A service evaluation of the accuracy of electronic prescriptions used to calculate nebulised medication adherence in adult with cystic fibrosis

Adherence to nebulised medications in people with cystic fibrosis (CF) is known to be suboptimal. CFHealthHub uses an electronic prescription (e-prescription) as a denominator and chipped nebuliser devices which capture the frequency of nebulised medications inhaled by the patient. This enables a calculation of nebulised medication adherence to be made. However, e-prescriptions may contain errors which can affect the adherence calculation. This service evaluation sought to review the accuracy of CFHealthHub e-prescriptions at a single adult CF centre, to understand the nature and causes of any inaccuracies and to evaluate the effect of prescription complexity on prescription accuracy. A total of thirty e-prescriptions from CFHealthHub were compared to ‘gold standard’ prescriptions. Inaccuracies and types of error in the e-prescriptions were recorded and analysis was conducted to understand the effect of prescription complexity on this. The two prescriptions were discussed with participants to determine the causes of inaccuracies. Inaccuracies were found in 43% (13/30) of e-prescriptions and were significantly associated with alternating medication regimens (p = 0.025). There were four error types found within the e-prescriptions: inaccurate medication list, incorrect medication duration, incorrect medication frequency and prescription duplication errors. Medication list errors were significantly associated with alternating medication regimens (p = 0.007). Causes of e-prescription inaccuracy were due to failure to update the prescription following a change, errors in prescription entry and inaccuracies caused by using two different nebuliser devices. CFHealthHub e-prescriptions contain inaccuracies and prescription complexity can increase the risk of prescription inaccuracy, although the small sample size limits the ability of the service evaluation to draw strong conclusions. Causes of e-prescription accuracy should be addressed by the local CF team.