Medication Error Reporting Research Articles

Factors influencing the reporting of medication errors and near misses among nurses: A systematic mixed methods review.

This study aimed to systematically review empirical evidence on factors influencing nurses to report medication errors and near misses. There is underreporting of medication errors among nurses, in particular among novice and beginner nurses. To improve quality of care, factors influencing the reporting of medication errors and near misses should be documented. A systematic mixed methods review was conducted. CINAHL, Cochrane Collaboration, Embase, Medline, PsycINFO and Web of Science databases were explored and analysed from December 1990 to December 2023. Two reviewers independently selected and extracted data using a standardized data extraction grid. Data were analysed using thematic analysis based on the adapted theory of planned behaviour. Forty-two studies met the eligibility criteria. Principal factors influencing the reporting of medication errors and near misses among nurses were associated with perceived behavioural control, subjective norm and attitude. Few studies examined factors influencing reporting medication errors and near misses among novice and beginner nurses, and sociodemographic and professional factors. To understand factors influencing reporting of medication errors and near misses, further studies should be conducted to investigate sociodemographic and professional factors.

Improvement proposals and actions in medication error reports: Quality and strength: A cross-sectional study.

Medication errors (MEs) are a significant source of preventable harm in patient care. Voluntary incident reporting and ME reporting systems are essential for managing medication safety. Analyzing aggregated ME reports instead of individual reports can reveal organizational risks. Organizational culture influences reporting activity and the effectiveness of safety improvements depends on their system-focus. This study uses aggregated ME reports to investigate the ME management process and reporting culture in medication safety. It aims to create a hierarchy for ME improvement actions and analyze their strength and management flow in aggregated reports. A retrospective, cross-sectional study was conducted to review improvement proposals and actions of ME reports in a Finnish tertiary hospital in 2017-2021. The improvement proposals and actions were categorized into strength classes during three stages: reporter proposals, manager proposals, and documented actions. The report management flow was analyzed. Descriptive statistics were used to describe the characteristics and the chi-squared test for categorical variables in the statistical analysis. A new strength classification hierarchy was created with three classes and corresponding numerical values: "strong (3)," "medium (2)," and "weak (1)" Additionally, categories for "no action (0)" and "vague (0)" were included. Out of 5463 ME reports analyzed, improvement proposals and actions were predominantly weak, ranging from 23.4% to 54.2% across different stages of the management process. A significant proportion had no action included (20.5-49.1%) or were vague (4.2-20.6%). Analyzing the strength of improvement proposals and actions in aggregated ME reports provides new insights into reporting culture and the ME management. The new combined strength classification hierarchy is a suitable tool for this analysis.

Incidence and type of voluntary reported perianesthetic medication errors in community veterinary clinics in Calgary, Canada.

To collect medication error (ME) data during the perianesthetic period from small animal clinics. 6 small animal general practice veterinary clinics. Small animal general practice veterinary clinics were recruited in this prospective observational study, with staff given a presentation on medical errors and instructed on how to submit medication error reports to an online reporting system. Errors were classified according to type and timing. A total of 2,728 general anesthesia or sedation procedures were performed, with 49 ME reports submitted. One duplicated report of the same error was excluded, resulting in a ME rate of 1.8%. Most reports (69% [33/48]) were near misses. The remaining 31% were MEs that reached the patient but did not cause harm. Wrong dose errors were the most common type (63% [30/48]), of which 80% (24/30) were calculation errors. Premedication/sedation and maintenance were the most reported stages, at 47% (20/43) and 23% (10/43), respectively. None of the MEs reported resulted in an adverse event, with an approximately 2:1 ratio of near-miss to no-harm MEs. The observed patterns of MEs reported, including type and timing, represent a target for further education. These results quantify the ME rate in general practice veterinary clinics, providing an initial benchmark for MEs during the perianesthetic period.

Addressing Medication Administration Safety Through Simulation: A Quasi-Experimental Study Among Nursing Students.

Healthcare institutions are dedicated to minimizing medication errors and promoting their reporting. This study investigates the impact of simulation on nursing students' attitudes toward and intention to report medication errors. A quasi-experimental one-group pre-post-test study was conducted. Third-year nursing students (N = 63) participated in a scenario-based simulation for medication administration. Participants' errors were documented. Participants self-reported attitudes toward medication administration safety and intention to report errors. The most reported error was "contraindicated in disease" (61%). The simulation increased attitudes of preparedness by the training program received (p < 0.01) and belief in the patient's involvement in preventing errors (p < 0.01), and decreased the belief that professional incompetence reveals errors (p = 0.015). Intention to report errors was influenced by medication error training received (p = 0.045), confidence in error reporting (p < 0.001), and a sense of responsibility to disclose errors (p = 0.001). Simulation effectively shapes attitudes and intentions regarding medication error reporting. Improving nursing students' awareness, skills, and clinical judgment can foster a safety culture and potentially reduce patient harm. Future research should examine the long-term effects of simulation and its impact on reducing medication errors.

Antiretroviral adverse drug events reported among adult HIV patients in a Nigerian tertiary hospital: A retrospective study

Background: The use of Highly Active Antiretroviral Therapy (HAART) has changed HIV/AIDS from a near-certainly fatal illness to one that can be managed chronically. A significant constraint of HAART is the high prevalence of adverse drug events (ADE) among HIV patients taking them. Objectives: The study determined the frequency and severity of reported antiretroviral adverse events among HIV-infected adults (≥16 years) at the Institute of Human Virology (IHV) Clinic of Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria, within five years. Antiretroviral therapies implicated in the reported adverse drug events were also determined. Method: Information on reported ADEs was extracted from the NAFDAC Pharmacovigilance forms in the Pharmacovigilance section of the IHV Clinic Pharmacy. The severity of ADEs was classified using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index for categorizing errors. Results: A hundred and nineteen (119) patients reported 161 ADEs within the 5-year study period (2017-2021). Most ADE reports came from females (74.53%) and patients 36-55 years old. Dizziness (31.1%), Rashes (14.3%), and Fatigue (13.0%) were prominent among all the ADE reports documented. TDF/3TC/EFV (57.8%) and AZT/3TC/NVP (11.8 %) combinations were the frequently implicated antiretroviral regimen. All the ADEs reported were mild (Category ‘E’). ADE reports appreciated in the second year and progressively declined afterwards. Conclusion: There is a need to improve the system for antiretroviral ADE reporting through sensitization and developing a specific tool that enhances ADE reports from patients and healthcare providers.

Factors Influencing Novice and Beginner Nurses' Intention to Report Medication Errors and Near Misses.

Novice and beginner nurses make more medical errors than senior nurses. However, there is significant underreporting of medication errors and near misses among novice and beginner nurses. To identify the factors that influence the intention of novice and beginner nurses to report medication errors and near misses. A cross-sectional exploratory study was carried out among third-year nursing students in a Quebec university (n = 143). Data was collected through a self-reported questionnaire based on the adapted Theory of Planned Behavior. Simple descriptive analyses and a series of contingency analyses were performed using Chi-2 or Fisher exact tests. Correction of multiple tests was done using Bonferroni test. All theoretical constructs were significantly associated with intention. Sociodemographic factors (age, sex, experience and education program) were also associated with intention. Further studies are needed to identify the determinants of intention to report medication errors and near misses among novice and beginner nurses. More attention is required in nursing practice and education to act on these factors, thus encouraging novice and beginner nurses to report medication errors and near misses.

A Comprehensive Analysis of Medication Errors on Antimicrobials in a Tertiary Care Hospital of Northern India

Background: Medication errors, resulting from incomplete understanding, pose significant risks to patient safety. Antimicrobial medication error is a global concern further exacerbated by underreporting. This study aims to determine the prevalence of antimicrobial medication errors at a tertiary care medical facility. Methodology: A retrospective study was conducted over six months. Antimicrobial medication errors were analyzed and categorized as prescription, transcription, indenting, dispensing, and administration errors. A total of 208 antimicrobial medication errors were analyzed using the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) risk index. Results: Among 6,439 medication charts assessed, 558 (9%) medication errors were identified, with antimicrobial errors accounting for 208 (37.2%). Prescription errors were the most prevalent (61%), followed by transcription errors (16%) and administration errors (11%). Dispensing, indenting, and documentation errors occurred at rates of 8%, 2%, and 2%, respectively. The primary causes of errors were incorrect doses (47.2%) and frequencies (30%). Approximately 55.3% of antimicrobial medication errors were classified as Category C according to the NCCMERP risk assessment. Conclusion: Prescription errors represent the majority of antimicrobial medication errors, underscoring the need for enhanced vigilance among consultant physicians during prescription writing and drug schedule checks.

Impact of pharmacist‐led discharge medication reconciliation on error and patient harm prevention at a large academic medical center

AbstractIntroductionMedication errors during hospital discharge can lead to adverse outcomes, medication‐related readmissions, and increased health care costs. Pharmacist‐led medication reconciliation at discharge is a potential solution to mitigate poor outcomes and optimize medication safety.ObjectivesThis study aimed to quantify medication errors identified at discharge and characterize the severity of patient harm prevented following pharmacist‐led discharge medication reconciliation. Cost avoidance analysis was conducted to determine its associated financial impact.MethodsPatients, who were discharged from an adult internal medicine service during October 2022, were included in this one‐month pilot prospective quality improvement study. The number of errors at discharge were documented, categorized by type, and adjudicated for severity of potential harm. Error severity was classified based on a modified National Coordinating Council for Medication Error Reporting and Prevention Medication Error Index. Cost avoidance was calculated based on whether each error would have resulted in additional medical encounters and length of stay.ResultsThirty‐one patients were included in the analysis. Forty errors were identified by pharmacist‐led medication reconciliation at discharge, with a mean of 1.3 ± 1.9 errors per patient and 68% of patients having at least one error. The most common errors were duplication of therapy (25%) and medication access barriers at discharge (25%). The severity of errors included low (22.5%), serious (75%), and life‐threatening harm (2.5%). Thirty‐five percent of errors could have led to emergency visits or hospital readmissions. The estimated total cost for errors was $25 600. Pharmacist labor cost for reconciliation was $816. Cost avoidance was $24 784 from the 14 errors at discharge that could have resulted in additional emergency or inpatient visits.ConclusionPharmacist‐led medication reconciliation at discharge may prevent harm from reaching patients, decrease cost from unnecessary health encounters, and stop the error from continuing across transitions of care.

Association Between Professional Commitment and Reported Medication Errors in Nurses

Association Between Professional Commitment and Reported Medication Errors in Nurses

Detection of Adverse Events With the Austrian Inpatient Quality Indicators.

Indicators based on routine data are considered a readily available and cost-effective method for assessing health care quality and safety. The Austrian Inpatient Quality Indicators (A-IQI) have been introduced in all Austrian public hospitals as a mandatory quality measurement. The purpose of this study was to assess the value of conspicuous A-IQI in predicting the presence of adverse events (AEs). We conducted an exploratory study comparing all indicator-positive patient cases contributing to 18 conspicuous A-IQI indicators to randomly selected indicator-negative control cases regarding the prevalence and severity of AEs. Structured medical record review using the Institute for Healthcare Improvement Global Trigger Tool was used as the gold standard. In 421 chart reviews, we identified 158 AEs. 70.9% (n = 112) of the AEs were found in cases with a positive indicator. The relative risk of an AE occurring was 3.47 (95% confidence interval: 2.30, 5.24) in indicator-positive cases compared to indicator-negatives. The proportion of severe events (National Coordination Council for Medication Error Reporting and Prevention Index categories H and I) was 54.5% (n = 61) in indicator-positive cases and only 15.3% (n = 7) in indicator-negative cases. Overall sensitivity of the A-IQI was 68.2%, specificity 69.4%, positive predictive value 36.0%, and negative predictive value 89.6%. Our study shows that significantly more AEs and more severe AEs were found in cases with positive A-IQI than in indicator-negative control cases. However, studies with larger numbers of cases and with larger numbers of conspicuous indicators are needed for the validation of the entire A-IQI indicator set.

Prevalence of Medications Errors and Factors of Harmful Errors in Neonates and Paediatrics at Tertiary and Paediatric Hospitals: A Multicenter Study

Medication errors (ME) are human mistakes that may occur during drug use, prescribing administration or monitoring. This study aimed to determine the Prevalence of MEs among pediatric patients receiving tertiary treatment in pediatric speciality hospitals and describe their patterns and causes. Three institutions participated in a multicenter retrospective analysis. Reports of all MEs involving paediatrics aged ≤13 years who were hospitalised or visited the Emergency Department or outpatient clinics were reviewed 1 January 2019 - 31 December 2019. The National Coordinating Council for Medication Error Reporting and Prevention classification was used to categorise MEs and to define PRME (category CI) and patient–harming MEs (category EI). A retrospective study was conducted with a total of 318 MEs reported, with an overall prevalence of 0.9 per 1,000 patients. The Prevalence was markedly lower in the CHT (0.35 / 1,000 patients) than in KAMC and KFSH&amp;RC (1.73 and 3.5). The highest rate of MEs was observed in admitted wards (14.69 / 1,000 patients). Most commonly, MEs occurred at the prescribing stage (81.1%), were caused by a physician (83.3%), and were discovered by the pharmacist (85.5%). Improper medication dosage (34.0%), frequency (14.2%), and duration (10.4%) were the three most common forms of MEs. Paediatric inpatient treatment has a significant frequency of MEs, accounting for 24% of hospitalisations. The ME may not get to the patient if independent double-check prescriptions, accurate medication reconciliation of new prescriptions against the previously prescribed, and improved medicine labelling and packaging techniques are used.

Evaluation of medication errors in one of the largest public hospital: A retrospective study

BackgroundIn hospitals, medication errors still occur, especially in developing countries such as Indonesia. However, most incidents can be prevented. ObjectiveTo evaluate medication prescription errors for in and out-patients at hospitals based on pharmacists' reports of medical errors. MethodsA retrospective study was carried out between January and December 2021. Pharmacists analyzed medication error reports based on age, sex, drug name list or quantity recorded, prescription listed in the medication error report, and length of hospital stay.Statistical analysis of drug interaction and the factors affecting potential drug interactions was carried out by using multiple linear regression. ResultsApproximately 338 medication errors from 251,491 prescriptions were recorded by pharmacists across hospital departments in 2021. The age of patients with medication errors ranged from newborn babies to 86 years old, with an average of 40.9 years old (±21.03). The most common types of medication errors were prescribing errors (184, 54.4 %). The average length of hospital stay was 11.35 days (±10.36). A total of 557 potential drug interactions were recorded in 182 (53.85 %) prescriptions. The risk for potential drug interaction is increased by the number of medications per prescription (COR = 3.361, P < 0.001) and the age (COR = 1.001, P = 0.033). ConclusionsThe number of medication errors reported was 0.13 per 100 prescriptions, and most of these errors did not affect patients and were, therefore, not harmful. However, further research is needed to analyze medication error reports through collaboration with hospital healthcare professionals.

An Exploration of Nurses' Attitudes and Beliefs on Reporting Medication Errors.

Medication errors in health care are prevalent. Nurses play an important role in reporting; however errors remain underreported in incident reporting systems. Understanding the perspective of nurses will inform strategies to improve reporting and build systems to reduce errors. The purpose of this study was to explore nurses' perceptions and attitudes of medication error reporting practices. This qualitative study used direct content analysis to analyze interview sessions with 21 total nurses. Participant's description of medication error reporting practices fell into 2 themes. Internal factors described circumstances within nurses themselves that affect reporting. External factors described outside influences from processes or places. Medication error reporting is a multidimensional phenomenon with internal and external factors impacting nurses' attitudes and willingness to report errors. Nurses need support from leadership to understand that reporting medication errors can improve practice and impact patient outcomes.

Estimating Proportion and Barriers of Medication Error Reporting Among Nurses in Hail City, Saudi Arabia: Implications for Improving Patient Safety.

Determining the proportion of nurses reporting medication errors (MEs) and identifying the barriers they perceive in ME reporting are crucial to encourage nurses to actively report MEs. This study aimed to determine the proportion of nurses experiencing and reporting MEs, perceived barriers to reporting MEs and their association with nurses' sociodemographic and work-related characteristics. A cross-sectional study was conducted among 350 nurses from June to November 2023. Data about sociodemographic and work-related characteristics, and ME reporting, were collected using a validated self-administered questionnaire. The study found that 34.3% of nurses reported MEs, while 11.1% reported experiencing MEs during their practice. ME reporting was higher proportion among nurses who were older than 40 years (52.1%), males (41.4%), held a master's degree (58.7%), Saudi nationals (37.8%), experienced for more than 10 years (43.1%), working in intensive care units (44.3%), working for 48 hours or more per week (39.7%), working in hospitals with a nurse-to-patient ratio of 1:3 (44.9%) and having a system for incident reporting (37.7%) and with no training on patient safety (44.6%) compared to their counterparts. The rate of experiencing MEs was higher proportion among nurses who were older than 40 years (16.7%), males (17.3%), married (14.8%), Saudi nationals (13.4%), experienced for more than 10 years (15.6%) and with no training on patient safety (15.3%) compared to their counterparts. Lack of knowledge of the person responsible for reporting MEs was the most frequent perceived barrier to ME reporting (66.6%), followed by fears of blame (65.4%). In this study, nurses reported and experienced MEs during their practice. Most nurses perceive the lack of knowledge and fear of blame or disciplinary actions as barriers to reporting. Healthcare administrators should implement educational programs and workshops to increase nurses' awareness of ME reporting.

Competency-Based Medication Administration and Error Reporting.

Accuracy is needed with medication administration, a skill that involves rule-based habits and clinical reasoning. This pilot study investigated the use of an evidence-based checklist for accuracy with oral medication administration and error reporting among prelicensure nursing students. Checklist items were anchored in the mnemonic C-MATCH-REASON© (Client, Medication, ADRs, Time, Client History, Route, Expiration date, Amount, Site, Outcomes, Notation). Nineteen participants randomly assigned to crossover sequence AB or BA (A: checklist; B: no checklist) practiced simulation scenarios with embedded errors. Nursing faculty used an observation form to track error data. Using the C-MATCH-REASON© checklist compared with not using the checklist supported rule adherence (p = .005), knowledge-based error reduction (p = .011), and total error reduction (p = .010). The null hypothesis was not rejected for errors found (p = .061) nor reported (p = .144), possibly due to sample size. C-MATCH-REASON© was effective for error reduction. Study replication with a larger sample is warranted. [J Nurs Educ. 2024;63(5):320-327.].

Reducing Discharge Medication Reconciliation Errors at a Pediatric Neurology Inpatient Unit.

Medication reconciliation errors are a common problem in health care, particularly during transitions of care. Discharge medication reconciliation (DMR) errors in a pediatric setting can range from 26% to 42.2%. We conducted a quality improvement project to decrease DMR error rate at Dayton Children's Hospital in Dayton, Ohio. We conducted 2 interventions, each with 3 Plan-Do-Study-Act cycles from September 2021 through February 2023. The first intervention focused on using current specialty neurology nurses as scribes and creating a template note to include the plan of care and review of DMR before discharge. Our second intervention consisted of standardizing the seizure rescue medication order by creating an order panel within our electronic medical record system for all the rescue medications presently available. Medication errors were documented by the specialty neurology nurse during a phone conversation on the next business day post discharge. DMR error rates were calculated for each week using a control chart. Medication errors and patient harm were classified according to the National Coordinating Council for Medication Error Reporting and Prevention Index. One hundred six errors were noted. Of these, 98 (92%) occurred in patients with seizure and 64 (60%) were related to prescription of seizure rescue medication specifically. The baseline error rate was calculated at 15.7% or 7 errors per month (January 2021 through June 2021). The average error rate dropped from 15.7% to 5.3% (2 errors per month) after initiation of our first intervention (September 2021). Twelve weeks after initiation of the second intervention, a 2.9% (1 error per month) was noted. Afterward, there was a ten-week period of 0% errors. Sustainable reduction of DMR errors in pediatric patients with epilepsy was achieved by using specialty neurology nurses to scribe the care plan and creating order panels to facilitate accuracy of discharge medication orders without additional cost to the hospital.

Examining Barriers and Perceptions in Reporting Medication Administration Errors among Nurses at the Tertiary Care Hospitals in Peshawar Pakistan

Medication administration is vital for patient safety, yet medication errors can lead to life-threatening situations and increased mortality rates. Nurses, being essential members of the healthcare team, are constantly present with patients and regularly tasked with drug administration, facing a significant burden of medication errors compared to other healthcare providers. Objectives: To explore the barriers and perceptions of nurses' regarding medication errors reporting in public sector tertiary care hospitals. Methods: A convenient sample of 209 staff nurses participated in this cross-sectional survey from June to October 2022. A three-part questionnaire was used to gather information on the general characteristics of nurses, the causes of medication errors, and the justifications for not reporting them. Results: The Pharmacy supplies inappropriate doses to this unit with a mean of (2.53 ± 1.28) and an insufficient number of staff nurses in each working shift (4.23 ± 0.76) were the two least and most significant contributing factors to medication errors. Additionally, the two most and least significant factors for not reporting medication errors were that nurses may be held accountable if the patient suffered harm (3.94 ± 1.16) and that nurses did not agree with the hospital's definition of a medication error (2.33 ± 1.26) on average. Conclusions: The main causes of drug mistakes and failure to reveal them were nursing and management issues. Moreover, attempt to establish a blame-free culture to motivate reporting errors.

Barriers to medication error reporting in a federally qualified health center

ObjectiveTo explore the National Coordinating Council for Medication Error Reporting and Prevention Categories of Errors health professionals are most likely to report and characterize what barriers to medication error reporting influence decisions to report and the extent they do so at a large federally qualified health center (FQHC). DesignProspective, cross-sectional, survey. Setting and participantsA total of 161 medical professionals at a large FQHC clinic with a small pharmacy team. Outcome measuresSurvey responses to explore respondent understanding of medication error categories and the influence of barriers to medication error reporting on their decision to report. ResultsThirty-six (22.4%) respondents completed the survey. Nearly 40% of respondents would not report a near-miss error and were influenced by workplace/environmental barriers significantly more than those who would report. Regardless of reporting experience or patient-care role, assessed barrier categories influence the decision to report similarly. ConclusionNear-miss medication errors are inconsistently reported. Efforts to improve reporting should emphasize addressing workplace/environmental barriers.

Prevalence of medication errors and its related factors in Iranian nurses: an updated systematic review and meta-analysis

BackgroundNurses may make medication errors during the implementation of therapeutic interventions, which initially threaten the patient’s health and safety and prolong their hospital stay. These errors have always been a challenge for healthcare systems. Given that factors such as the timing, type, and causes of medication errors can serve as suitable predictors for their occurrence, we have decided to conduct a review study aiming to investigate the prevalence of medication errors and the associated factors among Iranian nurses.MethodsIn this systematic review and meta-analysis, studies were searched on PubMed, Web of Science, Scopus, Google Scholar, IranMedex, Magiran, and SID databases using a combination of keywords and Boolean functions. The study that reported the prevalence of medication errors among nurses in Iran without time limitation up to May 2023 was included in this study.ResultsA total of 36 studies were included in the analysis. The analysis indicates that 54% (95% CI: 43, 65; I2 = 99.3%) of Iranian nurses experienced medication errors. The most common types of medication errors by nurses were wrong timing 27.3% (95% CI: 19, 36; I2 = 95.8%), and wrong dosage 26.4% (95% CI: 20, 33; I2 = 91%). Additionally, the main causes of medication errors among nurses were workload 43%, fatigue 42.7%, and nursing shortage 38.8%. In this study, just 39% (95% CI: 27, 50; I2 = 97.1%) of nurses with medication errors did report their errors. Moreover, the prevalence of medication errors was more in the night shift at 41.1%. The results of the meta-regression showed that publication year and the female-to-male ratio are good predictors of medical errors, but they are not statistically significant(p > 0.05).ConclusionsTo reduce medication errors, nurses need to work in a calm environment that allows for proper nursing interventions and prevents overcrowding in departments. Additionally, considering the low reporting of medication errors to managers, support should be provided to nurses who report medication errors, in order to promote a culture of reporting these errors among Iranian nurses and ensure patient safety is not compromised.

Error reporting in a large animal veterinary teaching hospital identifies medication errors occur most often in the prescribing phase of therapy.

To identify the rate at which medication errors occurred over a 2-year period in a large animal veterinary teaching hospital and describe the types of errors that occurred. 226 medication errors over 6,155 large animal visits occurred during the study period. Multiple errors may have affected the same patient. Medication error reports from March 1, 2021, to March 31, 2023, were reviewed retrospectively and classified by species, type of drug, and month and day of the week the error occurred. Errors were categorized according to multiple previously developed systems to allow for comparison to other studies. 226 medication errors occurred over 6,155 patient visits in a 2-year period: 57.5% (130/226) were identified by a dedicated large animal pharmacist, and 64.2% (145/226) of errors were identified and corrected before reaching the patient. Prescription/medication order errors (58.4% [132/226]) occurred significantly more often than errors in medication preparation (21.7% [49/226]; P < .001) and administration (19.6%; P < .001). Antibiotics (48.7% [110/226]) and NSAIDs (17.7% [40/226]) were the drug classes most involved in errors. Most medication errors in this study occurred in the ordering/prescribing phase. This is similar to reports in human medicine, where standardized medication error reporting strategies exist. Developing and applying similar strategies in veterinary medicine may improve patient safety and outcome.