Acute settings and transcribing

Tracy Rogers, Director, Medicines Use & Safety, Medicines Use and Safety TeamPublished

Consideration needs to be given to the risk factors particularly associated with transcribing in acute settings

Risk factors

Factors will be considered in terms of those that confer risk, those that reduce risk and those factors that have the potential to influence risk either way, depending on other variables.

Examples of acute settings

Acute care settings include:

  • Acute hospitals
  • Mental health acute unit
  • Tertiary care hospitals

Healthcare setting factors

Conferring risk

  • There is risk associated with not transcribing the latest regimen due to acutely unwell patients having frequent changes to medicines.
  • A greater stocklist of medicines in clinical areas presents risk because transcribing errors may result in patient administration, simply due to easy accessibility of the medicine.
  • Transcribing between different dependency settings may have different risks.

Reducing risk

  • The need for transcribing should be minimal as prescribers are available.
  • Where available, electronic prescribing systems reduce the need for transcribing unless patients moving between different care settings.
  • Administration charts should be designed to reflect average length of stay, which minimises need for transcribing onto new chart.

Personnel factors associated with setting

Variable risk

  • Transcribing may be seen as an administrative task by registered staff.

Reducing risk

  • Registered staff should be familiar with medicines and indications.
  • Sufficient clinical pharmacy involvement should act as a layer of defence.
  • Where a pharmacist is the transcriber, the clinical pharmacy service should be provided by another member of the team.

Process factors associated with setting

Variable risk

  • Transcribed chart cannot be used as a prescription to supply medicines.

Reducing risk

  • Medicines reconciliation on admission within 24 hours should reduce risk of errors being continued.
  • Prescribing process will include clinical review as the patient presents, which should reduce risk.
  • Administration undertaken by registered staff who should act as layer of defence, if there is transcribing error.

Medicine factors associated with setting

Conferring risk

  • Some settings with have high risk medicines, e.g. high dose antipsychotics.
  • Some settings high risk administration methods, e.g. the Z-track method for administering depot antipsychotics.