Prescription Clarifications in an Ambulatory Endocrinology and Metabolism Clinics:  Setting the Stage for Quality Improvement?

Presentation Number: SUN 291
Date of Presentation: April 2nd, 2017

Sara F.M. Awad*1, Janine Charisse Malcolm2 and Heather Anne Lochnan3
1The Ottawa Hospital, University of Ottawa, Ottawa, ON, CANADA, 2University of Ottawa, Ottawa, ON, Canada, 3university of ottawa, Ottawa, ON, Canada



Prescription medications are essential components in the care of ambulatory endocrinology and metabolism patients and are the primary method of communication concerning patient medication information between prescribers and pharmacists. The need for clarification by pharmacists may result in delays in therapy and increased use of clerical resources and physician time and potentially introduction of new errors. Although previous studies have evaluated and categorized prescriptions errors in ambulatory settings, no studies to date have examined prescriptions queries by pharmacists in Endocrinology and Metabolism outpatient clinics.


The purpose of this study is to evaluate and categorize types of prescription clarification requests by pharmacists concerning hand-written prescriptions in an ambulatory Endocrinology and Metabolism clinic in a tertiary care hospital in Ontario, Canada. This project will aid in designing and implementing interventions to reduce the need for prescription clarifications, including the design of our electronic prescription process.


Sequential anonymized faxed prescription requests for clarification from pharmacists concerning handwritten prescriptions written by attending and resident physicians in ambulatory Endocrinology and Metabolism clinics at the Ottawa Hospital (TOH) in Ottawa, Canada were collected. The queries were categorized based on the reason for clarification and the therapeutic classification of the drug.


A total of 1575 prescriptions written from September 10 to November 1, 2016. Seventy-one prescriptions written by 22 physicians including endocrinology staff, endocrinology or rotating residents were analyzed during that period for pharmacists’ queries. The most commonly prescribed drug was insulin (16/71), followed by oral diabetic agents (12/71) and diabetes supplies (9/71). The most common reasons for pharmacist’s queries were missing medication quantity to dispense (17/71), and missing duration or refills (11/71) followed by incorrect dose (8/71) and missing prescriber’s or patient’s instructions (8/71). Attending staff wrote 59 of the prescriptions that required clarification and 12 were written by resident physicians.


Seventy–one pharmacist queries occurred in a 7-week period, accounting for 4.5% of written prescriptions. Queries were most common among diabetes medications including insulin. The most common queries involved essential components of prescription writing such as medication quantity and refills. These results represent a valuable needs assessment that can underpin strategies to raise awareness and reduce the rate of prescription clarifications by pharmacists. Continued tracking can assist in the measurement of impact of our awareness campaign.


Nothing to Disclose: SFMA, JCM, HAL