The frequency and potential causes of dispensing errors in a hospital pharmacy

Eye-tracking-based analysis of pharmacists' thought processes in the dispensing work: research related to the efficiency in dispensing based on right-brain thinking

BACKGROUND

Pharmacists should be aware of their thought processes in dispensing work, including differences in the dispensing complexities owing to different drug positions in the left, center, and right areas. Dispensing errors associated with "same-name drugs (a pair of drugs with the same name but a different ingredient quantity)" are prevalent and often negatively affect patients. In this study, using five pairs of comparative models, the gaze movements of pharmacists in dispensing work were analyzed using an eye-tracking method to elucidate their thought processes.

METHODS

We prepared verification slides and displayed them on a prescription monitor and three drug rack monitors. The dispensing information (drug name, drug usage, location display, and total amount) was displayed on a prescription monitor. A total of 180 drugs including five target drugs were displayed on the three drug rack monitors. Total gaze points in the prescription area, those in the drug rack area, total vertical movements between the two areas, and time required to dispense drugs were measured as the four classifications Gaze 1, Gaze 2, Passage, and Time, respectively. First, we defined the two types of location displays as "numeral combination" and "color/symbol combination." Next, we defined two pairs of models A1-A2 (numerals) and B1-B2 (color/symbol) to compare differences between the left and right areas. Moreover, three pairs of models C1-C2 (left), D1-D2 (center), and E1-E2 (right) were established to compare differences between "numeral combination" and "color/symbol combination."

RESULTS

Significant differences in the complexities of dispensing work were observed in Gaze 2, Passage, and Time between the models A1-A2 (A1B2), and in Gaze 2 and Time between the models C1-C2, D1-D2, and E1-E2 (C1>C2, D1>D2, and E1>E2, respectively).

CONCLUSIONS

Using the current dispensing rules, pharmacists are not good at dispensing drugs located in the right area. An effective measure for reducing the dispensing complexity is to introduce visual information in the prescription content; the utilization of the right brain facilitates reducing the complexity in the right dispensing area.

Impact of implementing the aseptic compounding management system, Medcura, on internal error rates within an oncology pharmacy aseptic unit: a mixed methods evaluation

BACKGROUND

As cancer survivorship improves, pressure on oncology services to provide safe, timely treatments increases. Traditional manual compounding processes are error prone, putting patients at risk. Additionally, errors have a detrimental impact on service delivery and staff morale. Information technology is increasingly utilised to improve safety and service delivery of systemic anti-cancer therapy (SACT). The compounding process control system, Medcura, was developed to manage the end-to-end process and reduce transcription and calculation errors.

OBJECTIVES

To evaluate the impact of implementing Medcura on internal errors and staff perceptions of errors.

METHOD

An aseptic process control system, Medcura, was implemented in a busy pharmacy chemotherapy production unit. Internal error and severity data were collected and analysed for 14 months before and during implementation, and 24 months after implementation. In addition, one-to-one semi-structured interviews were carried out with pharmacy staff, pre- and post-implementation. Interviews were transcribed and thematically analysed.

RESULTS

Error rates decreased after implementation from 2.9% to 2.1%. The types of error detected also changed with a decrease in worksheet and labelling errors, and an increase in assembly errors. The severity of the errors, as a percentage of total errors made, also decreased after implementation. Staff were predominantly positive about Medcura; it reduced the number of errors, eased the preparation of worksheets and labels, reduced pressure and work-related stress, and improved job satisfaction.

CONCLUSIONS

Implementing Medcura has resulted in a reduction in both error rate and severity. Specifically, errors related to label and worksheet generation have seen the largest reduction. Staff have viewed these changes positively and report reduced levels of work-related stress. Further development and roll-out will improve patient safety and staff morale.

A refined management system focusing on medication dispensing errors: A 14-year retrospective study of a hospital outpatient pharmacy

Objectives

This study aimed to evaluate the efficiency of a 14-year refined management system for the reduction of dispensing errors in a large-scale hospital outpatient pharmacy and to determine the effects of person-related and environment-related factors on the occurrence of dispensing errors.

Methods

A retrospective study was performed. Data on dispensing errors, inventory and account management from 2008 to 2021 were collected from the electronic system and evaluated using the direct observation method and the Plan-Do-Check-Act (PDCA) cycle.

Results

The consistency of the inventory and accounts increased substantially (from 86.93 % to 99.75 %) with the implementation of the refined management program. From 2008 to 2021, the total number of dispensing errors was reduced by approximately 96.1 %. The number of dispensing errors in quantity and name was reduced by approximately 98.2 % and 95.07 %, respectively. A remarkable reduction in the error rate was achieved (from 0.014 % to 0.00002 %), and the rate of dispensing errors was significantly reduced (0.019 % vs. 0.0003 %, p < 0.001). Across all medication dispensing errors, human-related errors decreased substantially (208 vs. 7, p < 0.05), as did non-human-related errors also (202 vs. 9, p < 0.05). There was a correlation between the occurrence of errors and pharmacists' sex (females generally made fewer errors than males), age (more errors were made by those aged 31-40 years), and working years (more errors were made by those with more than 11 years of work experience) from 2016 to 2021. The technicians improved during this procedure.

Conclusions

Refined management using the PDCA cycle was helpful in preventing dispensing errors and improving medication safety for patients.

Status of Patient Safety Culture in Community Pharmacy Settings: A Systematic Review

OBJECTIVES

This systematic aimed to understand the global status using the results of survey studies based on the Community Pharmacy Survey on Patient Safety Culture and set the directions of development in terms of the patient safety culture of community pharmacies.

METHODS

Electronic searches were performed in EMBASE, MEDLINE, PubMed, and CINAHL databases by using the words "patient safety," "culture," and "community pharmacy" with synonyms or associated words in the original English language research articles published between January 1, 2012, and March 2, 2023. This systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Eleven surveys from 10 countries were selected. Five studies were conducted on pharmacists, whereas 6 studies were carried out on all pharmacy staff members such as pharmacists, technicians, clerks, and pharmacy students on apprenticeship. There was a considerable variation in the positive response rates across the dimensions of all the surveys. The highest positive response score was demonstrated for "teamwork" and "patient counseling," whereas the "staffing, work pressure, and pace" dimension was essential for improving patient safety culture in community pharmacy settings. For overall rating of the pharmacy on patient safety, 84.8% of pharmacy staff members gave good, very good, or excellent as their responses.

CONCLUSIONS

Despite the differences among studies, findings of this study are expected to be used as valuable evidence to develop patient safety improvement strategies after reflecting each country's health care setting or community pharmacy practice. Furthermore, the results would offer meaningful assistance to achieve the goals of global campaigns such as the World Health Organization Patient Safety Challenge.

An observational study of the cause and frequency of prescription rework in community pharmacies

BACKGROUND

When prescriptions are being processed in pharmacies, 'rework' is a phenomenon where an activity occurs that requires the return to a prior procedural step in the process for correction. To date, little is known regarding rework prevalence in community pharmacies or how this might be minimised.

AIM

To evaluate the cause and frequency of prescription rework in community pharmacies.

METHOD

A list of reworks was designed for community pharmacists to self-record prescription rework instances and causes in their workplace across a two-week period. Community pharmacists in Ireland were recruited via convenience sampling and snowballing. Descriptive statistics were used to assess rework frequency according to the various causes, as well as the pharmacist and pharmacy characteristics.

RESULTS

Eight pharmacists participated, recording 325 reworks across 92.9% of the 65 study days (mean 5 reworks/day). The pharmacists' mean ranged from 1.82 to 15 reworks/day. Pharmacists and pharmacy technicians alone or together were involved in 72.3% of reworks. The three most common rework categories were involving labelling errors (22.8%), prepared prescriptions which necessitated opening and repackaging (15.1%), and medication owings to patients (13.9%).

CONCLUSION

This study reveals that prescription rework occurs frequently in community pharmacies and has provided an indication of some of the main causes. These findings demonstrate areas where pharmacy staff can address rework and should aid the development of approaches to minimise rework in future - thus decreasing workload and facilitating more time for community pharmacy staff to focus on providing patient care.

A Survey of Near-Miss Dispensing Errors in Hospital Pharmacies in Japan: DEPP-J Study-Multi-Center Prospective Observational Study

The aim of this study was to determine the proportion of near-miss dispensing errors in hospital pharmacies in Japan. A prospective multi-center observational study was conducted between December 2018 and March 2019. The primary objective was to determine the proportion of near-miss dispensing errors in hospital pharmacy departments. The secondary objective was to determine the predictive factors for near-miss dispensing errors using multiple logistic regression analysis. The study was approved by the ethical committee at The Institute of Medical Sciences, University of Tokyo, Japan. A multi-center prospective observational study was conducted in 20 hospitals comprising 8862 beds. Across the 20 hospitals, we assessed data from 553 pharmacists and 53039 prescriptions. A near-miss dispensing error proportion of 0.87% (n = 461) was observed in the study. We found predictive factors for dispensing errors in day-time shifts: a higher number of drugs in a prescription, higher number of quantified drugs, such as liquid or powder formula, in a prescription, and higher number of topical agents in a prescription; but we did not observe for career experience level for clinical pharmacists. For night-time and weekend shifts, we observed a negative correlation of near-miss dispensing errors with clinical pharmacist experience level. We found an overall incidence of near-miss dispensing errors of 0.87%. Predictive factors for errors in night-time and weekend shifts was inexperienced pharmacists. We recommended that pharmacy managers should consider education or improved work flow to avoid near-miss dispensing errors by younger pharmacists, especially those working night or weekend shifts.

Analysis of the thinking process of pharmacists in response to changes in the dispensing environment using the eye-tracking method

Background

Pharmacists must understand the mechanisms by which dispensing errors occur and take appropriate preventive measures. In this study, the gaze movements of pharmacists were analyzed using an eye-tracking method, to elucidate the thinking process of pharmacists when identifying target drugs and avoiding dispensing errors.

Methods

We prepared verification slides and projected them on a large screen. Each slide comprised a drug rack area and a prescription area; the former consisted of a grid-like layout with 55 drugs and the latter displayed dispensing information (drug name, drug usage, location number, and total amount). Twelve pharmacists participated in the study, and three single-type drugs and six double-type drugs were used as target drugs. We analyzed the pharmacists’ method of identifying the target drugs, the mechanisms by which errors occurred, and the usefulness of drug photographs using the error-induction (−) /photo (+), error-induction (+) / (+), and error-induction (+) /photo (−) models.

Results

Visual invasion by non-target drugs was found to have an effect on the subsequent occurrence of dispensing errors. In addition, when using error-induction models, the rate of dispensing error was 2.8 and 11.1% for the photo (+) and photo (−) models, respectively. Furthermore, based on the analysis of eight pharmacists who dispensed drugs without errors, it was clear that additional confirmation of “drug name” was required to accurately identify the target drug in the photo (+) model; additionally, that of “location number” was required to pinpoint directly the position of target drug in the photo (−) model.

Conclusions

By analyzing the gaze movements of pharmacists using the eye-tracking method, we clarified pharmacists’ thinking process which was required to avoid dispensing errors in a complicated environment and proved the usefulness of drug photographs in terms of both reducing the complexity of the dispensing process and the risk of dispensing errors. Effective measures to prevent dispensing errors include ensuring non-adjacent placement of double-type drugs and utilization of their image information.

The Myth of Multitasking and What It Means for Future Pharmacists

Objective The primary purposes of this study were to determine the extent to which multitasking affects the speed and accuracy with which Doctor of Pharmacy students identify prescription errors and whether there is a relationship between students' self-perception of their multitasking ability and their actual ability.Methods One hundred twenty-one second-year pharmacy students enrolled in the required course Introduction to Dosage Forms spent one week in an experimental (multitasking) condition and one week in a control (undistracted) condition. Subjects were given 10 minutes to check 10 prescriptions and record any identified filling errors. A cellular phone was placed in each room. Subjects in the experimental (multitasking) condition answered a call from a researcher posing as a talkative customer during the prescription-checking task while subjects in the control condition were not interrupted by a cell phone call during the task. Subjects' completion times and accuracy were recorded.Results When subjects were multitasking, they took significantly longer to complete the prescription-checking task than when they were not multitasking. Furthermore, when subjects were multitasking, they scored significantly lower on the prescription-checking task than when they were not multitasking. Finally, students' self-perceptions of their multitasking abilities were not related to the speed with which they completed the prescription-checking task nor to their accuracy.Conclusion Multitasking negatively affects speed and accuracy of prescription verification in student pharmacists. Our procedure can be used as an in-class activity to demonstrate the limits of attention and to shape how future pharmacists practice.

Liability for Dispensing Errors in Hong Kong

The United Kingdom (UK) case R v Lee (2010) EWCA Crim 1404 resulted in a pharmacist being convicted for an inadvertent dispensing error and paved way for the decriminalisation of such errors by way of a due diligence defence enacted in 2018. In relation to Hong Kong (HK), what is its legal position for dispensing errors, and can it follow the decriminalising steps of UK? The primary objective of this paper is to explore whether and how HK can reach the normative position for a dispensing error legal regime: (1) I posit that the normative position for healthcare professional (HCP) liability for dispensing errors should prioritise the public interest of minimisation of future dispensing errors over the retribution of past wrongs; (2) I illustrate HK's current position for the liabilities of HCPs on dispensing errors, focusing analysis on the relatively controversial aspects of HK's criminal liability, referencing the landmark cases Hin Lin Yee v HKSAR (2009) 13 HKCFAR 142 and Kulemesin v HKSAR (2013) 16 HKCFAR 195 to assist my analysis of the requisite mental element for relevant statutory offences; (3) through comparison with UK's development post-R v Lee and application of Rule of Law principles, HK's current position is critiqued, coming to the conclusion that while there are compelling reasons for the decriminalisation of dispensing errors in HK, the prerequisite for this to happen is an overhaul of regulatory frameworks by significantly increasing levels of accountability.

Medication-related adverse events in health care-what have we learned? A narrative overview of the current knowledge

Purpose

Although medication-related adverse events (MRAEs) in health care are vastly studied, high heterogeneity in study results complicates the interpretations of the current situation. The main objective of this study was to form an up-to-date overview of the current knowledge of the prevalence, risk factors, and surveillance of MRAEs in health care.

Methods

Electronic databases (PubMed, MEDLINE, Web of Science, and Scopus) were searched with applicable search terms to collect information on medication-related adverse events. In order to obtain an up-to-date view of MRAEs, only studies published after 2000 were accepted.

Results

The prevalence rates of different MRAEs vary greatly between individual studies and meta-analyses. Study setting, patient population, and detection methods play an important role in determining detection rates, which should be regarded while interpreting the results. Medication-related adverse events are more common in elderly patients and patients with lowered liver or kidney function, polypharmacy, and a large number of additional comorbidities. However, the risk of MRAEs is also significantly increased by the use of high-risk medicines but also in certain care situations. Preventing MRAEs is important as it will decrease patient mortality and morbidity but also reduce costs and functional challenges related to them.

Conclusions

Medication-related adverse events are highly common and have both immediate and long-term effects to patients and healthcare systems worldwide. Conclusive solutions for prevention of all medication-related harm are impossible to create. In the future, however, the development of efficient real-time detection methods can provide significant improvements for event prevention and forecasting.

Using Prospective Risk Analysis Tools to Improve Safety in Pharmacy Settings: A Systematic Review and Critical Appraisal

OBJECTIVES

This study aimed to review and critically appraise the published literature on 2 selected prospective risk analysis tools, Failure Mode and Effects Analysis and Socio-Technical Probabilistic Risk Assessment, as applied to the dispensing of medicines in both inpatient and outpatient pharmacy settings.

METHODS

A comprehensive search of electronic databases (PubMed and Scopus) was conducted (January 1990-March 2016), supplemented by hand search of reference lists. Eligible articles were assessed for data sources used for the risk analysis, uniformity of the risk quantification framework, and whether the analysis teams assembled were multidisciplinary.

RESULTS

Of 1011 records identified, 11 articles met our inclusion criteria. These studies were mainly focused on dispensing of high-alert medications, and most were conducted in inpatient settings. The main risks identified were transcription, preparation, and selection errors, whereas the most common corrective actions included electronic transmission of prescriptions to the pharmacy, use of barcode, and medication safety training. Significant risk reduction was demonstrated by implementing corrective measures in both inpatient and outpatient pharmacy settings. The main Failure Mode and Effects Analysis limitations were its subjectivity and the lack of common risk quantification criteria.

CONCLUSIONS

The prospective risk analysis methods included in this review revealed relevant safety issues and hold significant potential for risk reduction. They were deemed suitable for application in both inpatient and outpatient pharmacy settings and should form an integral part of any patient safety improvement strategy.

Nature of dispensing errors in selected hospitals providing free healthcare: a multi-center study in Sri Lanka

Background

Dispensing errors, known to result in significant patient harm, are preventable if their nature is known and recognized. However, there is a scarcity of such data on dispensing errors particularly in resource poor settings, where healthcare is provided free-of-charge. Therefore, the purpose of this study was to determine the types, and prevalence of dispensing errors in a selected group of hospitals in Sri Lanka.

Methods

A prospective, cross sectional, multi-center study on dispensing errors was conducted, in a single tertiary care, and two secondary care hospitals, in a cohort of 420 patients attending medical, surgical, diabetic and pediatric clinics. The patients were selected according to the population size, through consecutive sampling. The prescription audit was conducted in terms of dispensing errors which were categorized as i) content, ii) labelling, iii) documentation, iv) concomitant, and v) other errors based on in-house developed definitions.

Results

A total of 420 prescriptions (1849 medicines) were analyzed (Hospital-I, 248 prescriptions-1010 medicines; Hospital-II, 84 prescriptions-400 medicines; Hospital-III, 88 prescriptions-439 medicines), and a cumulative total of 16,689 dispensing errors (at least one dispensing error in a prescription) were detected. Labelling errors were the most frequent dispensing error (63.1%; N = 10,523; Mostly missing information on the dispensing label), followed by concomitant prescribing and dispensing errors (20.5%; N = 3425; Missing prescribing information overlooked by the pharmacist), documentation errors (10.6%; N = 1772 Missing identification of pharmacist on dispensing label), clinically significant medication interactions overlooked by pharmacists (0.5%; N = 82), content errors (4.9%; N = 812; Discrepancies between medication dispensed and prescription order), medications dispensed in unsuitable packaging (0.4%; N = 74), and lastly medication dispensed to the wrong patient (0.01%; N = 1).

Conclusions

Dispensing errors are frequent in Sri Lankan hospitals which operate with limited resources and provide free healthcare to all citizenry. Over one half of the errors were labeling errors with minimal content errors. Awareness on common types of dispensing errors and emphasis on detecting them could improve medication safety in Sri Lankan hospitals.

Categorizing and understanding medication errors in hospital pharmacy in relation to human factors

BACKGROUND

Medication errors (MEs) in hospital settings are attributed to various factors including the human factors. Human factors researches are aiming to implement the knowledge regarding human nature and their interaction with surrounding equipment and environment to design efficient and safe systems. Human Factors Frameworks (HFF) developed awareness regarding main system's components that influence healthcare system and patients' safety. An in-depth evaluation of human factors contributing to medication errors in the hospital pharmacy is crucial to prevent such errors.

OBJECTIVE

This study, therefore, aims to identify and categorize the human factors of MEs in hospital pharmacy using the Human Factors Framework (HFF).

METHOD

A qualitative study conducted in King Saud Medical City, Riyadh, Kingdom of Saudi Arabia. Data collection was carried out in two stages; the first stage was the semi-structured interview with the pharmacist or technician involved in the medication error. Then, occupational burnout and personal fatigue scores of participants were assessed. Data analysis was done using thematic analysis.

RESULTS

A total of 19 interviews were done with pharmacists and technicians. Themes were categorized using HFF into five categories; individual, organization and management, task, work, and team factors. Examples of these themes are poor staff competency, insufficient staff support, Lack of standardization, workload, and prescriber behaviour respectively. Scores of fatigue, work disengagement, and emotional exhaustion are correlating with medium fatigue, high work disengagement, and high emotional exhaustion, respectively.

CONCLUSIONS

The study provided a unique insight into the contributing factors to MEs in the hospital pharmacy. Emotional stress, lack of motivation, high workload, poor communication, and missed patient information on the information system, are examples of the human factors contributing to medication errors. Our study found that among those factors, organizational factors had a major contribution to medication safety and staff wellbeing.

Identifying dispensing errors in pharmacies in a medical science school in Trinidad and Tobago

BACKGROUND

A dispensing error can be defined as an inconsistency between the drug prescribed and drug dispensed to a patient. These errors can lead to ineffective and sometimes unwanted pharmaceutical outcomes. Dispensing errors can be harmful or even fatal to patients.

CASE PRESENTATION

The objective to this study was (a) to determine the types and frequency of dispensing errors at the Eric Williams Medical Sciences Complex (EWMSC), (b) to explore the reasons for the occurrence of dispensing errors, and (c) to make suitable recommendations for their prevention. An observational study for a period of 2 weeks was carried out at various in- and outpatient departments of the EWMSC. The observations were carried out during 7:00 am to 3:00 pm. Dispensing errors identified during this period were recorded and analyzed.

RESULTS

Sixty-eight errors were identified in the adult outpatient pharmacy of the EWMSC; 19 errors in the pediatric outpatient pharmacy, whereas 22 errors were found in inpatient pharmacy. The most common plausible causes for the dispensing errors include high workload, failure to verify patient information, incorrect data in the pharmacy's record system, inadequate notes made by pharmacists during prior patient visit, and in a few cases, uncomfortable working conditions.

CONCLUSION

Dispensing errors were encountered in 2.1% of all the prescriptions filled at the EWMSC pharmacies. The factors which influenced these dispensing errors include but are not limited to a heavy workload, distractions, failure to verify patient information, and uncomfortable working conditions.

Recognition of multifont English electronic prescribing based on convolution neural network algorithm

The printed character recognition is an efficient and automatic method for inputting information to a computer nowadays that is used to translate the printed or handwritten images into an editable and readable text file. This paper aims to recognize a multifont and multisize of the English language printed word for a smart pharmacy purpose. The recognition system has been based on a convolution neural network (CNN) approach where line, word, and character are separately corrected, and then each of the separated characters is fed into the CNN algorithm for recognition purposes. The OpenCV open-source library has been used for preprocessing, which can segment English characters accurately and efficiently, and for recognition, the Keras library with the backend of TensorFlow has been used. The training and testing data sets have been designed to include 23 different fonts with six different sizes. The CNN algorithm achieves the highest accuracy of 96.6% comparing to the other state-of-the-art machine learning methods. The higher classification accuracy of the CNN approach shows that this type of algorithm is ideal for the English language printed word recognition. The highest error rate after testing the system using English electronic prescribing written with all proposed font-types is 0.23% in Georgia font.

A mixed methods analysis of lithium-related patient safety incidents in primary care

BACKGROUND

Lithium is a drug with a narrow therapeutic range and has been associated with a number of serious adverse effects. This study aimed to characterise primary care lithium-related patient safety incidents submitted to the National Reporting and Learning System (NRLS) database with respect to incident origin, type, contributory factors and outcome. The intention was to identify ways to minimise risk to future patients by examining incidents with a range of harm outcomes.

METHODS

A mixed methods analysis of patient safety incident reports related to lithium was conducted. Data from healthcare organisations in England and Wales were extracted from the NRLS database. An exploratory descriptive analysis was undertaken to characterise the most frequent incident types, the associated chain of events and other contributory factors.

RESULTS

A total of 174 reports containing the term 'lithium' were identified. Of these, 41 were excluded and, from the remaining 133 reports, 138 incidents were identified and coded. Community pharmacies reported 100 incidents (96 dispensing related, two administration, two other), general practitioner (GP) practices filed 22 reports and 16 reports originated from other sources. A total of 99 dispensing-related incidents were recorded, 39 resulted from the wrong medication dispensed, 31 the wrong strength, 8 the wrong quantity and 21 other. A total of 128 contributory factors were identified overall; for dispensing incidents, the most common related to medication storage/packaging (n = 41), and 'mistakes' (n = 22), whereas no information regarding contributory factors was provided in 41 reports.

CONCLUSION

Despite the established link between medication packaging and the risk of dispensing errors, our study highlighted storage and packaging as the most commonly described contributory factors to dispensing errors. The absence of certain relevant data limited the ability to fully characterise a number of reports. This highlighted the need to include clear and complete information when submitting reports. This, in turn, may help to better inform the further development of interventions designed to reduce the risk of incidents and improve patient safety.

Workload of pharmacists and the performance of pharmacy services

Objective

To evaluate the influence of pharmacists’ dispensing workload (PDW) on pharmacy services as measured by prescription suggestion rate (PSR) and dispensing error rate (DER).

Method

This was an observational study in northern and southern Taiwan’s two largest medical centers, from 2012 to 2018. We calculated monthly PDW as number of prescriptions divided by number of pharmacist working days. We used monthly PSR and DER as outcome indicators for pharmacists’ review and dispensing services, respectively. We used Poisson regression model with generalized estimation equation methods to evaluate the influence of PDW on PSR and DER.

Results

The monthly mean of 463,587 (SD 32,898) prescriptions yielded mean PDW, PSR and DER of 52 (SD 3) prescriptions per pharmacist working days, 30 (SD 7) and 8 (SD 2) per 10,000 prescriptions monthly, respectively. There was significant negative impact of PDW on PSR (adjusted rate ratio, aRR: 0.9786; 95%CI: 0.9744–0.9829) and DER (aRR: 0.9567; 95%CI: 0.9477–0.9658). Stratified analyses by time periods (2012–2015 and 2016–2018) revealed the impact of PDW on PSR to be similar in both periods; but with positive association between PDW and DER in the more recent one (aRR: 1.0086, 95%CI: 1.0003–1.0169).

Conclusions

Reduced pharmacist workload was associated with re-allocation of pharmacy time to provide prescription suggestions and, more recently, decrease dispensing errors. Continuous efforts to maintain appropriate workload for pharmacists are recommended to ensure prescription quality.

Dispensing errors and self-medication practice observed by community pharmacists in Jordan

BACKGROUND

Drug dispensing is the major function of community pharmacists, the pharmacists should have the ability to counsel the patients and be aware of dispensing errors. Self- medication is a universal phenomenon that is widely practiced in developing countries and it may lead to irrational usage of drugs.

OBJECTIVES

The objectives of this study were identifying the factors that associated with dispensing errors and how to minimize them and identifying patients' reasons for self-medication, drugs purchased as Over-The-Counter drugs, patients' source of drug information.

METHODS

A cross-sectional survey of a stratified random sample of three hundred registered community pharmacists in all Jordanian regions (north, middle and south). Statistical analysis was done by using SPSS software version 17.0.

RESULTS

The majority of respondents were female (72.7%). Poor doctor's handwritten prescription was the major identified factor that associates with despising errors (3.78 out of 5) and improving doctor handwritten or using printed prescription was the most appreciated factor in reducing these errors (4.62 out of 5). Regarding community pharmacists' opinions toward self-medication practice, the majority said that it is not acceptable (4.12 out of 5) and most of the time it leads to bad sequences. Financial problem was the major reason behind self-medication (4.72 out of 5), analgesics/antipyretics were most drug groups that dispensed as OTC drugs (4.85 out of 5) and the pharmacists were a major source of patient' drug information.

CONCLUSION

Drugs dispensing errors and self-medication practices are widespread in Jordan and they should be regulated and restricted throughout applying strong policies and laws. They should be strictly enforced among pharmacies and there is a great responsibility to increase community awareness regarding appropriate drugs using.

New Users of Herbal Medicine Containing Aristolochic Acids and the Risk of Dementia in the Elderly: A Nationwide, Population-Based Study in Taiwan

BACKGROUND

Herbal medicine containing aristolochic acids (HMCAA) was used for inflammatory and infectious diseases. This study aimed to investigate the association between the usage of HMCAA and the risk of dementia.

METHODS

A total of 199 new users of HMCAA were enrolled, along with 597 controls without the usage of HMCAA, at a ratio of 1:3 - matched by age, sex, and comorbidity, between 2000 and 2003 - from the National Health Research Institutes Database (NHRID) of Taiwan, which contains two million randomly sampled subjects, in this cohort study. We used Fine and Gray's survival analysis (competing with mortality) to compare the risk of developing dementia during a 15-year follow-up period (2000-2015).

RESULTS

In general, HMCAA was not significantly associated with dementia (adjusted subdistribution hazard ratio [SHR] = 0.861, 95% confidence interval [CI] = 0.484-1.532, p = 0.611) for the HMCAA-cohort, although differential risk was observed among the groups at risk. The patients with usage of HMCAA aged ≧ 85 years were associated with a higher risk in dementia (adjusted SHR: 6.243, 95% CI=1.258-21.084, p = 0.001), in comparison to those aged 50-54 years. Furthermore, the patients with usage of HMCAA that had cerebrovascular accidents were associated with an increased risk of dementia.

CONCLUSION

The usage of HMCAA was associated with the risk of developing dementia in the patients aged ≧ 85 years.

Integration of a Commercial Barcode-Assisted Medication Dispensing System in a Teaching Hospital

OBJECTIVES

A commercial barcode-assisted medication administration (BCMA) system was integrated to secure the medication process and particularly the dispensing stage by technicians and the administration stage with nurses. We aimed to assess the impact of this system on medication dispensing errors and barriers encountered during integration process.

METHODS

We conducted a controlled randomized study in a teaching hospital, during dispensing process at the pharmacy department. Four wards were randomized in the experimental group and control group, with two wards using the system during 3 days with dedicated pharmacy technicians. The system was a closed loop system without information return to the computerized physician order entry system. The two dedicated technicians had a 1-week training session. Observations were performed by one observer among the four potential observers previously trained. The main outcomes assessed were dispensing error rates and the identification of barriers encountered to expose lessons learned from this study.

RESULTS

There was no difference between the dispensing error rate of the control and experimental groups (7.9% for both, p = 0.927). We identified 10 barriers to pharmacy barcode-assisted system technology deployment. They concerned technical (problems with semantic interoperability interfaces, bad user interface, false errors generated, lack of barcodes), structural (poor integration with local information technology), work force (short staff training period, insufficient workforce), and strategic issues (system performance problems, insufficient budget).

CONCLUSION

This study highlights the difficulties encountered in integrating a commercial system in current hospital information systems. Several issues need to be taken into consideration before the integration of a commercial barcode-assisted system in a teaching hospital. In our experience, interoperability of this system with the electronic health record is the key for the success of this process with an entire closed loop system from prescription to administration. BCMA system at the dispensing process remains essential to purchase securing medication administration process.

The Impact of Phone Interruptions on the Quality of Simulated Medication Order Validation Using Eye Tracking: A Pilot Study

INTRODUCTION

Order validation is an important component of pharmacy services, where pharmacists review orders with a focus on error prevention. Interruptions are frequent and may contribute to a reduction in error detection, thus potential medication errors. However, studying such errors in practice is difficult. Simulation has potential to study these events.

METHODS

This was a pilot, simulation study. The primary objective was to determine the rate of medication error detection and the effect of interruptions on error detection during simulated validation. Secondary objectives included determining time to complete each prescription page. The scenario consisted of validating three handwritten medication order pages containing 12 orders and 17 errors, interrupted by three phone calls timed during one order for each page. Participants were categorized in groups: seniors and juniors (including residents). Simulation sessions were videotaped and eye tracking was used to assist in analysis.

RESULTS

Eight senior and five junior pharmacists were included in the analysis. There was a significant association between interruption and error detection (odds ratio = 0.149, 95% confidence interval = 0.042-0.525, P = 0.005). This association did not vary significantly between groups (P = 0.832). Juniors took more time to validate the first page (10 minutes 56 seconds vs. 6 minutes 42 seconds) but detected more errors (95% vs. 69%). However, all major errors were detected by all participants.

CONCLUSIONS

We observed an association between phone interruptions and a decrease in error detection during simulated validation. Simulation provides an opportunity to study order validation by pharmacists and may be a valuable teaching tool for pharmacists and pharmacy residents learning order validation.

Contributing factors to outpatient pharmacy near miss errors: a Malaysian prospective multi-center study

Background Detecting errors before medication dispensed or 'near misses' is a crucial step to combat the incidence of dispensing error. Despite this, no published evidence available in Malaysia relating to these issues. Objective To determine the incidence of medication labeling and filling errors, frequency of each type of the errors and frequency of the contributing factors at the final stage before dispensing. Setting Six Penang public funded hospitals outpatient pharmacies. Methods A prospective multicentre study, over 8 week's period. Pharmacists identified and recorded the details of either medication labeling and/or filling error at the final stage of counter-checking before dispensing. Besides, the contributing factors for each error were determined and recorded in data collection form. Descriptive analysis was used to explain the study data. Main outcome measure The incidence of near misses. Results A total of 187 errors (near misses) detected, with 59.4% (n = 111) were medication filling errors and 40.6% (n = 76) were labeling errors. Wrong drug (n = 44, 39.6%) was identified as the highest type of filling errors while incorrect dose (n = 34, 44.7%) was identified as the highest type of labeling errors. Distracted and interrupted work environment was reported to lead the highest labeling and filling errors, followed by lack of knowledge and skills for filling errors and high workload for labeling errors. Conclusion The occurrence of near misses related to medication filling and labelling errors is substantial at outpatient pharmacy in Penang public funded hospitals. Further research is warranted to evaluate the intervention strategies needed to reduce the near misses.

Assessment of patient safety culture: a nationwide survey of community pharmacists in Kuwait

BACKGROUND

Medication errors have been the largest component of medical errors threatening patient safety worldwide. Several international health bodies advocate measuring safety culture within healthcare organizations as an effective strategy for sustainable safety improvement. To the best of our knowledge, this is the first study conducted in a Middle Eastern country at the level of community pharmacy, to examine safety culture and to evaluate the extent to which patient safety is a strategic priority.

METHODS

A descriptive cross-sectional study was conducted. The Pharmacy Survey on Patient Safety Culture (PSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ), was used to collect data. PSOPSC is a self-administered questionnaire which was previously tested for validity and reliability. The questionnaire was distributed among pharmacists who work in community pharmacies from the five governorates of Kuwait (Capital, Hawalli, Farwaniya, Jahra, and Ahmadi). The Statistical Package for Social Science (SPSS) software, version 24 was used for analysing data.

RESULTS

A total of 255 community pharmacists from the five governorates were approached to participate in the study, of whom 253 returned a completed questionnaire, with the response rate of 99%. Results from the study showed that patient safety is a strategic priority in many aspects of patient safety standards at the level of community pharmacies. This was reflected by the high positive response rate (PRR) measures demonstrated in the domains of "Teamwork" (96.8%), "Organizational Learning-Continuous Improvement" (93.2%) and "Patient Counselling" (90.9%). On the other hand, the lowest PRR was given to the "Staffing, Work Pressure, and Pace" domain which scored 49.7%.

CONCLUSIONS

Understanding community pharmacists' perspectives of patient safety culture within their organization is critical. It can help identify areas of strength and those that require improvement, which can help support decision about actions to improve patient safety. The current study showed that urgent attention should be given to the areas of weakness, mainly in the dimension of "Staffing, Work Pressure and Pace." The pharmacists pointed the need for adequate breaks between shifts and less distractible work environment to perform their jobs accurately.

Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993-2015

Importance

While much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates.

Objective

The aim of this study was to determine the rate of community pharmacy dispensing errors in the USA.

Methods

English language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature. Studies with a denominator reflecting the total number of prescriptions in the sample were necessary for inclusion in the meta-analysis. A random effects meta-analysis was conducted to estimate an aggregate community pharmacy dispensing error rate. Heterogeneity was assessed using the I² statistic prior to analysis.

Results

The search yielded a total of 8490 records, of which 11 articles were included in the systematic review. Two articles did not have adequate data components to be included in the meta-analysis. Dispensing error rates ranged from 0.00003% (43/1 420 091) to 55% (55/100). The meta-analysis included 1 461 128 prescriptions. The overall community pharmacy dispensing error rate was estimated to be 0.015 (95% CI 0.014 to 0.018); however, significant heterogeneity was observed across studies (I²=99.6). Stratification by study error identification methodology was found to have a significant impact on dispensing error rate (p<0.001).

Conclusion and relevance

There are few published articles that describe community pharmacy dispensing error rates in the USA. Thus, there is limited information about the current rate of community pharmacy dispensing errors. A robust investigation is needed to assess dispensing error rates in the USA to assess the nature and magnitude of the problem and establish prevention strategies.

The Impact of an Automated Dispensing System for Supplying Narcotics in a Surgical Unit: The Experience of the National Cancer Institute Foundation of Milan

Objective: An automated dispensing system for narcotic drugs was introduced in a surgical unit to be compliant with the Italian narcotic drugs regulation. The aim of this study was to evaluate the impact of this automated dispensing system on the incidence of registry errors and corrections and on staff time and hospital costs. Methods: In 2014, Pyxis MedStation 3500 was introduced in a surgical unit of the National Cancer Institute of Milan, to improve the effectiveness of narcotics dispensing and avoid potential errors. Two different time periods of 8 months were compared, respectively, before and after the introduction of the automated dispensing system. In the pre-Pyxis period, drug movements were recorded through paper registries, while in the post-Pyxis period, electronic reports were automatically created from the system. For each period, the number of load/unload registry entries and corrections, the number of registry errors, the staff time dedicated to dispensing and registry activities, and stock and expired drug quantities were recorded. Results: Load and unload errors were reduced by 100% from the pre-Pyxis period to the post-Pyxis period, while registry corrections were lowered by 95%. Time dedicated from nurses to dispensing registration activities was reduced from 36 to 2 hours/month, while pharmacist time lowered from 9 to 1 hours/month. These time savings correspond to an economic saving of ~€4,120 and ~€3,730, respectively. In the post-Pyxis period, average operating room stock quantities were reduced versus the pre-Pyxis period, with wastage being 100% avoided. The reduction in stock drug quantities could correspond to an economic saving of ~€22,300 over the examined 8-month period, while the impact of drug wastage avoidance is modest (~€650). Conclusion: The overall economic impact of Pyxis use, over the 8-month time horizon in analysis, was around €31,000 saved or possibly converted into resource cost dedicated to other added value activities.

Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events during Anesthesia Care

Background

When workload is low, anesthesia providers may perform non–patient care activities of a clinical, educational, or personal nature. Data are limited on the incidence or impact of distractions on actual care. We examined the prevalence of self-initiated nonclinical distractions and their effects on anesthesia workload, vigilance, and the occurrence of nonroutine events.

Methods

In 319 qualifying cases in an academic medical center using a Web-based electronic medical chart, a trained observer recorded video and performed behavioral task analysis. Participant workload and response to a vigilance (alarm) light were randomly measured. Postoperatively, participants were interviewed to elicit possible nonroutine events. Two anesthesiologists reviewed each event to evaluate their association with distractions.

Results

At least one self-initiated distraction was observed in 171 cases (54%), largely during maintenance. Distractions accounted for 2% of case time and lasted 2.3 s (median). The most common distraction was personal internet use. Distractions were more common in longer cases but were not affected by case type or American Society of Anesthesiologists physical status. Workload ratings were significantly lower during distraction-containing case periods and vigilance latencies were significantly longer in cases without any distractions. Three distractions were temporally associated with, but did not cause, events.

Conclusions

Both nurse anesthetists and residents performed potentially distracting tasks of a personal and/or educational nature in a majority of cases. Self-initiated distractions were rarely associated with events. This study suggests that anesthesia professionals using sound judgment can self-manage nonclinical activities. Future efforts should focus on eliminating more cognitively absorbing and less escapable distractions, as well as training in distraction management.

Development of an Automatic Dispensing System for Traditional Chinese Herbs

The gathering of ingredients for decoctions of traditional Chinese herbs still relies on manual dispensation, due to the irregular shape of many items and inconsistencies in weights. In this study, we developed an automatic dispensing system for Chinese herbal decoctions with the aim of reducing manpower costs and the risk of mistakes. We employed machine vision in conjunction with a robot manipulator to facilitate the grasping of ingredients. The name and formulation of the decoction are input via a human-computer interface, and the dispensing of multiple medicine packets is performed automatically. An off-line least-squared curve fitting method was used to calculate the amount of material grasped by the claws and thereby improve system efficiency as well as the accuracy of individual dosages. Experiments on the dispensing of actual ingredients demonstrate the feasibility of the proposed system.

Development of fine-grained pill identification algorithm using deep convolutional network

OBJECTIVE

Oral pills, including tablets and capsules, are one of the most popular pharmaceutical dosage forms available. Compared to other dosage forms, such as liquid and injections, oral pills are very stable and are easy to be administered. However, it is not uncommon for pills to be misidentified, be it within the healthcare institutes or after the pills were dispensed to the patients. Our objective is to develop groundwork for automatic pill identification and verification using Deep Convolutional Network (DCN) that surpasses the existing methods.

MATERIALS AND METHODS

A DCN model was developed using pill images captured with mobile phones under unconstraint environments. The performance of the DCN model was compared to two baseline methods of hand-crafted features.

RESULTS

The DCN model outperforms the baseline methods. The mean accuracy rate of DCN at Top-1 return was 95.35%, whereas the mean accuracy rates of the two baseline methods were 89.00% and 70.65%, respectively. The mean accuracy rates of DCN for Top-5 and Top-10 returns, i.e., 98.75% and 99.55%, were also consistently higher than those of the baseline methods.

DISCUSSION

The images used in this study were captured at various angles and under different level of illumination. DCN model achieved high accuracy despite the suboptimal image quality.

CONCLUSION

The superior performance of DCN underscores the potential of Deep Learning model in the application of pill identification and verification.

Opinions of Maltese doctors and pharmacists on medication errors

BACKGROUND

Pharmacovigilance directive 2010/84/EU focused attention on medication errors and encouraged regulators to identify causing and contributing factors.

OBJECTIVES

(1) To study opinions of doctors/pharmacists on factors bearing a causal link to MEs as well as ways to minimise MEs (2) to test whether differences in opinion exist between subgroups of doctors and pharmacists working in community, hospital or office settings.

METHODS

Different questionnaires were circulated to doctors and pharmacists. Respondents were subdivided according to their primary practice.

RESULTS

320 responses were received (204 doctors/116 pharmacists). Differences in opinion reaching statistical significance were observed on distractions from staff, overwork and fatigue, availability of technical resources and having more than 1 doctor on duty. For pharmacists', differences on issues of generic medicine availability and interruptions were found.

CONCLUSION

Distractions and interruptions while executing tasks was flagged as an area requiring attention. Issues of overwork and fatigue affect especially doctors in hospital the majority of which are of the opinion that regulatory control on patient numbers could minimize errors. Increasing technical resources and keeping knowledge up-to-date, addressing overwork and high patient workloads have been identified as important areas when looking to reduce MEs.

Using an integrated information system to reduce interruptions and the number of non-relevant contacts in the inpatient pharmacy at tertiary hospital

Patient care is provided by a multidisciplinary team of healthcare professionals intended for high-quality and safe patient care. Accordingly, the team must work synergistically and communicate efficiently. In many hospitals, nursing and pharmacy communication relies mainly on telephone calls. In fact, numerous studies have reported telephone calls as a source of interruption for both pharmacy and nursing operations; therefore, the workload increases and the chance of errors raises. This report describes the implementation of an integrated information system that possibly can reduce telephone calls through providing real-time tracking capabilities and sorting prescriptions urgency, thus significantly improving traceability of all prescriptions inside pharmacy. The research design is based on a quasi-experiment using pre-post testing using the continuous improvement approach. The improvement project is performed using a six-step method. A survey was conducted in Prince Sultan Military Medical City (PSMMC) to measure the volume and types of telephone calls before and after implementation to evaluate the impact of the new system. Beforehand of the system implementation, during the two-week measurement period, all pharmacies received 4466 calls and the majority were follow-up calls. Subsequently of the integrated system rollout, there was a significant reduction (p > 0.001) in the volume of telephone calls to 2630 calls; besides, the calls nature turned out to be more professional inquiries (p > 0.001). As a result, avoidable interruptions and workload were decreased.

Physicians' Practice of Dispensing Medicines: A Qualitative Study

OBJECTIVES

The physical act of giving medication to patients to administer away from a health care setting, dispensing, is normally performed by pharmacists. Dispensing of medication by physicians is a neglected patient safety issue, and having observed considerable variation in practice, the lead author sought to explore this issue further. A literature review yielded zero articles pertaining to this, so an exploratory study was commenced. The qualitative arm, relating to junior physicians' experience of, and training in, dispensing, is reported here.

METHODS

Focus groups were conducted to explore the beliefs, ideas, and experiences of physicians-in-training pertaining to dispensing of medication. These were recorded and transcribed. The transcriptions were thematically analyzed using the grounded theory.

RESULTS

The emergency department was the most common site of dispensing. No formal training in dispensing had been received. Informal training was variable in content and utility. The physicians felt that dispensing was part of their role.

CONCLUSIONS

Despite being expected to dispense, and the patient safety issues involved in giving drugs to patients to use at home, physicians do not feel that they have been trained to undertake this task. These findings from 1 hospital raise questions about the wider quality and safety of this practice.

Perception of Community Pharmacists towards Dispensing Errors in Community Pharmacy Setting in Gondar Town, Northwest Ethiopia

Background

Dispensing errors are inevitable occurrences in community pharmacies across the world.

Objective

This study aimed to identify the community pharmacists' perception towards dispensing errors in the community pharmacies in Gondar town, Northwest Ethiopia.

Methods

A cross-sectional study was conducted among 47 community pharmacists selected through convenience sampling. Data were analyzed using SPSS version 20. Descriptive statistics, Mann–Whitney U test, and Pearson's Chi-square test of independence were conducted with P ≤ 0.05 considered statistically significant.

Result

The majority of respondents were in the 23–28-year age group (N = 26, 55.3%) and with at least B.Pharm degree (N = 25, 53.2%). Poor prescription handwriting and similar/confusing names were perceived to be the main contributing factors while all the strategies and types of dispensing errors were highly acknowledged by the respondents. Group differences (P < 0.05) in opinions were largely due to educational level and age.

Conclusion

Dispensing errors were associated with prescribing quality and design of dispensary as well as dispensing procedures. Opinion differences relate to age and educational status of the respondents.

The Relationship between Occurrence Timing of Dispensing Errors and Subsequent Danger to Patients under the Situation According to the Classification of Drugs by Efficacy

There are many reports regarding various medical institutions' attempts at the prevention of dispensing errors. However, the relationship between occurrence timing of dispensing errors and subsequent danger to patients has not been studied under the situation according to the classification of drugs by efficacy. Therefore, we analyzed the relationship between position and time regarding the occurrence of dispensing errors. Furthermore, we investigated the relationship between occurrence timing of them and danger to patients. In this study, dispensing errors and incidents in three categories (drug name errors, drug strength errors, drug count errors) were classified into two groups in terms of its drug efficacy (efficacy similarity (-) group, efficacy similarity (+) group), into three classes in terms of the occurrence timing of dispensing errors (initial phase errors, middle phase errors, final phase errors). Then, the rates of damage shifting from "dispensing errors" to "damage to patients" were compared as an index of danger between two groups and among three classes. Consequently, the rate of damage in "efficacy similarity (-) group" was significantly higher than that in "efficacy similarity (+) group". Furthermore, the rate of damage is the highest in "initial phase errors", the lowest in "final phase errors" among three classes. From the results of this study, it became clear that the earlier the timing of dispensing errors occurs, the more severe the damage to patients becomes.

Improving patient safety through the involvement of patients: development and evaluation of novel interventions to engage patients in preventing patient safety incidents and protecting them against unintended harm

Background

Estimates suggest that, in NHS hospitals, incidents causing harm to patients occur in 10% of admissions, with costs to the NHS of > £2B. About one-third of harmful events are believed to be preventable. Strategies to reduce patient safety incidents (PSIs) have mostly focused on changing systems of care and professional behaviour, with the role that patients can play in enhancing the safety of care being relatively unexplored. However, although the role and effectiveness of patient involvement in safety initiatives is unclear, previous work has identified a general willingness among patients to contribute to initiatives to improve health-care safety.

Aim

Our aim in this programme was to design, develop and evaluate four innovative approaches to engage patients in preventing PSIs: assessing risk, reporting incidents, direct engagement in preventing harm and education and training.

Methods and results

We developed tools to report PSIs [patient incident reporting tool (PIRT)] and provide feedback on factors that might contribute to PSIs in the future [Patient Measure of Safety (PMOS)]. These were combined into a single instrument and evaluated in the Patient Reporting and Action for a Safe Environment (PRASE) intervention using a randomised design. Although take-up of the intervention by, and retention of, participating hospital wards was 100% and patient participation was high at 86%, compliance with the intervention, particularly the implementation of action plans, was poor. We found no significant effect of the intervention on outcomes at 6 or 12 months. The ThinkSAFE project involved the development and evaluation of an intervention to support patients to directly engage with health-care staff to enhance their safety through strategies such as checking their care and speaking up to staff if they had any concerns. The piloting of ThinkSAFE showed that the approach is feasible and acceptable to users and may have the potential to improve patient safety. We also developed a patient safety training programme for junior doctors based on patients who had experienced PSIs recounting their own stories. This approach was compared with traditional methods of patient safety teaching in a randomised controlled trial. The study showed that delivering patient safety training based on patient narratives is feasible and had an effect on emotional engagement and learning about communication. However, there was no effect on changing general attitudes to safety compared with the control.

Conclusion

This research programme has developed a number of novel interventions to engage patients in preventing PSIs and protecting them against unintended harm. In our evaluations of these interventions we have been unable to demonstrate any improvement in patient safety although this conclusion comes with a number of caveats, mainly about the difficulty of measuring patient safety outcomes. Reflecting this difficulty, one of our recommendations for future research is to develop reliable and valid measures to help efficiently evaluate safety improvement interventions. The programme found patients to be willing to codesign, coproduce and participate in initiatives to prevent PSIs and the approaches used were feasible and acceptable. These factors together with recent calls to strengthen the patient voice in health care could suggest that the tools and interventions from this programme would benefit from further development and evaluation.

Trial registration

Current Controlled Trials ISRCTN07689702.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Impact of Medication Dose Tracking Technology on Nursing Practice

Objective: The impact of providing nursing staff access to data collected through a medication dose tracking technology (MDTT) web portal was investigated. Methods: A quasi-experimental, nonrandomized, pre-post intervention study was conducted in the Cardiothoracic Intensive Care Unit (CTICU) at Duke University Hospital. The change in the number of medication requests per dispense routed to the pharmacy electronic health record (EHR) in-basket was analyzed pre and post web portal access. Other endpoints included the number of MDTT web portal queries per day by nursing staff, change in nursing satisfaction survey scores, and technician time associated with processing medication requests pre and post web portal access. The pre web portal access phase of the study occurred from June 1, 2014 to August 31, 2014. The post web portal access phase occurred from October 1, 2014 to December 31, 2014. Results: An 11.4% decrease in the number of medication requests per dispense was exhibited between the pre and post web portal access phases of the study (0.0579 vs 0.0513, respectively; p < .001). Pre and post surveys showed a significant improvement in nurses' satisfaction regarding access to information on the location of medications (p = .009). Additionally, CTICU nursing staff utilized the MDTT web portal for 3.21 queries per day from October 1, 2014 to December 31, 2014. Conclusion: Providing nurses access to data collected via an MDTT decreased the number of communications between nursing and pharmacy staff regarding medication availability and led to statistically significant improvements in nursing satisfaction for certain aspects of the medication distribution process.

Medication dispensing errors in Palestinian community pharmacy practice: a formal consensus using the Delphi technique

Background Medication dispensing errors (MDEs) are frequent in community pharmacy practice. A definition of MDEs and scenarios representing MDE situations in Palestinian community pharmacy practice were not previously approached using formal consensus techniques. Objective This study was conducted to achieve consensus on a definition of MDEs and a wide range of scenarios that should or should not be considered as MDEs in Palestinian community pharmacy practice by a panel of community pharmacists. Setting Community pharmacy practice in Palestine. Method This was a descriptive study using the Delphi technique. A panel of fifty community pharmacists was recruited from different geographical locations of the West Bank of Palestine. A three round Delphi technique was followed to achieve consensus on a proposed definition of MDEs and 83 different scenarios representing potential MDEs using a nine-point scale. Main outcome measure Agreement or disagreement of a panel of community pharmacists on a proposed definition of MDEs and a series of scenarios representing potential MDEs. Results In the first Delphi round, views of key contact community pharmacists on MDEs were explored and situations representing potential MDEs were collected. In the second Delphi round, consensus was achieved to accept the proposed definition and to include 49 (59 %) of the 83 proposed scenarios as MDEs. In the third Delphi round, consensus was achieved to include further 13 (15.7 %) scenarios as MDEs, exclude 9 (10.8 %) scenarios and the rest of 12 (14.5 %) scenarios were considered equivocal based on the opinions of the panelists. Conclusion Consensus on a definition of MDEs and scenarios representing MDE situations in Palestinian community pharmacy practice was achieved using a formal consensus technique. The use of consensual definitions and scenarios representing MDE situations in community pharmacy practice might minimize methodological variations and their significant effects on the number and rate of MDEs reported in different studies.

Relationship between incident types and impact on patients in drug name errors: a correlational study

Background

There are many reports regarding various medical institutions’ attempts at incident prevention, but the relationship between incident types and impact on patients in drug name errors has not been studied. Therefore, we analyzed the relationship between them, while also assessing the relationship between preparation and inspection errors. Furthermore, the present study aimed to clarify the incident types that lead to severe patient damage.

Methods

The investigation object in this study was restricted to “drug name errors”, preparation and inspection errors in them were classified into three categories (similarity of drug efficacy, similarity of drug name, similarity of drug appearance) or two groups (drug efficacy similarity (+) group, drug efficacy similarity (−) group). Then, the relationship between preparation and inspection errors was investigated in three categories, the relationship between incident types and impact on patients was examined in two groups.

Results

The frequency of preparation errors was liable to be caused by the following order: similarity of drug efficacy > similarity of drug name > similarity of drug appearance. In contrast, the rate of inspection errors was liable to be caused by the following order: similarity of drug efficacy < similarity of drug name < similarity of drug appearance. In addition, the number of preparation errors in the drug efficacy similarity (−) group was fewer than that in the drug efficacy similarity (+) group. However, the rate of inspection errors in the drug efficacy similarity (−) group was significantly higher than that in the drug efficacy similarity (+) group. Furthermore, the occupancy rate of preparation errors, incidents more than Level 0, 1, and 2 in the drug efficacy similarity (−) group increased gradually according to the rise of patient damage.

Conclusions

Our results suggest that preparation errors caused by the similarity of drug appearance and/or drug name are likely to lead to the incidents (inspection errors), and these incidents are likely to cause severe damage to patients subsequently.

Electronic supplementary material

The online version of this article (doi:10.1186/s40780-015-0011-x) contains supplementary material, which is available to authorized users.

A systematic review of the nature of dispensing errors in hospital pharmacies

Background

Dispensing errors are common in hospital pharmacies. Investigating dispensing errors is important for identifying the factors involved and developing strategies to reduce their occurrence.

Objectives

To review published studies exploring the incidence and types of dispensing errors in hospital pharmacies and factors contributing to these errors.

Methods

Electronic databases including PubMed, Scopus, Ovid, and Web of Science were searched for articles published between January 2000 and January 2015. Inclusion criteria were: studies published in English, and studies investigating type, incidence and factors contributing to dispensing errors in hospital pharmacies. One researcher searched for all relevant published articles, screened all titles and abstracts, and obtained complete articles. A second researcher assessed the titles, abstracts, and complete articles to verify the reliability of the selected articles.

Key findings

Fifteen studies met the inclusion criteria all of which were conducted in just four countries. Reviewing incident reports and direct observation were the main methods used to investigate dispensing errors. Dispensing error rates varied between countries (0.015%–33.5%) depending on the dispensing system, research method, and classification of dispensing error types. The most frequent dispensing errors reported were dispensing the wrong medicine, dispensing the wrong drug strength, and dispensing the wrong dosage form. The most common factors associated with dispensing errors were: high workload, low staffing, mix-up of look-alike/ sound-alike drugs, lack of knowledge/experience, distractions/interruptions, and communication problems within the dispensary team.

Conclusion

Studies relating to dispensing errors in hospital pharmacies are few in number and have been conducted in just four countries. The majority of these studies focused on the investigation of dispensing error types with no mention of contributing factors or strategies for reducing dispensing errors. Others studies are thus needed to investigate dispensing errors in hospital pharmacies, and a combined approach is recommended to investigate contributing factors associated with dispensing errors and explore strategies for reducing these errors.

Perceived barriers to pharmacist engagement in adverse drug event prevention activities in Ghana using semi-structured interview

Background

Pharmacist involvement in the prevention of medication errors is well documented. One such method, the process by which hospital pharmacists undertake these clinical interventions needs to be described and documented. The perceived barriers to pharmacists succeeding in getting their recommendations accepted could inform future safety strategy development. This study was therefore to trace the typical process involved and explore the perceived barriers to pharmacists’ medication safety efforts.

Methods

This study involved a retrospective evaluation of routine clinical interventions collected at a tertiary hospital in Ghana over 23 months. A sample of pharmacists who had submitted these reports were then interviewed.

Results

The interventions made related to drug therapy changes (76.0 %), monitoring (13.0 %), communication (5.4 %), counselling (5.0 %) and adverse drug events (0.6 %). More than 90 % of interventions were accepted. The results also showed that undertaking clinical interventions by pharmacists followed a sequential order with two interlinked subprocesses: Problem Identification and Problem Handling. In identifying the problem, as much information needed to be gathered, clinical issues identified and then the problems prioritised. During the problem handling stage, detailed assessment was made which led to the development of a pharmaceutical plan. The plan was then implemented and monitored to ensure appropriateness of desired outcomes.

The main barrier mentioned by pharmacist related to the discrepant attitudes of doctors/nurses. The other barriers encountered during these tasks related to workload, and inadequate clinical knowledge. The attitudes were characterised by conflicts and egos resulting from differences in status/authority, responsibilities, and training.

Conclusions

Though the majority of recommendations from pharmacists were accepted, the main barrier to hospital pharmacist engagement in medication error prevention activities related to discrepant attitudes of doctors and nurses. Proper initiation and maintenance of collaborative working relationship in hospitals is desired between the healthcare team members to benefit from the medication safety services of hospital pharmacists.

When the phone rings - factors influencing its impact on the experience of patients and healthcare workers during primary care consultation: a qualitative study

Background

In the primary health care setting, patients interact directly with their healthcare workers (HCW), which include their primary physicians, nurses and pharmacists. Studies have shown that such interactions, when interrupted by phone calls received by either party, can lead to adverse outcomes and negative experiences. There is insufficient data however on the factors affecting the reaction and responses of both patients and HCWs when phone calls occur amidst their interaction. Understanding these factors will allow for the introduction of targeted measures to mitigate the negative impact of such interruptions and improve patient-HCW relationships. This study therefore aims to understand the impact of unplanned phone calls during primary health care consultations on patient–HCW interactions and the factors affecting the patient and the HCW responses.

Method

This study used focus group discussions (FGD) to gather qualitative data from patients and HCWs who had visited or worked in a major public primary healthcare institution in Singapore. The FGDs were audio-recorded, transcribed, audited and analyzed using standard content analysis to identify emergent themes.

Results

15 patients and 16 HCWs participated in 5 FGDs. The key themes that emerged from these FGDs were patients’ and HCWs’ attitudes toward professionalism and respect, task and thought interruption, call characteristics, the impact on patient safety and stakeholders’ experiences. Phone calls during consultations answered by either party often resulted in the answering party feeling apologetic and would usually keep the phone conversations short as a sign of respect to the other party. Both stakeholders valued the consultation time and similarly reported negative experiences if the phone-call interruptions became prolonged. Calls from the desk phone answered by HCWs were perceived by most patients to be relevant to healthcare services, with the assumption that HCWs exercised professionalism and would not attend to personal calls during their clinical duties.HCWs expressed their concerns and distress about potential medical errors due to phone-calls interrupting their clinical tasks and thinking processes. However, they acknowledged that these same phone-calls were important to allow clarifications of instructions and improved the safety of other patients.

Conclusion

Phone interruptions affected patient and HCW interaction during consultations and factors leading to their adverse reactions need to be recognized and addressed.

Differences in recognition of similar medication names between pharmacists and nurses: a retrospective study

Background

Differences in error rates between pharmacists and nurses in terms of drug confirmation have not been studied. The purpose of this study was to analyze differences in error rates between pharmacists and nurses from the viewpoint of error categories, and to clarify differences in recognition regarding drug name similarity.

Methods

In this study, preparation errors and incidents were classified into three categories (drug strength errors, drug name errors, and drug count errors) to investigate the influence of error categories on pharmacists and nurses. In addition, errors in two categories (drug strength errors and drug name errors) were reclassified into another two error groups, to investigate the influence of drug name similarity on pharmacists and nurses: a “drug name similarity (−) group” and a “drug name similarity (+) group”. Then, differences in error rates of pharmacists and those of nurses were analyzed respectively within three categories and two groups. Furthermore, differences in error rates between pharmacists and nurses were analyzed in each of the three categories and two groups.

Results

Error rates of pharmacists for both drug strength errors and drug name errors were significantly higher than that for drug count errors, and similar results were obtained for nurses (P < 0.05). However, there were no significant differences in error rates between pharmacists and nurses in each of the three categories. Furthermore, error rate of nurses was significantly higher than that of pharmacists in the drug name similarity (+) group (P < 0.05), while there was no significant difference in error rates between pharmacists and nurses in the drug name similarity (−) group.

Conclusions

These results suggest that in contrast to pharmacists, nurses are easily affected by similarities in drug names. Therefore, pharmacists should offer information on medications having plural strengths or similar names to nurses, in order to minimize damage to patients resulting from errors.

Electronic supplementary material

The online version of this article (doi:10.1186/s40780-015-0017-4) contains supplementary material, which is available to authorized users.

Consumers' perceptions on the contribution of community pharmacists in the dispensing process at Dawadmi

BACKGROUND

Community pharmacies are widely distributed and developments in this sector will greatly improve pharmaceutical health care delivery.

OBJECTIVES

To provide consumer's perceptions towards the contribution of community pharmacists in the dispensing process.

METHOD

The study was performed from mid-October to mid-November 2013 in Dawadmi, KSA. Data were carried out using a structured face-to-face questionnaire with randomly selected 100 consumers at different community pharmacies. The questionnaire composed of nine closed questions about consumer's perceptions towards the pharmacist's role, counselling quality and dispensing errors in community pharmacies.

RESULTS

Consumers perceive that pharmacists are not committed to dispense medications with prescription (72%), it is embarrassing to ask questions to the pharmacist in the current pharmacy premises (48%), pharmacists do not give enough counselling about their medications (48%) and they previously encountered a dispensing error (26%).

CONCLUSION

The professional performance of community pharmacists in dispensing is below expectation. Majority of consumers perceive that community pharmacists are violating pharmacy law and giving them insufficient medicine information while dispensing. Authorities should stimulate both pharmacist's and consumer's awareness by educational campaign, improve standards for the profession and penalise violators. It is a necessity for community pharmacies to develop consultation areas to assure privacy, improve counselling quality, and reduce dispensing errors.