Assessment of Pharmacist Prescription Screening Processes Using Eye Tracking Technology: A Mixed-Method Pilot Study

Background: Accurate medication dispensing is essential for patient safety. Electronic prescription (EP) systems are effective because they support the cognitive functions of pharmacists. Eye tracking provides rapid, objective insights into the visual attention and cognitive engagement of pharmacists interacting with EP interfaces, offering details unmatched by other methods. Objective: To assess prescription screening practice of pharmacists by analyzing their visual attention (fixation duration, scanpath length, and heatmaps) and cognitive engagement (qualitative responses and error detection) with EP systems using eye-tracking technology. Methods: Ten hospital pharmacists reviewed 2 medication error scenarios using eye tracking with the Tobii Eye Tracker 4C. The interface mimicked routine hospital software, allowing free review with no time limits. Participants recorded subjective responses after identifying errors, while software logs captured their visual attention patterns (eg, fixations, scanpaths, and heatmaps) and qualitative responses to assess cognitive engagement. Results: Ten pharmacists participated, including 5 seniors with an average of 9.4 years of hospital experience and 5 juniors with an average of 3 years. A quantitative analysis of heatmaps revealed that senior pharmacists adopt a comprehensive approach, integrating clinical data and medication details, whereas junior pharmacists primarily focus on medication names and doses. A qualitative analysis of participant responses revealed that senior pharmacists demonstrated broader attention patterns during prescription review, facilitating faster, more holistic decision-making. Although most participants correctly identified dosing errors, few participants detected interactions or duplications. These results suggest that experience influences visual focus and accuracy in prescription screening, thereby informing targeted training strategies. Conclusions: Heatmap data revealed that senior pharmacists conducted more comprehensive reviews, with longer fixations correlating with higher accuracy. Most dosing errors were identified, and interactions and duplications were often overlooked because of over-reliance on EP tools and limited clinical judgment. These outcomes indicate the need for targeted pharmacy interventions, including enhanced clinical reasoning training and improved EP interface design for better drug interaction detection.