Errors In Community Pharmacies Research Articles

Outpatient prescriptions practice and writing quality in a paediatric university hospital

The writing of prescriptions is an important aspect of medical practice. This activity presents some specific problems given a danger of misinterpretation and dispensing errors in community pharmacies. The objective of this study was to determine the evolution of the prescription practice and writing quality in the outpatient clinics of our paediatric university hospital. Copies of prescriptions written by physicians were collected from community pharmacies in the region of our hospital for a two-month period in 2005 and 2010. They were analysed according to standard criteria, including both formal and pharmaceutical aspects. A total of 597 handwritten prescriptions were reviewed in 2005 and 633 in 2010. They contained 1,456 drug prescriptions in 2005 and 1,348 in 2010. Fifteen drugs accounted for 80% of all prescriptions and the most common drugs were paracetamol and ibuprofen. A higher proportion of drugs were prescribed as International Nonproprietary Names (INN) or generics in 2010 (24.7%) compared with 2005 (20.9%). Of the drug prescriptions examined, 55.5% were incomplete in 2005 and 69.2% in 2010. Moreover in 2005, 3.2% were legible only with difficulty, 22.9% were ambiguous, and 3.0% contained an error. These proportions rose respectively to 5.2%, 27.8%, and 6.8% in 2010. This study showed that fifteen different drugs represented the majority of prescriptions, and a quarter of them were prescribed as INN or generics in 2010; and that handwritten prescriptions contained numerous omissions and preventable errors. In our hospital computerised prescribing coupled with advanced decision support is eagerly awaited.

Dispensing errors in community pharmacy: patient interview as a tool to determine attitudes

Abstract Focal points

Addition of electronic prescription transmission to computerized prescriber order entry: Effect on dispensing errors in community pharmacies

The addition of electronic prescription transmission to computerized prescriber order entry (CPOE) and its effect on dispensing errors in community pharmacies were evaluated. A controlled, before-and-after trial to measure the effect of electronic prescribing on dispensing errors in two control clinics and one e-prescribing clinic already using CPOE was conducted between January and November 2006. Prescriptions documented within the CPOE system were reconciled with dispensed prescription information from participating pharmacy chains via a national pharmacy information exchange network. Dispensing errors were defined as discrepancies between the prescriber's written orders and the dispensed prescription information. Prescriptions filled at nonparticipating pharmacies were not analyzed. A total of 11,447 prescriptions were written in the control clinics, and 29,575 were written in the e-prescribing clinic. During the intervention period, 2,179 (22%) of 9,905 intervention clinic prescriptions were electronically transmitted, including 621 (28%) available for analysis. There was no significant difference in the dispensing-error rates between the baseline and intervention periods for the control clinics. Similarly, the dispensing-error rates did not differ significantly for the e-prescribing clinic between the baseline and intervention periods for prescriptions that were not electronically transmitted. The e-prescribing clinic's dispensing-error rate for electronically transmitted prescriptions during the intervention was significantly lower than its baseline dispensing-error rate (p = 0.03). Electronic transmission of prescription data from physicians' offices to a pharmacy nearly halved the risk of dispensing errors compared with generating the prescription with outpatient CPOE and printing it and giving it to the patient.

Dispensing errors in community pharmacy: frequency, clinical significance and potential impact of authentication at the point of dispensing

Abstract Objective Our aims were to explore the nature of dispensing errors in community pharmacy, and investigate the potential impact of authentication at the point of dispensing using barcodes or radio-frequency identification tags. Objectives were to develop a dispensing error definition for use in the community setting, to describe the incidence, types and clinical significance of dispensing errors in UK community pharmacies and to assess the likely impact of authentication at the point of dispensing. Setting Eleven UK community pharmacies. Method A definition of a dispensing error was developed using the Delphi technique. A research pharmacist checked dispensed items awaiting collection and compared them against the original prescription to identify dispensing errors. An expert panel assessed the potential clinical significance of the errors identified. We then predicted the likely impact of three different systems of authentication at the point of dispensing: (a) stand-alone; (b) linked to patient medication records (PMR); and (c) linked to electronic transfer of prescriptions (ETP). Key findings We found a content error in 49 (1.7%) of 2859 dispensed items, and a labelling error in 46 (1.6%). The majority (67%) were of minor clinical significance. We estimated that a stand-alone system would prevent about one in five content errors and very few labelling errors, a PMR-linked system would prevent one-quarter of content errors and one-third of labelling errors, and an ETP-linked system would prevent nearly half of content and labelling errors. While none of the three systems would have prevented the one serious error identified, 22–60% of moderate errors could have been prevented, depending on the system used. Conclusion Content errors were identified in 1.7% of dispensed items, and labelling errors in 1.6%. Authentication at the point of dispensing could prevent a significant proportion of these, particularly if the system were linked to PMR or ETP. An experimental study is now needed.

A dictation system for reporting prescribing errors in community pharmacies

Abstract Objective To pilot and evaluate dictation as a novel method of reporting prescribing errors in community pharmacies. Setting Seven community pharmacies in northwestern Vermont. Method An intervention reporting form was developed and implemented in seven community pharmacies. Using a crossover design, pharmacists reported by both dictation and paper methods for six weeks each. The primary objective was to determine if dictation stimulated more prescribing error reports than a paper-based reporting method. Secondary objectives included a qualitative assessment of dictation feasibility, pharmacist satisfaction with reporting in general, pharmacist preference for a dictation or paper reporting method, and a content description of the prescribing errors reported. Key findings Pharmacists completed a total of 72 reports, describing 80 interventions, during the 12-week study. Thirty-three reports were dictated and 39 were completed on paper (P= 0.56). There were no differences in completeness of reports between paper and dictation (P = 0.62). Seven out of the nine pharmacists (78%) stated they preferred the paper method to dictation. Conclusion Dictation does not appear to increase prescribing error reporting as compared with a paper method. Implementing dictation in community pharmacies proved feasible although most of the pharmacists in this study preferred the paper method. Further investigation to explore dictation as a useful technology in community pharmacies is warranted.

Medication errors in community pharmacy: an investigation into the types and potential causes

Abstract Objectives To establish the nature of medication errors occurring within community pharmacy and analyse common error patterns. To identify factors which influence the occurrence of medication errors and near misses, with the intention of designing systems or strategies to reduce the occurrence of these events. Setting Fifteen community pharmacies situated within Brighton and Hove City Primary Care Trust, East Sussex, between January and March 2004. Method A self-reporting form was designed, piloted and administered to pharmacists, which gathered information on the detection of an error or near miss in the dispensing process. Key findings One-hundred and thirteen near misses and thirty-two medication errors were reported. The majority of near misses were detected by the pharmacist at the final check, and the majority of medication errors were detected by the patient or patient's representative. Selection errors were most common, with similar drug names and packaging cited as the main contributory factors. ‘Business’ was frequently cited as the circumstance surrounding the error. Conclusion This study demonstrates that pharmacists do have an important part to play and the positive impact of community pharmacists in preventing, detecting and correcting errors and thus preventing harm to patients in the primary care setting. However, medication errors do occur, and therefore a multifactorial approach by manufacturers, marketing and packaging personnel, in addition to input from pharmacists, may be an effective permanent solution in reducing the errors made.

保険薬局を対象とした調剤過誤管理システムＰＲＥＭ‐Ｓの開発

Various systems for preventing dispensing errors have been developed.Although serious dispensing errors have been reduced by the introduction of these systems,they have not managed to eliminate all dispensing errors in pharmacies since prevention of human error is difficult.Few effective countermeasures have been established due to a lack of information on background factors in reports on dispensing errors and it takes a long time to analyze data if reports are handwritten.We therefore decided to develop a new risk management system to solve these problems.The development of the new system and its effectiveness when used in AIN PHARMACIEZ from October to December in 2008 are described in this report.The new system has 3 features : citation=1)direct reporting of dispensing errors by staff concerned,citation=2)clear distinction between errors and background factors in reports,and citation=3)simple input by means of multiple choice questions.Direct reporting of a dispensing error by the person responsible for it provides information that others can easily understand and it can be used to evaluate any staff problems.Moreover,the input of both numerical data and background factor information to the database enables organizational problems to be analyzed from various points of view.Such analysis should reveal the limitations of current systems for prevention of dispensing errors and lead to the establishment of effective countermeasures.The newly developed system is therefore expected to contribute greatly to the prevention of dispensing errors in pharmacies.

An Investigation on Safety Climate for Preventing Dispensing Errors in Community Pharmacies

We investigated consciousness of the prevention of dispensing errors with the pharmacists and clerical staffs which work in community pharmacies and analyzed the structure of those subconscious to examine preventive measures of dispensing errors. Questionnaire survey was performed for all pharmacists and clerical staffs working in community pharmacies where each is affiliated with four pharmacy groups. The questionnaire consisted of 38 questions about "atmospheres for the prevention of dispensing errors" in the pharmacy along their attributions. And data were analyzed by occupation to confirm the difference. As a result of factor analysis, five factors such as "the posture of the boss", "information exchange", "the order of the pharmacy" were extracted from the pharmacists. Moreover, in the case of the clerical staffs, five similar factors have been extracted besides "a sense of responsibility to duties" replaced "the order of the pharmacy". As a result of structural equation modeling, the pass model with high goodness of fit to which "measures for dispensing error prevention" and "consciousness to the dispensing error of a pharmacy" were assumed to be a subordinate concept respectively by each occupational category. It became clear that a suggestion of the concrete preventive measures drafting was provided even from the investigation of the consciousness level.

Dispensing errors in community pharmacy: perceived influence of sociotechnical factors

This study examined the impact of pharmacists' perceptions of errors in dispensing, errors in communication, delays in prescription processing, efficiency and physical mobility in the pharmacy by practice setting and sociotechnical factors (i.e. pharmacy design, drive through pick-up window services and automated dispensing systems). Community pharmacy practice in the USA. A two-page survey was mailed to a geographically stratified random sample of 1047 community pharmacies. One-way analysis of variance was used to determine the impact of attitudinal items with respect to pharmacy practice setting (e.g. mass merchant, supermarket, chain and independent) and sociotechnical factors. Pharmacy characteristics, pharmacist experience and total dispensing errors were also addressed. The response rate was 45.0% (n = 429). Pharmacists perceived that pharmacy design significantly (P < 0.05) contributed to dispensing errors, errors in communication, problems with efficiency and those similar problems were observed for all items relating to drive through window pick-up services. Automated dispensing systems were perceived as less likely (P < 0.05) to contribute to dispensing errors, errors in communication, efficiency problems and extra physical movement. Perceived dispensing error rate was 0.057%, and the number of dispensing errors was positively and significantly (P < 0.001) correlated with prescription volume. Cognitive errors accounted for approximately 80% of the dispensing errors. Perceptions of dispensing errors by pharmacists are influenced by design, drive through pick-up window services, and automated dispensing systems. However, more effort is needed to determine how cognitive processes relate to sociotechnical variables in pharmacy practice and other environments.

A Survey of the Medication Error Experiences of Pharmacy Technicians

Background: Little is known about pharmacy technicians and their experiences with medication errors in community pharmacies. Objective: To document the opinions and self-reported experiences of medication errors in a sample of community pharmacy technicians. Methods: A telephone survey of one self-identified pharmacy technician from each Vermont community pharmacy was conducted between August and October 2004. Surveys were administered using a standard script. Descriptive statistics were used to summarize quantitative data, and qualitative data were organized into similar categories. Results: Of 128 operating community pharmacies, 72 (56.3%) responded by providing a technician interview. Approximately 70% of technicians reported receiving training in medication errors. Nearly all (93.1%) respondents stated they had come into contact with prescribing errors; 62.7% of technicians cited illegible prescriptions or poor handwriting as examples. Two-thirds (66.7%) of all respondents stated they personally had detected a medication error. Only 2 (2.8%) technicians responded that they had ever completed a medication error report; both submitted the report to their corporate reporting programs. Conclusions: Most technicians are aware of medication errors in their practice, and the majority had personally detected errors. However, nearly one-third of technicians responded that they had never received any training in medication errors. Further research exploring pharmacy technicians' level of training, job experience, and understanding of and ability to report medication errors in a larger, more diverse sample is warranted.

Designing Safe Drug Names

Recent observational studies of medication errors in community pharmacies suggest that 'wrong drug' errors, which occur when a patient receives a drug other than the one prescribed, may occur as many as 3.9 million times per year in the US. Similarity between drug product attributes, especially similarity between drug names, is thought to be a contributing cause of these errors. The challenge facing drug companies is to design new drug names that will not be confused with existing names. In this paper, we attempt to lay out a systematic approach to the design of safe drug names by characterising the process of design as a multiple-objective optimisation problem. We then identify and define the most important constraints (both technical and legal/regulatory) and objectives (such as meaning, memorability, and pronouncability) that a drug name must satisfy and critique methods for evaluating a given name with respect to each safety objective and constraint. There are a variety of preapproval tests that can be done on a name to test its vulnerability to confusion. These include computerised searches for existing similar names or products, soliciting expert judgements, doing traditional psycholinguistic tests on memory and perception and observing error rates during simulated ordering, dispensing and administration tasks. A different set of strategies is needed to prevent confusion between similar names that are already in use. Preventing confusion between already marketed products typically involves collecting voluntary reports of names involved in confusion errors, posting warnings and alerts both electronically and in areas where drugs are used, including the indication on the prescription, storing confusing drugs in different locations, improving lighting, providing magnifiers, removing one of the confusing drugs from the system or insisting on double-checking for products thought to be vulnerable to confusion.Finally, since no single design will be optimal with respect to all of the objectives, we describe several approaches to selecting one design from a set of competing alternatives. The pharmaceutical industry and the US FDA have taken important steps recently to improve the preapproval screening of new drug names, but a great deal of research still needs to be done to establish a valid scientific basis for these decisions.

Prospective study of the incidence, nature and causes of dispensing errors in community pharmacies.

Each year over 600 million prescription items are dispensed in community pharmacies in England and Wales. Despite this, there is little published evidence relating to dispensing errors and near misses occurring in this setting. This study sought to determine their incidence, nature and causes. Prospective study over a 4-week period in 35 community pharmacies (9 independent pharmacies and 26 chain pharmacies) in the UK. Pharmacists recorded details of all incidents that occurred during the dispensing process, including information about: the stage at which the error was detected; who found the error; who made the error; type of error; reported cause of error and circumstances associated with the error. 125,395 prescribed items were dispensed during the study period and 330 incidents were recorded relating to 310 prescriptions. 280 (84.8%) incidents were classified as a near miss (rate per 10,000 items dispensed=22.33, 95%CI 19.79-25.10), while the remaining 50 (15.2%) were classified as dispensing errors (rate per 10,000 items dispensed=3.99, 95%CI 2.96-5.26). Selection errors were the most common types of incidents (199, 60.3%), followed by labeling (109, 33.0%) and bagging errors (22, 6.6%). Most of the incidents were caused either by misreading the prescription (90, 24.5%), similar drug names (62, 16.8%), selecting the previous drug or dose from the patient's medication record on the pharmacy computer (42, 11.4%) or similar packaging (28, 7.6%). This study has demonstrated that a wide range of medication errors occur in community pharmacies. On average, for every 10,000 items dispensed, there are around 22 near misses and four dispensing errors. Given the current plans for reporting adverse events in the NHS, greater insight into the likely incidence and nature of dispensing errors will be helpful in designing effective risk management strategies in primary care.

Medication Dispensing Errors in Community Pharmacies: A Nationwide Study

The available literature concerning medication dispensing errors provides relatively few studies that focus on community-based pharmacies. This paper presents the results of a nationwide, observation-based study of dispensing errors. Although community-based pharmacies were the primary focus, a small number of health-system pharmacies were also included. Investigators collected information concerning the frequency and type of errors and near errors as well as data regarding a number of task and environmental factors previously correlated with dispensing errors. A total of 5,784 prescriptions were inspected, revealing 91 errors (1.57%) and 74 near errors (1.28%). Errors were categorized as either content (41.76%) or labeling (58.24%) errors. Results are consistent with findings in the available literature. In particular, lighting levels, type of inspection system used (e.g., bar code product verification), number of available employees, and the arrangement of drug stock were significantly associated with both types of errors.