An investigation published on bmj.com yesterday reveals that administrative staff and receptionists at general practices across the UK make significant “hidden” contributions to repeat prescriptions. According the study the safety and quality of repeat prescribing can be affected due to over-reliance on electronic health records. Researchers found that receptionists frequently use “practical judgments” in order to help close the gap between formal prescribing protocols and the complex reality of the repeat prescribing process.

The researchers state that in order to help keep patients safe, training in repeat prescribing must go further than technology.

For a long time quality and safety has been a considerable concern of repeat prescribing. Repeat prescribing makes up for approximately three quarters of all drugs prescribed as well as four fifths of medication costs in UK general practice.

Although it is often assumed that electronic records reduce human error therefore making repeat prescribing safer, according to some suggestions however, human errors could be ‘replaced’ by technology-related errors.

To distinguish possible threats to patient safety and characteristics of good practice, investigators at Queen Mary, University of London examined how receptionists, doctors, and other administrative staff contributed to, and worked together on, repeat prescribing routines at 4 UK general practices.

They discovered that repeat prescribing is a complex, technology-supported social practice, which requires clinicians and administrative staff to work together. In addition they found that a “model-reality gap” exists between formal prescribing protocols and the real time activity of repeat prescribing, but that often staff help close this gap by making “practical judgments” which helped keep patients safe.

According to the researchers, this work was creative and required both tacit and explicit knowledge, even though often clinicians were not aware of this input.

They conclude that administrative staff and receptionists make important “hidden” contributions to repeat prescribing in general practice. Even though they are not formally responsible for prescriptions doctors sign, they believe that they are informally responsible to patients for the safety and quality of these contributions. The researchers add, “Studying technology-supported work routines opens up a relatively unexplored agenda for patient safety research.”

In an associated report, Professor Anthony Avery from the University of Nottingham Medical School, explains: “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.

There is little evidence that the high levels of autonomy and engagement shown by some receptionists is a cause for concern. Nevertheless errors do occur in the repeat prescribing process.” Avery calls for further investigations in order to determine why.

Written by Grace Rattue