Download Transcribing Training and Assessment

Transcribing Training and
Assessment
For all healthcare staff
Visit MedsLearning at www.ewin.nhs.uk and
medslearning.wordpress.com
Contact: Administration Team
Pharmacy Workforce Yorkshire
T: xxxxxxxxxxxxx
E: xxxxxxxxxxxxxxx
Document Reference Number: PDU/MM/008
Review Date: January 2018
Version: 3.1
Supersedes: v2.0 and v3.0
Transcribing
Acknowledgements
This document has been produced by the Yorkshire and Humber Pharmacy
Development Unit (Y&H PDU) to assist in the training and development of staff
involved in Medicines Management. It should be read in conjunction with the
Medicines Code and/or procedures provided by the employing organisation.
Thanks are given to the many staff of Yorkshire and the Humber NHS Trusts who
have provided information, shared resources and reviewed the module.
Further acknowledgement is given to members of the Medicines Management
Development Group in development of Yorkshire and Humber Medicines
Management training. This is one of a series of Medicines Management Work Based
Learning Programmes, and associated training resources which can be accessed via
https://www.ewin.nhs.uk/groups/medslearning/activity
2
Transcribing
Contents
Acknowledgements .................................................................................................... 2
Introduction to the module .......................................................................................... 4
Aims and Objectives................................................................................................... 5
Learning Outcomes for this module............................................................................ 5
Definition of Transcribing............................................................................................ 6
Transcribing Processes .............................................................................................. 7
Transcribing Risks ...................................................................................................... 8
Transcribing Error Examples ...................................................................................... 9
Essential Transcribing Information ........................................................................... 10
Clinical Checks on Wards and Units ........................................................................ 11
Electronic Systems ................................................................................................... 12
Assessment Section ................................................................................................. 15
Task 1 Essential Reading Organisational Procedures and Policies ......................... 16
Task 2 Essential Reading......................................................................................... 17
Assessment 1 - Practical Simulation Exercises ........................................................ 18
Assessment 2 - The Practical (100 items Diary Log)................................................ 19
Assessment 3 - Observed Holistic Practice Based Assessments ............................ 22
Summary of Achievements ...................................................................................... 25
Confirmation of Completion of Module ..................................................................... 27
Appendix 1 Marking scheme for errors..................................................................... 28
Appendix 2 Transcribing errors once module is complete ........................................ 29
Appendix 3 Suggested further reading ..................................................................... 30
Appendix 4 Reflection on Learning .......................................................................... 31
Appendix 5 Activities and Exercises ......................................................................... 32
3
Transcribing
Introduction to the module
This assessed training competency will enable appropriate staff to transcribe the
required medications for individual patients onto the appropriate documentation
whether using electronic or paper based systems.
This module is one of the optional modules available within the Yorkshire and the
Humber Region Medicines Management Training Scheme.
This is your learning programme to develop your knowledge and skills. The
recommended timescale for completion is no more than 3 months. It is in your
interest to ensure you understand each section before moving on to the next.
Candidates must have a nominated learning mentor* to support them through this
module.
It is recommended that training and assessment methods and assessment criteria in
this module workbook are followed for all candidates. They have been developed to
provide a structured approach to training and assessment across the Yorkshire and
Humber region.
The information contained in this booklet provides a variety of training and
assessment methods, which may be adapted to address the content and depth of
training required in each organisation.
Errors made during training and assessment must be assessed on a case by case
basis depending on the candidates overall abilities, performance and competence.
Mentors/trainers must decide on an appropriate course of action to take with the
candidate. In all cases errors must be followed up with a self-reflective entry and a
candidate interview.
Pharmacy Technicians taking this training must keep up to date with skills through
CPD and should complete a CPD entry after training.
Information for certification under the Yorkshire and the Humber Medicines
Management Training Scheme
Once this module has been successfully completed ask your mentor to complete the
Confirmation of Module Completion form and forward it to the Y&H Pharmacy
Development Unit. A certificate will be issued to confirm successful completion of
modules of Yorkshire and the Humber Medicines Management Training Scheme.
* The mentor will be a pharmacist or pharmacy technician (or authorising organisations representative), who has
been approved to mentor candidates in the Yorkshire and Humber Region (see medslearning website at
https://www.ewin.nhs.uk/ for more details).
4
Transcribing
Aims and Objectives
Aim
To equip the candidate with the necessary skills to effectively and efficiently
transcribe pharmaceutical items from patients records onto the appropriate paper
based documents or onto an electronic medicine management system.
Objectives
On completion of this module, the candidate will be able to confidently and without
error, transcribe items onto the correct paper based documents or on to an electronic
medicine management system in the correct manner.
Learning Outcomes for this module
Correctly and confidently:
 Transcribe the required medications for individual patients onto the
appropriate documentation.
 Transcribe electronically unless electronic systems are not available
 Transcribe onto individual worksheets for each named patient (if appropriate)
 Check transcriptions of other staff
Communication skills
Have the required communication skills to:
 approach prescribers , nurses and pharmacy teams where necessary
 highlight discrepancies and interventions to the appropriate member of staff or
team
Accountability and Responsibility
 Recognise own limitations and refer where appropriate
 Apply self-checking and safe checking systems
 Apply problem solving skills
The learning outcomes will be achieved in 4 ways either electronically or paper
based (depending on systems in use in each organisation) by
1. Completion of essential reading tasks
2. Completing the simulation exercises
3. Completing the transcribing logs
4. Completing observed holistic practice based assessments
NHS Knowledge and Skills Framework (KSF) Criteria
Once this training package has been completed, the following KSF Levels will have
been achieved: Core 1/ Level 2, Core 2 / Level 2, Core 5 / Level 3, HWB10 / Level 2
5
Transcribing
Definition of Transcribing
Transcribing is usually referred to as the accurate and comprehensive transfer of
information regarding a particular patient and their medication, from a prescription
onto a pharmacy requisition form i.e. paper based documents or on to an electronic
medicine management system
“Any act by which medicinal products are written from one form of direction to
administer to another is transcribing. This includes, for example, discharge letters,
transfer letters, copying illegible patient administrations charts onto new charts,
whether hand-written or computer-generated”. (NMC)
When might it happen?
Transcribing is often necessary when there is no access to a prescriber. In this case
it allows continuation of administration or supply of previously prescribed medicines
where the patient would be at risk if the medicines were withheld.
Transcribing Examples

the patient’s existing treatment (from GP)onto an in-patient prescription

prescription sheet to be rewritten when the original one is full

inpatient treatment  transcribed on to a discharge prescription

eDAN copy or discharge letter from hospital or unit transcribed by GP staff
onto patients records
Transcribing Checking
In some organisations pharmacy staff are trained to check and sign off the
transcriptions of prescribers.
E.g. check that an Inpatient Prescription and Administration Record has been
correctly copied by a prescriber onto another Inpatient Prescription and
Administration Record (usually because the original record was full).
Certain criteria must also be met, for example:
 All the prescribed items on the original record have been validated by a
pharmacist
 Pharmacist has carried out a medicines review in the last 7 days
 The new record has been completed by a prescriber
6
Transcribing
Transcribing Processes













Staff must be trained and competent to transcribe or perform checking of
transcriptions.
Each individual organisation will decide which groups of healthcare professionals
are allowed to transcribe and what they can or cannot transcribe. This may, for
example include nurses, pharmacists and pharmacy technicians.
Staff undertaking transcribing are accountable for their actions or omissions
Items transcribed must be verified for accuracy and clinical appropriateness
and/or signed off by a registered prescriber.
Policies and procedures for transcribing must be in place with appropriate risk
assessments.
The information must be obtained from the most authoritative place possible and
must take into account any recently prescribed changes.
Professional discretion must be applied when assuring the quality of information
obtained.
If there is any uncertainty regarding the accuracy or appropriateness of
transcribed medicines then the medicine must not be given
Where appropriate ensure a Drug History has been completed/verified by either a
Pharmacist/Pharmacy Technician.
Transcribe all items including once only and when required medicines
Remember to include the original start dates of medicines if appropriate
Annotate according to procedures
Transcribers must not amend, initiate or discontinue treatments as this would be
classed as prescribing.
Distractions
 Transcribing must be carried out in an environment where the risk of interruptions
and distractions are minimised as far as possible.
 Errors may occur in certain settings where there are already a number of
distractions e.g. patients own home, busy/noisy clinics, wards, departments,
reception areas, high numbers of phone calls
.
7
Transcribing
Transcribing Risks







Transcription errors can occur due to having to interpret the prescriber’s
handwriting with paper based systems, or where records are incomplete,
ambiguous or there is a discrepancy.
Understanding medicines strengths and concentrations and instructions
When using drop down lists on electronic systems ensure you select the correct
item from that list
Ensure you select the correct tab to complete your transcription (if more than one
tab is available)
When free-typing into appropriate fields ensure your message is clear and
precise
When patients have interactions, allergies or the medicine is contra-indicated the
prescriber must be contacted
Extra care and consideration must be taken when transcribing high risk drugs*
o
o
o
o
o
o
o
o
Anticoagulants
Antibiotics (allergy related)
Injectable sedatives
Chemotherapy
Opiates
Antipsychotics
Insulin
Infusion fluid
*The fourth report from the Patient Safety Observatory details that 60,000 medication
incidents were reported to the NPSA via the National Reporting and Learning
System(NRLS) between January 2005 and June 2006. The report reviews 92 of
these medication incidents in detail, 38 of which resulted in death. The report finds
that these medicines were most frequently associated with severe harm.
Ref: National Patient Safety Agency. Patient Safety Observatory Report 4. Safety in Doses, July 2007, NPSA,
London www.npsa.nhs.uk/patientsafety/medication-zone.
From: http://www.patientsafetyfirst.nhs.uk/
8
Transcribing
Transcribing Error Examples
Example 1
Whilst reviewing a patient’s medication in the general practice an error was noticed.
The patient had been moved from a nursing home to another home and had
changed GP.
The home had requested a prescription for the patient:
lithium carbonate 400 mg one tablet each day.
It had been put on the computer records as one tablet twice a day.
Patient had been taking double the dose. The error was not picked up by the home
or community psychiatric nurse.
Outcome: Patient was hospitalised due to lithium toxicity.
Example 2
An elderly patient had been taking 5 mg nitrazepam at night whilst on a hospital
ward.
This was erroneously transcribed onto the discharge prescription as
nitrazepam 5 mg twice a day.
The error was not identified before the patient went home on the wrong dose.
Outcome: Patient subsequently fell and suffered a fractured hip.
Extracts from NRLS-0486-safety-in-doses Fourth Observatory Report
http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59822
Example 3
An elderly patient from a nursing home was admitted to hospital with severe
drowsiness and confusion. When a drug history was taken it was discovered that the
GP surgery had transcribed the dose of amisulpride incorrectly when the patient was
changed from tablets to a liquid form of the preparation.
Original prescription = Amisulpride tablets 50mg at night (half a 100mg tablet)
Transcribed information= Amisulpride solution 2.5mL at night (thinking of half)
(= a dose of 250mg as the solution is 100mg/mL, instead of 0.5mL (50mg))
Outcome: Patient received an overdose of five times the intended medication.
See appendix 5 for more examples, activities and exercises
9
Transcribing
Essential Transcribing Information
The necessary pharmacy information when transcribing should include:
 Patients Name, Ward, Unit Number, Date of Birth, Consultant - should be
checked and updated on the electronic patient record (if epma is in use)

Allergy status - to be confirmed and updated to provide the most accurate history
(if epma is in use)

Name, form and strength of all drugs using generic names (except where patients
should remain on specific brands) N.B. some products are compounds and will
be in emm by brand name

The dose, frequency and route of all required drugs, with administration times
specified where necessary (formulation of drug can be changed electronically at
this point)

The date to indicate when a supply is needed (may use a message field if drug is
needed ASAP or stat). Check local procedures for appropriate use of any urgent
message fields.

Duration of antibiotics and steroids (course length should be specified by
prescriber, if not follow procedures for appropriate supply)

If anything other than a standard supply, an indication of the quantity that needs
to be supplied and the format (local procedures apply).
Remember:
 Only approved abbreviations should be used. With electronic prescribing
abbreviations are not used.

Amendments should not be made (electronic prescribing /transcribing allows
editing to take place - editing (amending) should not be made on paper copies to
avoid confusion)

Any ambiguities and queries must be clarified. Usually clear and concise
transcribing is possible on electronic system due to set templating/use of drop
down menus/extra fields, by source provider

Copy any additional/special directions e.g. take after food (most already on set
template in electronic system but facility to add extra information if required, using
supplied fields on screen, may also allow free-typing)

Discuss omitted doses with appropriate staff i.e. nursing staff/pharmacist (Instant
messaging using electronic systems i.e. laptops and handheld devices, ward
work sheet, telephone and bleep systems and face to face communication)

Handwriting: do not transcribe items if you cannot clearly read what has been
written (seek confirmation from the prescriber if unclear)
10
Transcribing
Clinical Checks on Wards and Units
Paper based clinical checks
The prescription must be clinically checked by the pharmacist before being
dispensed. The pharmacist must sign and date the treatment card to indicate that a
clinical check has been performed.
Electronic systems clinical checks
With electronic prescribing the technician will send the transcriptions for clinical
checks to the pharmacist who will commit the clinical check electronically. This only
needs to be done once, unless there is a change in the prescribed dose.
This may be:
Before technician transcription, in which case the name of the pharmacist who
has clinically checked the prescription must be entered onto the requisition form
or will be visible on the electronic system.
After technician transcription, the pharmacist must sign the requisition form when
they have clinically checked the prescription. The transcription if already clinically
checked electronically will be sent directly to the dispensing worklist.
Signatures



Paper based transcriptions must be legible and signed by the transcriber
Electronic systems record a person’s details at login
Remember to log out of electronic systems when finished
11
Transcribing
Electronic Systems
General information on E-Prescribing and Medicines Administration Systems
(EPMA)
What is EPMA?
Use of an electronic prescribing and medicines administration (eMedicines) system
should combine three functions to provide all clinical staff with an integrated view of
a patient’s medication history, through:



Electronic communication of a prescription or medication order;
Aiding the choice, administration and supply of a medicine through knowledge
and clinical decision support, such as allergy and interaction checks and
information to guide and inform users
Providing a robust audit trail for the entire medicines use process, whereby all
medicines prescribed and the associated administration is recorded
electronically
Medicines are a key element of modern healthcare and almost every patient under
the care of a hospital requires medication during their stay. The current system for
the prescribing and administration of medicines in most NHS Trusts is based on a
paper model established over 40 years ago. Since then, the quantity of medicines
used has grown and medication regimens have become highly complex. This
demands increased knowledge and understanding from clinical staff and leads to an
increased risk of prescribing and medicines administration errors and the harm
caused by allergic reactions and missed doses.
eMedicine systems, where the prescribing and administration of medicines are
supported by electronic systems, are widespread in primary care in England and
almost all GP prescriptions are computer generated. Proven technology is also
available to facilitate electronic prescribing and medicines administration in
secondary care, with the number of Trusts implementing these systems steadily
increasing.
What might it include?
An electronic system used in in-patient, outpatient and discharge prescribing
includes patient details and drug information from admission (regular medicines
prescribed by GP), transfer, inpatient prescribing, changes in drugs, allergy
information, prescribing for outpatients, discharge prescribing with discharge letter
and medicines management of patient medication on the wards, by pharmacy and
nursing staff.
Some of the potential benefits of EPMA
 Improved patient safety-easy to read, clear and legible prescriptions and
directions

Can help to reduce prescribing and administration errors
12
Transcribing

Can help to reduce missed doses

Sharing medicines history between care settings

Allergy warnings

Real time medicines administration records

Reduced paperwork and improved audit trails

Releasing staff time due to not having to look for drug charts and completing
paper drug charts.

Paper prescription charts have limited space for number of administrations,
and therefore need to be transcribed after 14 days

Can produce an accurate and up to date current prescription chart for each
patient

ability to monitor and evaluate key performance indicators

Financial benefits – saving due to not using paper

more effective control and management of drug expenditure
the above information has been adapted from Leeds Teaching Hospitals NHS Trust eMedicines
business case (2013 Informatics Programme Office)
http://www.eprescribingtoolkit.com/tools/financial-aspects/
The EPMA system Medicines Management Module (eMM)
Electronic Medicines Management (eMM) is designed to support pharmacy staff on
wards. It allows pharmacy technicians or pharmacists to view each patients chart on
a computer screen.
The computer can be on a mobile trolley or a hand held device.
Although the pharmacy technician does not write lists of drugs and directions with
this system in place, the expertise of understanding what is required is paramount.
Problem solving skills and effective communication skills are still essential.
The Medicines Management module might involve the following (although systems
vary):

Logging on using individual user ID and password.

Selecting the patient by ward or hospital number.

Viewing the medicines prescribed by the doctor and selecting each one to
show how it is to be obtained (i.e. ward stock, POD, pharmacy to supply).
13
Transcribing

Adding any PODs to the meds on admission screen therefore creating the
start of a drug history.

Adding any comments or queries to be viewed by the pharmacist, nurse or
doctor (i.e. patient has Medidose compliance aid?, POD different dose to
prescribed medicine, missing medicine, specific brand of medicine)

Missed dosed - Any missed doses can be seen on the administration screen these can then be followed up with the nurse.

Printing off the dispensing worksheet when all patients have been seen and
faxing or sending electronically to the dispensary
For more information visit
http://www.eprescribingtoolkit.com/
14
Transcribing
Assessment Section
For completion of this module the following must be achieved:

Completion of essential reading tasks 1 and 2

Assessment of competence for transcribing role
o Assessment 1 Practical simulation tests
o Assessment 2 Completion of diary logs with range of situations
o Assessment 3 Observed Holistic Assessments

Completion of 2 reflection on learning (CPD) entries or self–reflective logs
And may include
 Testing of knowledge using questions & answers

Professional discussion/candidate interviews

Self-reflective log
Errors made during training and assessment must be assessed on a case by case
basis depending on the candidates overall abilities, performance and competence.
Mentors/trainers must decide on an appropriate course of action to take with the
candidate.
In all cases errors must be followed up with a self-reflective entry and a professional
discussion/candidate interview.
15
Transcribing
Task 1 Essential Reading Organisational Procedures
and Policies
All candidates must be able to demonstrate a good working knowledge of locally agreed
standard operating procedures.

List organisation and department procedures relating to relating to transcribing.

Read and make notes on areas you think are most important to your understanding and
learning. Discuss these with your mentor
Essential reading - Procedures and Policies
Insert title here
Notes for discussion:
Date Completed
Insert title here
Notes for discussion:
Insert title here
Notes for discussion:
Insert title here
Notes for discussion:
Add more as necessary
Mentors Comments/Candidate Review:
I confirm that the candidate has demonstrated knowledge and understanding of all relevant
procedures listed above and their purpose.
Candidates signature …………………………………
Date………………….……
Mentor signature………………………………………
Date……………………….
16
Transcribing
Task 2 Essential Reading
All candidates must be able to demonstrate a good understanding of transcribing.
 Make notes on the most important and relevant points for your learning and
understanding.
 Discuss these with your mentor.
Essential reading list
Title: Medicines optimisation: the safe and effective use of
medicines to enable the best possible outcomes.
NICE Guidelines NG5
https://www.nice.org.uk/guidance/ng5
Notes for discussion:
Date Completed
Title: Nursing and Midwifery Council Standards for Medicines
Management
http://www.nmc-uk.org/Documents/NMC-Publications/NMCStandards-for-medicines-management.pdf
Guidance: Standard 3 Transcribing (no.1-9)
Notes for discussion:
Title: Transcribing Guidance from East and South East England
Specialist Pharmacy Services (download PDF from NICE
https://www.evidence.nhs.uk)
Notes for discussion:
Title:
Notes for discussion:
Add more titles (as required)
Mentor Comments:
I confirm that the candidate has demonstrated learning from this reading.
Candidates signature ……………………………
Date ………………………
Mentor signature…………………………………
Date ………..…………….
17
Transcribing
Assessment 1 - Practical Simulation Exercises
These practical simulations will vary depending on organisation-it will be necessary
to set up some simulation exercises to reflect the transcribing that takes place in
your own organisation.
The candidate must complete 4 transcribing exercises without any errors.
For electronic systems - set up electronically in a testing account
If any errors are found (e.g. wrong strength) or any important information is missed,
(e.g. brand, allergy status), then the candidate must repeat the exercises and
complete an additional 4.
If further errors are made, then the process can be repeated a second time.
If after 8 transcribing exercises, the mentor feels that the candidate is not competent,
the candidate should not be allowed to work alone, more training should be
commenced until competency is achieved.
18
Transcribing
Assessment 2 - The Practical (100 items Diary
Log)
(This may vary depending on organisational procedures and policies)
Paper based systems
Transcribe a minimum of 100 items accurately and record the details on the
Transcriptions record sheet (diary log attached).
Electronic systems
Transcribe a minimum of 100 transcriptions onto the electronic system.
Re-writing an in-patient medication chart (or checking a transcription by another
person) complete a minimum of 5 to 10 patient medication charts (with minimum of
30 items)
a. keep a log of the patients name and items transcribed (you can also use the
log to accurately record your transcriptions and any errors made)
b. checks will be performed by the mentor/trainer
c. If possible print out the electronic transcriptions as evidence
Range of Situations
The diary logs whether electronic or paper based must use the range of situations for
assessment.
Errors
All errors show a lack of procedural knowledge or concentration. However errors are
classified according to the potential clinical outcome for the patient.
The marking scheme in appendix 1 will be adopted to reflect this:
 Minor error = retrain/ reflection/discussion

Severe error = instant fail (the competency training must start again)
Paper based and electronic - the candidate can make a maximum of 5 minor errors
in a total of 100 items. If more than 5 errors are made, then the competency MUST
be started again.
19
Transcribing
Diary Log - Transcribing Module
Pharmacy Workforce Yorkshire Medicines Management Training Scheme
Candidate’s Name
Assessor’s Name
Organisation
Item
no
Clinical
Check
Performed
Patient
Name &
Ward/dept
Medicine Name and
Form
(including brand where
appropriate)
Strength
/Dose
Frequency/
Directions
Assessors signature………………………………….. Date……………….
100 items required for diary logs
Quantity
Error Found
Minor or
major (see
appendix 1)
Range of
situations
Covered
(enter code
numbers)
Candidate
initials/
signature
Checkers
initials/
signature
Errors
detected
by
mentor
Candidates signature…………………………………… Date………………….
Page …...of………
20
Transcribing
Range of Situations - Transcribing Module
Pharmacy Workforce Yorkshire Medicines Management Training Scheme
Candidate’s Name
Assessor’s Name
Organisation
Range of situations
Initial & date when covered
(if using electronic systems write n/a
against any that are not applicable
and write the patients name against
completed situations)
1.Prescription problems with the following:
a) Patient details (incl hospital number)
b) Medicine name
c) Strength/dose
d) Instructions/frequency
e) Duration of therapy/quantity
f) Brand or compound medicine name
g) Not signed by prescriber
h) Non-formulary item
2. Clinical skills
a) Patient allergic to prescribed medicine
b) Clinical check missing
c) Interactions/contra-indications
d) Item is a high risk drug
e) Form of medicine inappropriate for patient
3. Communication skills
a) With department/ward/organisation staff
b) With prescriber
c) With pharmacist
4. Supply of medicines
a) Missed dose- supplies available on ward
b) Missed dose- supplies unavailable on ward
c) Urgently supply required
d) Item is a ‘to follow’ medicine
5. Changes to prescription
a) Items deleted from prescription
b) Items require amendment
c) Records are incomplete or ambiguous
6. Referral type
a) Intervention
b) Discrepancy
7. Referral
a) Referral to an appropriate person
8. Other
a) Free typing field for comments/message
b) Extra fields require completing e.g. special directions
(add more if required)
21
Transcribing
Assessment 3 - Observed Holistic Practice
Based Assessments
Minimum of 5 observed assessments covering all of the assessment criteria, which
also includes the skills needed to demonstrate full medicines management role,
includes assessment of communication skills with feedback on performance
completed and signed by mentor/assessor.
It is not necessary to cover all the learning outcomes on all five occasions; however,
all outcomes must be covered before the final sign off is undertaken.
Notes on this assessment
Some of the competencies in this assessment may not be applicable to
candidates/members of staff/organisations who do not have a ward/department
based role. In this case staff who transcribe patients medication from paper copies
e.g. in GP surgeries, should develop a work around the wording to cover their
processes.
E.g. competencies 1 and 2 apply to staff visiting wards and departments to
transcribe. This should be adapted to cover situations when and where transcribing
is to take place in the organisation (i.e. ensure an area free from interruptions).
E.g. competencies relating to clinical checks and missed doses may not be possible
to cover in some organisations. However these should be adapted to include for
example the use of a second check.
Feedback
Verbal feedback should be provided as soon as possible after the assessment,
ideally on the same day.
Written feedback must be provided using the feedback section of the assessment
form.
22
Transcribing
Observed Holistic Competency based assessment - Transcribing
Pharmacy Workforce Yorkshire Medicines Management Training Scheme
Candidate’s Name
Assessor’s Name
Organisation
Assessment Criteria-You must always:
Date:
Achieved
Y/N
Date:
Achieved
Y/N
Date:
Achieved
Y/N
Date:
Achieved
Y/N
Date:
Achieved
Y/N
Communication skills
1. Visit the dept at an appropriate time
2. Notify dept staff of identity/presence /role in dept
3. Use effective communication skills with all staff as required
Transcribing
4. Ensure that all prescribed medicines are clinically checked prior to
transcription
5. Check items for clinical appropriateness
6. Ensure correct department or ward is recorded
7. Correctly transcribe appropriate items following local SOPs
8. Ensure allergy status has been completed
9. Identify missed doses and report to the appropriate person
10. Ensure transfer of original start and stop dates
11. Ensure transcription of PRN medicines and stat doses
12. Complete the appropriate documentation using either paper or electronic
systems ensuring that all patient and medicine details are recorded and all
fields completed clearly and accurately according to SOPs
Professional
13. Deals with interruptions and distractions appropriately
14. Communicate any outcomes/findings/actions to relevant people
15. Refer any issues outside personal limitations
16. Resolve any issues found when able to do so within scope of role
17. Follow security/confidentiality/safety/hygiene procedures on wards and depts.
18. Follow professional codes of conduct, practice and ethical standards.
19. Complete all records accurately and legibly according to SOPs
Assessors signature (in each box)
All of the competency-based criteria must be covered on at least one occasion.
23
Transcribing
Observed Holistic Competency Based Assessment – Transcribing Feedback
Pharmacy Workforce Yorkshire Medicines Management Training Scheme
Assessment
1
Comments:
Assessor Signature:
Candidate initials:
Date:
Assessment
2
Comments:
Assessor Signature:
Candidate initials:
Date:
Assessment
3
Comments:
Assessor Signature:
Candidate initials:
Date:
Assessment
4
Comments:
Assessor signature:
Candidate initials:
Date:
Assessment
5
Comments:
Assessor Signature:
Candidate initials:
Date:
24
Transcribing
Summary of Achievements
Candidate Name.....................................................................
Date...............................
Organisation………………………………………………
The following criteria must be completed and signed by the authorised clinical pharmacist or medicines management technician (or
authorising organisations representative)
Requirements/Tasks
Part 1 Transcribing Simulations on paper and electronic systems
4 Simulation Exercises
Exercise 1
Completed
Y/N
Exercise 2
Completed
SIGN
DATE
Y/N
SIGN
Exercise 3
Completed
DATE
Y/N
SIGN
Exercise 4
Completed
DATE
Y/N
SIGN
DATE
Part 2 Transcribing Practical on paper or electronic systems
100 items transcribed (paper based system)
Date completed:
Candidate Signature:
Trainer Signature:
100 transcriptions (electronic system)
Date completed:
Candidate Signature:
Trainer Signature:
Observed holistic assessments
Date completed:
Candidate Signature:
Trainer Signature:
Accuracy Checking Completed
(where ACT essential prior to transcribing training)
Date completed:
Candidate Signature:
Trainer Signature:
Part 3 Assessment and sign off
Retraining is to be discussed if the required standard has not been achieved after guidelines have been followed.
(page 1 of 2)
25
Transcribing
Review of candidates overall performance:
Recommended reaccreditation time span:
I confirm that the candidate:
 has been assessed and has successfully completed all of the above areas of work.
I am satisfied that:
 the areas of work listed above have been carried out to a high standard
 procedures, policies and professional codes of conduct have been followed
 all work has been verified as the candidates own.
Date for review of skills:…………………………………………………
Signed………………………………..………………Print name………………………………..………………………..
Job title...........................................................................................................Date................................................
(page 2 of 2)
26
Transcribing
Confirmation of Completion of Module
Candidate’s Name:______________________________________________
Organisation______________________________________________
Name of Module:______________________________________________
Comments from Technician/Pharmacist (or authorising organisations
representative):
I confirm that this candidate has completed the above module and passed all
relevant assessments.
Signed (by authorised person): ___________________________________
Name (Please print):
_____________________________ Date: ___________
Signed (Candidate):
______________________________________________
Please return this sheet to Pharmacy Development Unit, Baines Wing, School
of Healthcare, University of Leeds, Leeds, LS2 9UT
[email protected]
A certificate of completion will be issued to Pharmacy Workforce Yorkshire staff on receipt
from a recognised mentor.
27
Transcribing
Appendix 1 Marking scheme for errors
Description of Error
Marks
(*these errors may not be applicable on electronic systems)
deducted
*Ordering personnel not identified i.e. Initial box not filled out
Minor
*Ward sheet not dated
Minor
Incorrect consultant/ no consultant/ cost centre/ cost code
Minor
*No hospital number
Minor
No date of birth
Minor
Incorrect ward (must be checked for each patient entry on emm)
Minor
*No ward identified (mandatory on emm)
Minor
*No drug formulation (all drug formulations linked to set templates)
Minor
*Recorded medicine ordered but no order sheet
Minor
Incorrect drug formulation
Severe
Incorrect patient name
Severe
Incorrect days/quantity supply (local procedures apply)
Severe
Eye drops – antibiotics – which eye? Both eyes x 2op?
Severe
*No allergy status (should be set electronically on admission and checked for each supply)
Severe
Incorrect transcription of hospital number
Severe
*Incorrect route (not applicable with emm due to set templates)
Severe
*Illegible handwriting
Severe
Incorrect drug name
Severe
Incorrect dose
Severe
*No strength (Emm will not allow transcriptions of drugs without a strength because of the set templates)
Severe
*No clinical check (Electronic transcription cannot be dispensed without a clinical check)
Severe
*Drug error (e.g. ordering items when obvious interactions, penicillin allergy,
Severe
reducing dose, short course etc) (set electronically-with warning system)
Severe
*Not transcribing items which are needed (Epma allows items to be ordered because patients
Severe
PMR is always accessible even if patient not on ward)
Any other errors – apply local policy
28
Transcribing
Appendix 2 Transcribing errors once module is
complete
Organisations must follow their own procedures and policies
If the candidate makes a transcription error once they have completed the module
and assessments, they may need to complete the module again.
This will depend on the severity of the error.
If the error is classified as severe (see appendix 1 marking scheme), then completion
of the entire module is required.
If the candidate makes a minor error, then they can have 3 minor errors in a period
of 12 months prior to re-completing the module (refer to local policy).
Training and development needs/use of action plans
Training and development needs identified during any reviews of candidates must be
recorded, followed up and completed by the Mentor.
The use of action plans with target dates may be a useful tool for candidates when
appropriate.
Organisations should follow their own training and development procedures
Revalidation of staff
Refer to your local policy
29
Transcribing
Appendix 3 Suggested further reading
The articles below are in journals which require subscription. Please contact your
pharmacy department to inquire about how to obtain copies.
Hobson RJ, Sewell CJ, ‘Responsibility, accountability and factors influencing
provision of pharmacist transcription of discharge prescription’, The International
Journal of Pharmacy practice, 2004, Vol 12, p163-168
Rose D, Evans SW, and Williams R, ‘Introducing a technician discharge prescription
transcribing service’, Hospital Pharmacist, 2005, Vol 12, p233-236
Thomas et al, ‘Empowering technicians to work in extended clinical roles’, Hospital
Pharmacist, 2008, Vol 15, p145-146
Acres, S, ‘New Professional Body- are technicians in or out?’, Hospital Pharmacist,
2008, Vol 15, p107-8
30
Transcribing
Appendix 4 Reflection on Learning
Continuing Professional Development for registered professionals-evaluation of
learning. Having completed this package you may wish to use this page to reflect on
your learning experience and add it to your GPhC CPD record.
CPD No.:
_________________
Entry No.:
Name of Entry:
_____________________
Date learning undertaken: _____/_____/_____
Action:
U1
_____________
Time taken______
Please describe the activity you have undertaken
(Describe the activity you carried out, being specific about the details)
U2
To which areas of competence does this learning relate?
(If you cannot find any competences that match, write your own.)
U3
What have you learnt as a result?
(Briefly describe what you learnt from doing the activities.)
Evaluation (Reflection on learning)
U4
Please describe an example of how you have applied this learning.
(Give an example of how you have used what you have learnt.)
U5
Describe any feedback you have had.
(This might include users of your services/products, staff and colleagues. The learning may have had an impact on
you, for example by affecting your confidence or motivation, and you should record this. Feedback may come in
many forms, for example, verbally, through surveys, or through statistics on performance.)
U6
Have you identified any learning needs as a result of undertaking this activity? (Tick box)
(If so, start a new CPD record that starts with Reflection)
 Yes
 No
31
Transcribing
Appendix 5 Activities and Exercises
A. Transcribing Activity-Common medicines
Complete the following table. Take a look at these common groups of medicinesTest yourself. What do you know about these drugs?
Medicines
Statins -lipid regulating drugs
atorvastatin)
What you know
(Simvastatin
e.g. strengths, form (tablets, liquid),
maximum doses, frequency, special
instructions etc
Proton pump inhibitors PPIs
(omeprazole,
lansoprazole)
Analgesics (paracetamol, co-codamol)
Thyroid (levothyroxine)
Cardiovascular
(ramipril, aspirin)
Antidepressants
(amitriptyline, citalopram)
Diuretics
(furosemide)
Antibiotics (penicillins)
Dementia (donepezil)
bronchodilators-asthma (salbutamol )
diabetes (metformin)
Anticoagulants (warfarin)
Data source: Prescriptions Dispensed in the Community: England 2003-13 http://www.hscic.gov.uk/
Useful Links:
British National Formulary www.evidence.nhs.uk/formulary/bnf/current
Electronic Medicines Compendium www.medicines.org.uk/emc
32
Transcribing
B. Medicines Error Activity
Almost 60,000 medication incidents were reported to the National Patient Safety
Agency (NPSA) via the National Reporting and Learning System between Jan 2005
and June 2006.
The 3 most frequently occurring types of medicine error accounted for over half
(57.3%) of all reported incidents:
 wrong dose or strength of medicine or frequency of medicine (28.7%)
 omitted medicine(patient did not receive their medicine)
 patient given the wrong medicine
Various drug strength errors for reflection
Error 1: A patient died after an intravenous overdose of 30 mg of diamorphine was
administered. A dose of 5 mg had been intended. (Death)
Error 2: A patient who was being resuscitated from a heart attack required infusions
of sodium bicarbonate. When the second infusion was set up, glucose with lidocaine
infusion was given instead of sodium bicarbonate. (Severe harm)
Error 3: Patient prescribed a dose of Morphine Sulphate 5mg. Drug checked by two
members of staff. The different names (Diamorphine and Morphine) were discussed
by the staff who concluded it was the same drug. Nurse then independently
administered subcutaneous 5mg dose of Diamorphine at 08.45hrs to patient instead
of morphine. Morphine and diamorphine doses are not equivalent-this resulted in an
overdose. Nurse became aware of her error at approx 09.15hrs when talking to ward
pharmacist. Patient died at 10.07hrs. (Death)
Extracts and references:

Safety in Doses: improving the use of medicines in the NHS 2009, http://www.nrls.npsa.nhs.uk/
The fourth report from the Patient Safety Observatory. Safety in doses: medication safety

incidents in the NH S National Patient Safety Agency 2007
Missed dose errors
Error 1: Patient admitted with severe multiple infections. At 15.00hrs the senior
house officer noticed that the patient had not had their 12.00hrs intravenous
antibiotics. Blood pressure observations recorded at lunch time were BP 77 (which is
low) but put on the chart as 120 systolic (which is normal), so IV fluids had been
stopped.
The SHO informed that nurse of the error and instructed them to give IV antibiotics
immediately and re-do observations. The SHO returned at 16.30hrs –observations
still not done. Antibiotics not given and the patient was drowsy. Staff Nurse took
manual BP 70/40– patient had increased heart rate. Patient had to go to ICU, died
from severe sepsis. (Death)
33
Transcribing
Insulin (remember this is a high risk medicine)
High risk medicines are medicines that are most likely to cause significant
harm to the patient, even when used as intended.
Injectable medicines are often the most complex and potent medicines, requiring
complex calculations, methods of preparation and administration, and systems for
monitoring treatment.
There are a large number of incident reports concerning unsafe use of insulin
products. These usually involve the wrong product selection, wrong dose, frequency
or rate of administration, or errors in monitoring the patient.
Ref: NRLS Safety in Doses 2009
The issues raised in medication incident reports relating to insulin may reflect similar
issues for medicines management of other chronic conditions. The prevalence of
people living with diabetes is increasing, and growing numbers of people are being
prescribed insulin. Insulin is a complex medicine and regimens vary between
patients. Close monitoring and management is required to ensure a patients’ blood
glucose (sugar) level is controlled.
High levels of blood glucose (hyperglycaemia) as a result of too little insulin can lead
to dehydration, coma and death, and low levels (hypoglycaemia) as a result of too
much insulin can lead to coma and death.
Ref: The fourth report from the Patient Safety Observatory. Safety in doses:
medication safety incidents in the NH S National Patient Safety Agency 2007
Insulin Error Examples:
1. A patient required a dose of dextrose and insulin prescribed for high potassium
levels (6 mmol/litre). The dose was not given and the patient later had a cardiac
arrest as a result of the high potassium and died. (Death)
2. A patient was found unresponsive at 6:40 am. The crash team was called but the
highest blood glucose measured during the arrest was 1.2 mmol. The previous
day the patient had received two doses of long-acting insulin analogue at 11:50
and 21:00, instead of a single dose in the morning. (Severe harm)
3. A patient on a GP unit was prescribed 10 units of Glargine insulin. At midday two
staff checked the medication chart and both read it as 100 units; this dose was
then administered. The patient became ill and was transferred to the acute trust
where her blood sugar level was recorded
as 0.5 mmol. A concentrated glucose oral gel was administered and blood sugar
recorded
at 8.4 mmol and then 12 mmol. Patient died in A&E department at 04.00hrs.
(Death)
34
Transcribing
Injectables (high risk medicines)
Paracetamol IV Overdose in a Child
A 3.9kg child was listed for emergency surgery for a bowel obstruction and was
prescribed paracetamol for postoperative pain. Following the surgery the child was
prescribed 29mg (2.9 mL) of IV paracetamol.
On that day, the ward was particularly busy. The nurses preparing to administer the
drug were interrupted at least five times during the preparation and administration
process (by other staff on the ward, patients, parents and the phone).
Loss of concentration and inability to complete the task immediately led to the patient
receiving an overdose of paracetamol. The dose administered was 290mg (29
mL), a ten-fold overdose of the intended strength and double the maximum
recommended dose in BNFC.
Known and well documented patient safety issues have been recorded with
paracetamol overdoses in children.
“In the treatment of children incident reports involving paracetamol, gentamicin,
morphine, vaccines, insulin products and intravenous fluid management were
frequently reported.” Ref: Safety in Doses: improving the use of medicines in the
NHS 2009, http://www.nrls.npsa.nhs.uk/
Gentamicin IV overdose in Adult
A 42 year old patient was admitted for cancer surgery. Patient was otherwise
healthy, without any family history of cancer. After surgery the patient developed a
high fever, which remained unchanged for a week.
A doctor prescribed antibiotics and the instruction was written as
IV. GENTAMICIN 80 mg x 3 P/D
The nurse copied the order as follows:
IV. GENTAMICIN 80 mg x 3 P/DOSE
The nurse who copied the order mistook the letter “D” to mean “dose”, while the
doctor who wrote the order actually meant “day”.
Over the next 10 days, the patient received 240 mg of Gentamicin, three times daily
(a total daily dose of 720mg) instead of a total daily dose of 240mg.
During this time the patient began showing signs of renal failure and hearing
impairment. On the tenth day of treatment, as the senior nurse was taking stock of
the drugs administered, the error was discovered.
The treatment was stopped, but the patient’s general status deteriorated; 10 days
later, the patient died of generalised organ failure.
Source: WHO Patient Safety Curriculum Guide for Medical Schools 2009, Topic 11 Improving
Medication Safety http://www.who.int/patientsafety/education/curriculum/download/en/
Extracted from a role play teaching exercise for students
35
Transcribing
Medicines Errors Activity (continued)
Try working in groups to discuss these examples and answer the questions below
a) What factors do you think contributed to the patient’s harm or death?
b) Who do you think was responsible/accountable?
c) What do you know about the medicines involved?
36
Transcribing
A. Transcribing Activity-High Risk Drugs
Purpose: be familiar with the medicines you deal with
Using the table below, complete this activity by writing down the name of the medicine you are involved in and the risks involved to the
patient if you make a mistake in your work.
You may need to look up these medicines in the BNF https://www.evidence.nhs.uk/formulary/bnf/current to check strengths-or ask
member of your team.
Mistakes could be a wrong strength, a wrong name which is similar, calculation error (mixing up of strengths when converting from
tablets to liquids etc). Don’t forget you can work in groups to help you complete this activity.
Remember: High risk medicines are medicines that are most likely to cause significant harm to the patient, even when used as intended.
What the report found was that the medicines most frequently associated with severe harm were*
Type of drug*
Names of drugs you have transcribed in this
group
Risks to patient if you make a mistake
Anticoagulants
Antibiotics (allergy
related)
Injectable sedatives
Chemotherapy
Opiates
Antipsychotics
Insulins
Infusion fluids
Links: *Reducing Harm from high risk medicines (2008)Patient Safety First! at http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/How-to-guides-2008-09-19/Medicines%201.1_17Sept08.pdf
37