When an operator service is used by hearing-impaired pharmacy staff, steps must be taken to avoid the possibility of medication errors.
A question was posed recently to the Institute for Safe Medication Practices: Can a relay service (ie, an operator service that allows people who are hearing impaired to place calls to and receive calls from standard telephone users) for spoken orders from prescribers be used safely by hearing-impaired pharmacists?
The question was prompted by 2 errors in which a hearing-impaired pharmacist was involved when using a relay service to receive telephone prescriptions. The relay service operator made 2 mistakes when transcribing the prescription from the prescriber. The pharmacist did not catch either error. The errors were noted by other pharmacy personnel, who could hear the prescriptions as they were communicated by the prescriber and see what the relay service sent to the pharmacy.
In the relay service process, the prescriber or the prescriber’s agent calls the pharmacist via the relay operator. The operator types the information the prescriber is dictating phonetically and the computer translates that into full English words. When the lay service computer dictionary does not contain the actual word, it will supply a word that is close based on the phonetic spelling. The computer-generated English translation then appears on a special phone or computer screen in the pharmacy for the pharmacist to read.
These relay services may not be staffed with medically trained personnel. This creates a situation in which poor computer translations of the operator’s phonetic spelling may not be caught by the operator and will be communicated to the pharmacy, placing the pharmacist at risk of misinterpreting the order.
Safe Practice Recommendations
Spoken orders are a method of communicating that is often misinterpreted, regardless of hearing ability. Although spoken orders may be convenient to those prescribing medications, their use should be limited when possible and “read back” (repeating back to the prescriber what has been recorded on paper or in the computer system) should be employed to minimize unnecessary obstacles to clear communication.
An alternative to the relay service may be to allow, as permitted by state law, an experienced certified pharmacy technician or pharmacy intern to listen in on the call and write down the necessary patient and drug information. Once the technician has reduced the prescription to writing, he or she would tell the caller, “I need to have the pharmacist read this back to you to make sure that I have this prescription transcribed correctly,” and then have the pharmacist read it back to the caller. A similar scenario is used in many mail order pharmacies.
Consider the following to reduce risks of miscommunication:
• Incorporate mandatory write down and read back procedures when accepting spoken prescriptions. This should be the standard of practice everywhere.
• Validate with the prescriber the patient’s identity using patient name and a second identifier, such as date of birth or address.
• Spell drug names back to the caller. Also, obtain from the caller the indication for the use for each drug, especially for sound-alike medications.
• Repeat numbers in digits for strengths and doses when receiving spoken orders (eg, 16 is stated “one-six”).
• Instruct staff never to use error-prone abbreviations or dose designations, drug name abbreviations, or abbreviated sig codes when reducing oral prescriptions to writing.
• Use prescription pads in the pharmacy and at the prescriber end that prompt the receiver to ask the prescriber for allergies, date of birth, and indication for the use or purpose of each drug.
• Establish procedures that specify the steps that should be taken when there is a question as to the safety of a prescription. If a relay service must be used, discuss possible translation problems with the service and ask if their operators have medical terminology and medication name training.
Michael J. Gaunt, PharmD Dr. Gaunt is a medication safety analyst and the editor of ISMP Medication Safety Alert! Community/ Ambulatory Care Edition.