rupp MT, Warholak TL. Evaluation of e-prescribing in chain community pharmacy: Best-practice recommendations J Am Pharm Assoc. 2008;48:364–70.
 NCPA-Pfizer Digest 2006. Alexandria, VA:  National Community Pharmacists Association;  2006.
Weant KA, Cook AM, Armitstead JA. Medication-error reporting and pharmacy resident experience during implementation of computerized prescriber order entry Am J Health Syst Pharm. 2007;64:526–30.[PubMed]
Flynn EA, Barker KN, Gibson JT, et al. Impact of interruptions and distractions on dispensing errors in ambulatory care pharmacy Am J Health Syst Pharm. 1999;56:1319–25.[PubMed]
Chisholm CD, Collison EK, Nelson DR, Cordell WH. Emergency department workplace interruptions: Are emergency physicians “interrupt-driven” and “multitasking”? Acad Emerg Med. 2000;7:1239–43.[PubMed]
Mackowiak L, Hayward SL. Issues of decision support in institutional pharmacy systems Pharm Pract Manag Q. 1998;18:35–45.[PubMed]
Leape L, Bates D, Cullen D. Systems analysis of adverse drug events JAMA. 1995;274:35–43.[PubMed]
Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children's hospitals Pediatrics. 1987;79:718–22.[PubMed]
Bates DW, Kuperman G, Teich JM. Computerized physician order entry and quality of care Qual Manag Health Care. 1994;2(4):18–27.[PubMed]
Rupp MT. The impact of e-prescribing on staff productivity in community pharmacy: Part 1 Computer Talk. 2005;25(3):15–22.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Please read the other comments before you post yours. Comments are moderated and will appear on the site at the discertion of the editorial staff.
* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content

Customize your page view by dragging & repositioning the boxes below.

JAPhA Articles
Topic Collections
PubMed Articles
  • Print
  • PDF Download
  • Email
  • Share
  • Get Citation
  • Submit Comment
  • Article Alerts
    Please Wait... Processing your request... Please Wait.
    You must sign in to sign-up for alerts.

    Please confirm that your email address is correct, so you can successfully receive this alert.

  • Letters To Editor
  • Reprints