Have you ever seen a medicine handed to the wrong patient? Or uncovered a dispensing record logged on the wrong patient profile?
Patient identification errors can have serious health consequences; either at the time the error occurs, or in the future when health records are relied on to make treatment decisions.
To improve patient safety, the date of birth (DOB) of every patient must be included on all prescriptions for Schedule 4 and Schedule 8 medicines in NSW from this week (1 November 2022). This includes handwritten and computer-generated prescriptions.
While DOB was already required for electronic prescriptions, the decision to extend the regulation to all prescriptions was made from a safety perspective, said PSA NSW State Manager Amanda Fairjones.
Describing the regulation as an ‘extra tool’ to identify patients, Ms Fairjones said pharmacists should have all patient’s DOB recorded in their dispensing software system so they can refer to it when supplying medicines.
‘It [helps] to make sure supply is safe and appropriate for patients,’ she said.
The new requirement will also improve the information recorded in SafeScript NSW to reduce the incidence of harm from monitored medicines.
Community pharmacist Hassan Taoube MPS, who works in several pharmacies from South Sydney to the NSW Central Coast also thinks the change is a step in the right direction.
‘When you’re doing your job as a pharmacist, you need to know someone’s age, which is very relevant to health,’ he said.
‘There’s geriatric medication and pediatric medication, and especially with the way things are now where people pick up scripts for each other, you need to know who the [medicine] is for and their characteristics.’
Important information for pharmacists
While it is a requirement for prescribers to include a patient’s DOB on paper prescriptions, pharmacists can still dispense medicines in its absence, said Ms Fairjones. However, pharmacists must ask the patient or their agent to supply this information so it can be recorded in the dispensing software before the medicine is dispensed.
For S8 medicines, a patient’s DOB must be included in the information recorded in SafeScript NSW when the medicine is dispensed.
However, this should occur automatically when a patient’s DOB is recorded in dispensing software which is connected to a prescription exchange service.
Community reception and practice changes
At this stage, Ms Fairjones said pharmacists have reported that not all paper scripts have a DOB recorded.
‘It’s a change of practice and they can always be difficult,’ she said.
In Mr Taoube’s experience, most patients have accepted the change. However there has been some frustration from some who are surprised that the information is now required.
With the recent data breaches impacting large companies such as Optus and Medibank, Mr Taoube has also experienced a reluctance from some patients to provide additional identifying information.
‘Some people don’t feel too comfortable with it. They [say], “Well, the doctor already has all this information, why do you need it as well?’” he said.
In this event, Ms Fairjones said pharmacists should reassure consumers their information is protected by privacy laws when giving it to pharmacists.
‘We just explain it and communicate clearly why it’s important, and [explain] “If there ever was a breach, by law, we’d have to notify you”,’ agreed Mr Taoube.
Preparation tips from NSW Health include:
- ensure the pharmacy has the latest version of dispensing software
- record the patient’s DOB in the patient profile before or during dispensing
- prepare a procedure for your pharmacy to establish patient DOB.
Adjusting his approach to account for the change, Mr Taoube has made it clear to pharmacy assistants that obtaining and recording a patient’s DOB is now a requirement.
Importantly, Mr Taoube has also impressed upon pharmacy staff that the new requirement is now part of the dispensing procedure.
‘Along with asking, “How many scripts do you have, would you like generic, are you waiting for the prescription or will you come back”, [we ask] “Can I get your date of birth”?
Patient identification tips for pharmacists
All pharmacists must gather identifying information to positively identify patients before providing services.
When it comes to dispensing, this is required at prescription intake and before supplying the medicine to a patient.
Here are some tips for identifying patients:
- Match all patients to an Individual Healthcare Identifier (IHI). Dispensing software retrieves an IHI when enough fields match that person’s record. If it can’t be downloaded, this usually means there are errors in your data. These are red flags for identification problems and need to be resolved.
- Ask patients to verify records but avoid leading questions. Confirming details with patients and their agents helps to avoid identification errors. Questions such as ‘Is your address still …’ or ‘Are you Mr Smith?’ will likely result in a ‘yes’ response, even if the information is incorrect.
- Don’t forget collection and deliveries. Delivery of medicines is one of the highest risks for wrong-patient identification. Ensure anyone delivering medicines you’ve supplied also uses positive identification techniques – this is especially important when using third parties such as couriers.
- Privacy still matters. Positive identification shouldn’t breach privacy – it should protect privacy. Asking for verbal confirmation of residential address or phone number in an open area may not be appropriate. Equally, confirming identity prevents inadvertently sharing the wrong person’s information.