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

Dispensing Errors and Self-medication Practices-Pharmacists' Experience in Tabuk: A Cross-sectional Study

Background

Community pharmacists are engaged in various professional activities starting from drug dispensing to promoting the well-being of patients. They dispense medications as stated in the prescription and are also licensed to prescribe over-the-counter (OTC) medications. Self-medication is widely practiced in various countries, which may lead to irrational drug use. The objectives of this study were to identify the factors associated with dispensing errors, to find ways to minimize dispensing errors, to identify patients' reasons for self-medication, and to find the drugs commonly utilized by patients as OTC medications and the sources of their drug information.

Methods

A cross-sectional survey of a convenience sample of 286 registered community pharmacists all over Tabuk was conducted using a self-administered questionnaire.

Results

Physician's unclear handwriting in the prescription was the major factor for dispensing error (2.6 out of 3) and writing the prescription clearly by the physician or using a printed form of prescription was an important factor in minimizing dispensing errors (2.91 out of 3). Previous similar complaints in the past were the main reason for self-medication (2.45 out of 3) with analgesics and antipyretics being the commonly dispensed drug groups dispensed as OTC medications (2.95 out of 3).

Conclusion

Self-medication practices and dispensing errors are widespread in Tabuk. Antibiotics were dispensed as OTC medication, which may lead to more chance of irrational drug use. Writing the prescription clearly and legibly would reduce dispensing errors. It is the community pharmacists' responsibility to increase awareness regarding the appropriate use of drugs to the public.

Feasibility of using simulated patients for onsite structured practice feedback in Jordanian community pharmacy settings

Simulated patient (SP) visits followed with structured feedback is useful to outline training needs as well as preference for continuing professional education in community pharmacy settings. This study aimed to investigate community pharmacists' management of an over-the-counter (OTC) product request and feasibility of immediate SP feedback in Jordan. Four trained SP visited a sample of pharmacies in three main urban cities in Jordan requesting an antacid. Information request and professional behavior as well as content of information were evaluated. The SP provided structured immediate feedback. The pharmacy staff views on the visit and usefulness of the feedback were collected. A total of 57 visits were conducted. The average duration of SP visits was 1.55 min. The average score (±SD) for information seeking behavior was 16% (±7) and for professional behavior was 56% (±15). The average score for information provision provided spontaneously was 17.1% (±12). Upon demand by the SP; the average score for information improved to 47.6 (±18). Non-pharmacological advice was not offered often; only 6 (10.5%) visits. Written information was provided in 10 (17.5%) visits. Immediate feedback was accepted by all visited pharmacies. Participants expressed positive views about the SP visit and usefulness of the feedback. Community pharmacists supplied OTC drug without carful screening of symptoms and essential information. The SP approach with immediate feedback was shown feasible and well accepted. Further potential for use of SP with feedback formally in practice and professional development should be explored in future studies.

Assessing content and factors influencing responses to information requests in community pharmacies in Jordan: A simulated patients study

OBJECTIVES

To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community settings and explore the factors influencing the information content.

METHODS

A cross sectional study conducted using the stimulated patient (SP) method between November 2018 and May 2019. The SP conveyed the request at the beginning of the encounter in a standardized way based on predetermined plots and was instructed to ask the pharmacy staff directly if information was not discussed spontaneously. After the visit, the SP provided written feedback including information about the scenario and a copy of individualized feedback. The study was reported according to the checklist for reporting research using simulated patient methodology (CRiSP). Factors influencing information content with or without information demand were investigated.

RESULTS

A total of 55 visits were analyzed. The average content score for the information discussed spontaneously was 16.2% with the standard deviation (SD) equal to15.6. The score improved significantly after information was demanded by the SP; the average total information content score became 34.4% (SD = 16) with p < 0.001. The score of information discussed spontaneously was higher for male pharmacy staff, older age, more experience, and a Pharm D degree. When the SP prompted or demanded for information, older pharmacy staff with more experience and with a college degree scored higher. Independent pharmacies, longer visit durations, and less distraction were associated significantly with higher information scores Pharmacy staff aged 35-39 and those with 6-10 years of experience were significant contributors to spontaneous discussion of information with p values = 0.003 and 0.013, respectively. After the SP demanded information, pharmacy staff with less than 5 years of experience and greater confidence as well as longer visits were positively predicting higher information scores with p values of 0.049, 0.04, and 0.04, respectively.

CONCLUSIONS

Information provided by community pharmacists responding to information requests about prescription only medications was found to be suboptimal. Patient requests for information were found to be a positive driver for better information content. Further research of mixed methodologies is required to clarify the factors and motivators enabling information exchange in community settings and to outline true training needs.

Self-medication among medical students at the Copperbelt University, Zambia: A cross-sectional study

BACKGROUND

Self-medication is a common practice and cause for concern globally. There is a paucity of information regarding students' self‑medication in Zambia. Therefore, this study aimed at determining the self‑medication practices among the medical students at Copperbelt University.

METHODS

A descriptive cross-sectional study was conducted among 334 students. Data was collected using a semi-structured questionnaire, entered in excel, cleaned, and exported to SPSS version 21 for statistical analysis. Univariate analysis using Chi-Square or Fishers Exact test was performed. Independent predictors of self-medication practices were determined using logistic regression. Adjusted Odds ratios (AOR) and their 95% confidence intervals are reported.

RESULTS

A total of 334 medical students, with slightly more females (50.3%, n = 168), participated in the study. Of these 61.1% (n = 204) reported self-medicating. Reasons for self-medicating were the presence of long queues at health facilities and lack of time to visit the hospital. Only the year of study was independently associated with self-medicating with those in their 4th year of study being more likely to self-medicate [AOR:3.43, 95% CI: 1.52-7.73].

CONCLUSION

Students should be educated on the consequences of self-medication practices especially the rational use of antibiotics.

Teleoncology: The Youngest Pillar of Oncology

The core pillars of multimodal care of patients with cancer are surgical, radiation, and medical oncology. The global pandemic of coronavirus disease 2019 (COVID-19) has suddenly resurrected a new pillar in oncology care: teleoncology. With oncologists reaching out to patients through telemedicine, it is possible to evaluate and fulfill patients’ needs; triage patients for elective procedures; screen them for influenza-like illness; provide them with guidance for hospital visits, if needed; and bridge oral medications and treatments when a hospital visit is not desirable because of any high risk-benefit ratio. Teleoncology can bring great reassurance to patients at times when reaching an oncology center is challenging, and more so in resource-constrained countries. Evidence-based treatment protocols, dispensable by teleoncology, already exist for many sites of cancer and they can provide a bridge to treatment when patients are unable to reach cancer centers for their standard treatment. The young pillar of teleoncology is going to remain much longer than COVID-19.

Dispensing errors in community pharmacies in the United Arab Emirates: investigating incidence, types, severity, and causes

BACKGROUND

Medication dispensing is a fundamental function of community pharmacies, and errors that occur during the dispensing process are a major threat to patient safety. However, to date there has been no national study of medication dispensing errors in the United Arab Emirates (UAE).

OBJECTIVE

The study aimed to investigate the incidence, types, clinical significance, causes and predictors of medication dispensing errors.

METHODS

The study was conducted in randomly selected community pharmacies (n=350) across all regions of UAE over six months using a mixed-method approach, incorporating prospective disguised observation of dispensing errors and interviews with pharmacists regarding the causes of errors. A multidisciplinary committee, which included an otolaryngologist, a general practitioner and a clinical pharmacist, evaluated the severity of errors. SPSS (Version 26) was used for data analysis.

RESULTS

The overall rate of medication dispensing errors was 6.7% (n=30912/ 464222), of which 2.6% (n=12274/464222) were prescription-related errors and 4.1% (n= 18638/464222) pharmacist counselling errors. The most common type of prescription-related errors was wrong quantity (30.0%), whereas the most common pharmacist counselling error was wrong drug (32.1%). The majority of errors were caused by medicine replaced with near expire one (24.7%) followed by look-alike/sound-alike drugs (22.3%). The majority of errors were moderate (46.8%) and minor (44.5%); 8.7% were serious errors. Predictors of medication dispensing errors were: grade A pharmacies (dispensing ≥ 60 prescriptions a day (OR 2.1; 95%CI 1.4-3.6; p=0.03) and prescriptions containing ≥4 medication orders (OR 2.5; 95%CI 1.7-4.3; p=0.01).

CONCLUSIONS

Medication dispensing errors are common in the UAE and our findings can be generalised and considered as a reference to launch training programmes on safe medication dispensing practice.

Incidence, nature, severity, and causes of dispensing errors in community pharmacies in Jordan

Background Medication dispensing is a core function of community pharmacies, and errors that occur during the dispensing process are a major concern for pharmacy profession. However, to date there has been no national study of medication dispensing errors in Jordan. Objective The study aimed to investigate the incidence, nature, severity, causes and predictors of medication dispensing errors. Setting The study was conducted in randomly selected community pharmacies across Jordan. Method A mixed method approach was taken, incorporating prospective disguised observation of dispensing errors and interviews with pharmacists regarding the causes of errors. A multidisciplinary committee evaluated the severity of errors. Proportionate random sampling was used to include 350 pharmacies from across all regions of Jordan. SPSS (Version 24) was used for data analysis. Main outcome measure Incidence, nature, severity, causes and predictors of medication dispensing errors. Results The overall rate of medication dispensing errors was 24.6% (n = 37,009/150,442), of which 11.5% (n = 17,352/150,442) were prescription related errors and 13.1% (n = 19,657/150,442) pharmacist counselling errors. The most common type of prescription-related errors were wrong quantity (37.9%, n = 6584/17,352), whereas the most common pharmacist counselling error was wrong drug (41.9%, n = 8241/19,657). The majority of errors were caused by poor handwriting (30.7%, n = 75,651/37,009), followed by high workload (17.3%, n = 22,964/37,009). More than half of errors (52.6%) were moderate in severity, followed by minor errors (38.8%), and 8.6% of errors were rated as serious. Predictors of medication dispensing errors were: Sundays (OR 2.7; 95% CI 2.15-3.94; p = 0.02), grade A pharmacies (dispensing ≥ 60 prescriptions a day (OR 3.6; 95% CI 2.89-4.78; p = 0.04)), and prescriptions containing ≥ 4 medication orders (OR 4.1; 95% CI 2.9-6.4; p = 0.001). Conclusion Medication dispensing errors are common in Jordan and our findings can be generalised and considered as a reference to launch training programmes on safe medication dispensing and independent prescribing for pharmacists.