FRIDAY, Nov. 4 (HealthDay News) -- Receptionists and administrative staff of general practices in the United Kingdom make important contributions to quality and safety in repeat prescribing, which are often unknown to clinicians, according to a study published online Nov. 3 in BMJ.
Deborah Swingleherst, M.B.B.S., D.C.H., from the Barts and the London School of Medicine and Dentistry, and colleagues described and compared the organizational routines of repeat prescribing in general practice to identify contributors and barriers to safety and quality. The staff members from four urban general practices were observed ethnographically for 395 hours, and 28 documents and other artifacts were reviewed to see how doctors, receptionists, and other administrative staff contributed to, and collaborated on repeat prescribing.
The investigators found that more than half of the requests for repeat prescriptions were classed as exceptions, most frequently because the drug, dose, or timing differed from that on the electronic repeat list, and receptionists classified more than half of these requests as exceptions. The receptionists managed these exceptions by exercising their judgment. These judgments enabled them to bridge the gap between the assumptions that were built into the electronic patient record and formal protocols versus the actual repeat prescribing routine. Clinicians were often unaware of this creative work that demanded both explicit and tacit knowledge. This practice did not feature in policy documents or previous research, but was important for getting the job done, and safeguarding the patients.
"Repeat prescribing is a complex technology-supported social practice, requiring collaboration between clinicians and reception staff," the authors write.
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