Risk assessing transcribing

The joint RPS and RCN guidance on transcribing suggest that it should always be underpinned by risk assessment. This guidance was developed following withdrawal of the Medicines Management Standards by the Nursing and Midwifery Council, which stated that transcribing should only happen in exceptional circumstances.

Introducing transcribing into the care pathway introduces another stage which may increase the likelihood of an error in the process. The risks associated with transcribing are multi-factorial and are described in the following four categories:

• Healthcare setting
• Personnel factors
• Process factors
• Medicine factors

Healthcare setting

There will be different risks relating to each type of care setting.

Patient’s home

Transcribing in the patient’s home may present a lower risk than transcribing in a healthcare organisation.

For example, a patient in their own home will only have medicines belonging to the household available to administer. Therefore, in the event of a transcribing error, this may be corrected at the administration phase because only the correct medicine should be available in the patient’s home and the label should have the correct information.

Healthcare organisation

Within the same organisation there may be more than one type of care setting.  Therefore, organisations may need to restrict transcribing to certain areas where the risks are considered to be acceptable.

Personnel factors

These are factors associated with the staff involved in the process.

The personnel will be inter-related to the care setting and this influences the associated risks.

Acute care settings

There will be greater access to pharmacists in acute care settings, who may be better at identifying transcribing errors.

Community-based settings

Transcribing may be undertaken by healthcare professionals who are working in an environment removed from specialists and who may have limited access to clinical support.

Process factors

Transcribing can be considered as a stage in the process of prescribing, dispensing and administration and the robustness of these processes will impact on the transcribing procedure.

For example, medicines dispensed to an individual patient in their own home with “as directed” on the label will need some form of guidance from the prescriber as to how the medicines should be administered in order to make the transcription on to the administration record.

Medicine factors

Some medicines have inherently higher risks than others and these risks may be accentuated by the care setting.

Monitoring

Medicines that require monitoring might be considered more hazardous in the community than in an acute setting where there is easier access to testing.

Route

The route of administration may be considered more dangerous in different care settings.  For example, administering injections in the community may be considered to be a higher risk than administering oral medicines.

Mitigating risk

Organisations may decide that some medicines or routes of administration should not be transcribed under any circumstances.