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Wylegała K, Religioni U, Czech M. The Impact of Hospital Pharmacy Operation on the Quality of Patient Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4137. [PMID: 36901140 PMCID: PMC10002066 DOI: 10.3390/ijerph20054137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
This paper presents the role, tasks, and place of a hospital pharmacy in the structure of the entire facility. The role of hospital drug management and pharmacy seems to be extremely important in providing patients with high-quality care. Particular emphasis was placed on the distribution systems of medicinal products and medical devices in the hospital. The advantages and disadvantages of the classical distribution system and modern systems such as unit-dose and multi-dose-and the most important differences between them-are presented. Difficulties related to implementing modern distribution systems in hospitals were also discussed. The information provided is presented in the context of the legal regulations in Poland.
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Affiliation(s)
- Karolina Wylegała
- Chair and Department of Pharmacoeconomics and Social Pharmacy, Medical University of Poznan, 61-701 Poznan, Poland
- Independent Public Healthcare Center in Miedzychod, 64-400 Miedzychod, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-813 Warsaw, Poland
| | - Marcin Czech
- Department of Pharmacoeconomics, The Institute of Mother and Child, 01-211 Warsaw, Poland
- Business School, Warsaw University of Technology, 00-661 Warsaw, Poland
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Alanazi MF, Shahein MI, Alsharif HM, Alotaibi SM, Alanazi AO, Alanazi AO, Alharbe UA, Almfalh HSS, Amirthalingam P, Hamdan AM, Veeramani VP, Mohamed SHP, Ali MAS. Impact of automated drug dispensing system on patient safety. Pharm Pract (Granada) 2022; 20:2744. [PMID: 36793902 PMCID: PMC9891784 DOI: 10.18549/pharmpract.2022.4.2744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives Automated drug dispensing system (ADDs) is an emerging technology positively impacts drug dispensing efficiency by minimizing medication errors. However, the pharmacist perception of the impact of ADDs on patient safety is not well-established. This cross-sectional observational study aimed to evaluate the dispensing practice and pharmacist perception of ADDs towards patient safety through a validated questionnaire. Methods A self-designed questionnaire was validated and the pharmacist perception of dispensing practice was compared between two hospitals adopting ADDs and traditional drug dispensing system (TDDs). Results The developed questionnaire had an excellent internal consistency (both Cronbach's α and McDonald's ω coefficients were >0.9). Factor analysis retained three significant factors (subscales) that explained pharmacist perception of dispensing system, dispensing practice, and patient counseling (p<0.001 for each factor). The average number of prescriptions dispensed per day, drugs contained in each prescription, average time for labeling each prescription and inventory management were significantly varied between ADDs and TDDs (p=0.027, 0.013 0.044 and 0.004, respectively). The perception of pharmacists using ADDs on three domains were higher than the TDDs. The pharmacists in ADDs agreed that they had enough time to review the medications before dispensing than TDDs and this difference was found to be statistically significant (p=0.028). Conclusions ADDs was highly effective in improving dispensing practice and medication review; however, the pharmacists need to emphasize the importance of ADDs to translate the pharmacists' freed-time towards patient care.
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Affiliation(s)
- Majed Falah Alanazi
- Pharm.D student, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
| | | | | | | | | | | | - Umar Abdolah Alharbe
- Director of Pharmaceutical Care Department, King Fahd Multispecialty Hospital, Tabuk, Saudi Arabia.
| | - Hanad S S Almfalh
- Clinical Pharmacist, King Khalid Civil Hospital, Tabuk, Saudi Arabia.
| | | | - Ahmed Mohsen Hamdan
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
| | - Vinoth Prabhu Veeramani
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
| | | | - Mostafa A Sayed Ali
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia and Department of Clinical Pharmacy, Faculty of Pharmacy, Assuit University, Egypt.
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Alyami MH, Naser AY, Alswar HS, Alyami HS, Alyami AH, Al Sulayyim HJ. Medication errors in Najran, Saudi Arabia: reporting, responsibility, and characteristics: a cross-sectional study. Saudi Pharm J 2022; 30:329-336. [PMID: 35527831 PMCID: PMC9068573 DOI: 10.1016/j.jsps.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Medication error is a preventable adverse effect of medical care, whether or not it is evident or harmful to the patient. Disclosure of medication errors and improvement of patient safety are inexorably related, and they provide one of the strongest reasons to report and disclose errors, including near misses in which no harm comes to the patient. This study aimed to identify medication errors at the southern province of Saudi Arabia. Methods A cross-sectional retrospective study was conducted by reviewing all medical records in the King Khaled Hospital in Najran, Saudi Arabia. Medication errors related information were extracted from the electronic medical system for the duration between 2018 and 2020. Results During the study period of 2018 to 2020, a total of 4860 medication errors were identified. More than half of the reported medication errors (66.9%) were linked to ordering, prescribing, or transcribing medications. The most commonly reported medication errors connected to ordering/prescribing/transcribing were inappropriate dosage, dosage units, and therapeutic duplication of medication. The most commonly reported medication errors linked to administration were missing documentation during administration, not performing independent double-checks during the administration of high alert medications, and the administration of look-alike sound-alike (LASA) medications. The intensive care unit (ICU), female medical ward, and male medical ward were the most commonly reported locations for medication errors. Pharmacists detected more than half of the reported medication errors. Physicians were found to be responsible for 66.0% of reported medication errors, followed by nurses. Conclusion Medication errors are common in hospital settings in Saudi Arabia's southern provinces. Efforts should be made to improve drug ordering, prescribing, and transcription in hospital settings. To guarantee optimum practices, the entire medical team should take responsibility for the patient's optimal medication administration.
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The effect of educational interventions on medication dispensing errors: a randomised controlled trial in community pharmacies in Jordan. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dilsha RAN, Kularathne HMIP, Mujammil MTM, Irshad SMM, Samaranayake NR. Nature of dispensing errors in selected hospitals providing free healthcare: a multi-center study in Sri Lanka. BMC Health Serv Res 2020; 20:1140. [PMID: 33317531 PMCID: PMC7734753 DOI: 10.1186/s12913-020-05968-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/25/2020] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- R A N Dilsha
- Department of Pharmacy, Faculty of Health Sciences, The Open University of Sri Lanka, Nugegoda, Sri Lanka
| | - H M I P Kularathne
- Department of Pharmacy, Faculty of Health Sciences, The Open University of Sri Lanka, Nugegoda, Sri Lanka
| | - M T M Mujammil
- Department of Pharmacy, Faculty of Health Sciences, The Open University of Sri Lanka, Nugegoda, Sri Lanka
| | - S M M Irshad
- Department of Pharmacy, Faculty of Health Sciences, The Open University of Sri Lanka, Nugegoda, Sri Lanka
| | - N R Samaranayake
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
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Bellegarde J, Bernard L, Chennell P, Sautou V. On-call duties in hospital pharmacies: National survey and elaboration of a training program for pharmacy residents. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 79:142-151. [PMID: 33049254 DOI: 10.1016/j.pharma.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES During their residency, pharmacy residents are required to attend a hospital on-call program in order to insure the continuum of care for inpatients. This activity is subject to risks, and requires a prior training. Our aim was to develop and to optimize such a training program. METHODS To this end, we first established a baseline study of the existing training methods in our hospital and those in the different hospitals of France in which pharmacy residents realize in-house on-call duties, associated with an identification of both pharmacists and students' needs in our institution. These preliminary studies were used to create a transversal, structured and harmonized training program. RESULTS The results of our national survey highlighted great disparities of training between the establishments and point out the lack of structure, organization and harmonization of the training, which residents expected to be improved. Our training program contains 3 parts: initial theoretical training, initial practical training and continuous training. Beyond the harmonization of the theoretical training's materials between the different sectors of the pharmacy, new tools were introduced like an in-house on-call duty notebook complementary to trainings adapted to note taking, simulation's workshops and interactive quizzes. The training was gradually implemented in our hospital pharmacy, in collaboration with the pharmacists of the different activity sectors. CONCLUSIONS The next steps of our work will be to assess pharmacists and pharmacy residents' satisfaction about our program and its efficacy.
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Affiliation(s)
- J Bellegarde
- CHU de Clermont-Ferrand, pôle pharmacie, Clermont-Ferrand, France
| | - L Bernard
- Université Clermont-Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - P Chennell
- Université Clermont-Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - V Sautou
- Université Clermont-Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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Ibrahim OM, Ibrahim RM, Meslamani AZA, Mazrouei NA. Dispensing errors in community pharmacies in the United Arab Emirates: investigating incidence, types, severity, and causes. Pharm Pract (Granada) 2020; 18:2111. [PMID: 33149793 PMCID: PMC7603657 DOI: 10.18549/pharmpract.2020.4.2111] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/10/2020] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Osama Mohamed Ibrahim
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah. Sharjah (United Arab Emirates).
| | - Rana M Ibrahim
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah. Sharjah (United Arab Emirates).
| | - Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University of Science and Technology. Abu Dhabi (United Arab Emirates).
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah. Sharjah (United Arab Emirates).
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Abdel-Qader DH, Al Meslamani AZ, Lewis PJ, Hamadi S. Incidence, nature, severity, and causes of dispensing errors in community pharmacies in Jordan. Int J Clin Pharm 2020; 43:165-173. [PMID: 32803560 DOI: 10.1007/s11096-020-01126-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Derar H Abdel-Qader
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan.
| | | | - Penny J Lewis
- Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Salim Hamadi
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
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Portelli G, Canobbio M, Bitonti R, Della Costanza C, Langella R, Ladisa V. The Impact of an Automated Dispensing System for Supplying Narcotics in a Surgical Unit: The Experience of the National Cancer Institute Foundation of Milan. Hosp Pharm 2018. [DOI: 10.1177/0018578718797265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Vito Ladisa
- National Cancer Institute Foundation of Milan, Italy
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Ogunleye OO, Oreagba IA, Falade C, Isah A, Enwere O, Olayemi S, Ogundele SO, Obiako R, Odesanya R, Bassi P, Obodo J, Kilani J, Ekoja M. Medication errors among health professionals in Nigeria: A national survey. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2016; 28:77-91. [DOI: 10.3233/jrs-160721] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Olayinka O. Ogunleye
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Ibrahim A. Oreagba
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Catherine Falade
- Clinical Pharmacology Department, University College Hospital, Ibadan, Nigeria
| | - Ambrose Isah
- Department of Medicine, University of Benin Teaching Hospital, Benin-City, Nigeria
| | - Okezie Enwere
- Department of Medicine, Imo State University Teaching Hospital, Orlu, Imo State, Nigeria
| | - Sunday Olayemi
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Sunday O. Ogundele
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Rachel Odesanya
- Department of Pharmacy, Jos University Teaching Hospital, Jos, Nigeria
| | - Peter Bassi
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - John Obodo
- Department of Medicine, Delta State University Teaching Hospital, Asaba, Nigeria
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Stojković T, Marinković V, Krajnović D, Tasić L, Milošević-Georgiev A. PATIENT SAFETY AND MEDICATION ERRORS IN THE PROVISION OF HEALTH CARE SERVICES-CHALLENGES FOR CONTEMPORARY PRACTICE. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Aldhwaihi K, Schifano F, Pezzolesi C, Umaru N. A systematic review of the nature of dispensing errors in hospital pharmacies. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2016; 5:1-10. [PMID: 29354533 PMCID: PMC5741032 DOI: 10.2147/iprp.s95733] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Khaled Aldhwaihi
- Department of Pharmacy, University of Hertfordshire, Hatfield, UK
| | | | - Cinzia Pezzolesi
- Department of Pharmacy, University of Hertfordshire, Hatfield, UK
| | - Nkiruka Umaru
- Department of Pharmacy, University of Hertfordshire, Hatfield, UK
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Ernawati DK, Lee YP, Hughes JD. Nature and frequency of medication errors in a geriatric ward: an Indonesian experience. Ther Clin Risk Manag 2014; 10:413-21. [PMID: 24940067 PMCID: PMC4051811 DOI: 10.2147/tcrm.s61687] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the nature and frequency of medication errors during medication delivery processes in a public teaching hospital geriatric ward in Bali, Indonesia. METHODS A 20-week prospective study on medication errors occurring during the medication delivery process was conducted in a geriatric ward in a public teaching hospital in Bali, Indonesia. Participants selected were inpatients aged more than 60 years. Patients were excluded if they had a malignancy, were undergoing surgery, or receiving chemotherapy treatment. The occurrence of medication errors in prescribing, transcribing, dispensing, and administration were detected by the investigator providing in-hospital clinical pharmacy services. RESULTS Seven hundred and seventy drug orders and 7,662 drug doses were reviewed as part of the study. There were 1,563 medication errors detected among the 7,662 drug doses reviewed, representing an error rate of 20.4%. Administration errors were the most frequent medication errors identified (59%), followed by transcription errors (15%), dispensing errors (14%), and prescribing errors (7%). Errors in documentation were the most common form of administration errors. Of these errors, 2.4% were classified as potentially serious and 10.3% as potentially significant. CONCLUSION Medication errors occurred in every stage of the medication delivery process, with administration errors being the most frequent. The majority of errors identified in the administration stage were related to documentation. Provision of in-hospital clinical pharmacy services could potentially play a significant role in detecting and preventing medication errors.
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Affiliation(s)
- Desak Ketut Ernawati
- Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
- School of Pharmacy and Curtin Health Innovation and Research Institute, Curtin University, Perth, WA, Australia
| | - Ya Ping Lee
- School of Pharmacy and Curtin Health Innovation and Research Institute, Curtin University, Perth, WA, Australia
| | - Jeffery David Hughes
- School of Pharmacy and Curtin Health Innovation and Research Institute, Curtin University, Perth, WA, Australia
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Medication errors in a Spanish community pharmacy: nature, frequency and potential causes. Int J Clin Pharm 2012; 35:185-9. [PMID: 23250507 DOI: 10.1007/s11096-012-9741-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 12/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Medication safety has long been recognized as a key issue within the broader patient safety agenda. Errors can occur at any step along the way, from prescribing to the ultimate provision of the drug to the patient. OBJECTIVE To study the nature, frequency and potential causes of medication errors in one Spanish community pharmacy. METHODS A study was conducted over a 13-month period. The data included three types of written reports of incidents: prescribing errors, dispensing near-misses, and dispensing errors. Data for medication errors were collected through the internal records of the pharmacy. RESULTS The sample consisted of 42,000 individual prescriptions, in which there were 2,117 medication errors consisting of 1,127 prescribing errors, 216 dispensing errors, and 774 dispensing near-misses. On the basis of the number of prescriptions handled during the study period, we calculated an error rate of 5.0 % (95 % confidence interval 4.8-5.2 %). The most common cause was illegible prescription (26.2 %). CONCLUSION This study has shown the incidence of medication errors in the health system and the possibility of detecting them in the community pharmacy. Most of the errors that occurred were reported in the prescribing stage; dispensing errors were reported less frequently.
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Thomas L, Cordonnier-Jourdin C, Benhamou-Jantelet G, Diviné C, Le Louët H. Medication errors management process in hospital: a 6-month pilot study. Fundam Clin Pharmacol 2011; 25:768-75. [PMID: 21210845 DOI: 10.1111/j.1472-8206.2010.00907.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objectives of this study are to assess the relevance of the medication error reporting system in a French teaching hospital, to enable the collection of medication error reports and to take corrective actions to reduce occurrence. This is a prospective pilot study based on blame-free reporting by healthcare professionals. The study setting is five medical/surgical departments in a French teaching hospital over a 6-month period. The main outcomes of this study are types, frequency, and consequences of medication errors reported. Over a 6-month period, 47 medication errors were reported. Twenty-eight (60%) were related to the prescription process, of which 17 were prescribing errors, 10 were because of data capture error and one was because of software malfunction. Ten medication errors (21%) were related to the dispensing process and eight (17%) to errors occurring during drug administration. Finally, one medication error (2%) was related to prescription, dispensing, and administration. The reporting process was accepted by most healthcare professionals who agreed to initiate medication errors reports upon assurance that data collection will be confidential. The reporting process led to several avoidance actions to minimize the medication error risk. Maintaining confidentiality embedded within a nonpunitive environment, this method was accepted by all participating personnel. Medication errors could be collected, reviewed, and corrective actions taken. This strategy can be a first step in a long-term ongoing process to prevent future medication errors in hospitals.
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Affiliation(s)
- Laure Thomas
- Pharmacovigilance Center, Chenevier-Mondor Hospital, AP-HP, 51 av. du Mal de Lattre de Tassigny 94010 Créteil, France.
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T H, Heelon M, Siano B, Douglass L, Liebro P, Spath B, Kudler N, Kerr G. Medication safety improves after implementation of positive patient identification. Appl Clin Inform 2010; 1:213-20. [PMID: 23616837 DOI: 10.4338/aci-2010-02-ra-0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 06/10/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To report the incidence and severity of medication safety events before and after initiation of barcode scanning for positive patient identification (PPID) in a large teaching hospital. METHODS Retrospective analysis of data from an existing safety reporting system with anonymous and non-punitive self-reporting. Medication safety events were categorized as "near-miss" (unsafe conditions or caught before reaching the patient) or reaching the patient, with requisite additional monitoring or treatment. Baseline and post-PPID implementation data on events per 1,000,000 drug administrations were compared by chi-square with p<0.05 considered significant. RESULTS An average of 510,541 doses were dispensed each month in 2008. Total self-reported medication errors initially increased from 20 per million doses dispensed pre-barcoding (first quarter 2008) to 38 per million doses dispensed immediately post-intervention (last quarter 2008), but errors reaching the patient decreased from 3.26 per million to 0.8 per million despite the increase in "near-misses". A number of process issues were identified and improved, including additional training and equipment, instituting ParX scanning when filling Pyxis machines, and lobbying for a manufacturing change in how bar codes were printed on bags of intravenous solutions to reduce scanning failures. CONCLUSION Introduction of barcoding of medications and patient wristbands reduced serious medication dispensing errors reaching the patient, but temporarily increased the number of "near-miss" situations reported. Overall patient safety improved with the barcoding and positive patient identification initiative. These results have been sustained during the 18 months following full implementation.
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Alvarez Díaz AM, Delgado Silveira E, Pérez Menéndez-Conde C, Pintor Recuenco R, Gómez de Salazar López de Silanes E, Serna Pérez J, Mendoza Jiménez T, Bermejo Vicedo T. [New technologies applied to the medication-dispensing process, error analysis and contributing factors]. FARMACIA HOSPITALARIA 2010; 34:59-67. [PMID: 20206565 DOI: 10.1016/j.farma.2009.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/18/2009] [Accepted: 12/21/2009] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Calculate error prevalence occurred in different medication-dispensing systems, the stages of occurrence, and contributing factors. METHODOLOGY Prospective observational study. The staging of the dispensing process were reviewed in five dispensing systems: Stock, Unitary-Dose dispensing systems (UDDS) without Computerized Prescription Order Entry (CPOE), CPOE-UDDS, Automated Dispensing Systems (ADS) without CPOE and CPOE-ADS. Dispensing errors were identified, together with the stages of occurrence of such errors and their contributing factors. RESULTS 2,181 errors were detected among 54,169 opportunities of error. Error-rate: Stock, 10.7%; no-CPOE-UDDS, 3.7%, CPOE-UDDS, 2.2%, no-CPOE-ADS, 20.7%; CPOE-ADS, 2.9%. Most frequent stage when error occurs: Stock, preparation of order; no-CPOE-UDDS and CPOE-UDDS, filling of the unit dose cart; no-CPOE-ADS and CPOE-ADS, filling of the ADS. Most frequent error: Stock, no-CPOE-ADS and CPOE-ADS, omission; CPOE-UDDS, different amount of drug and no-CPOE-UDDS, extra medication. Contributing factor: Stock, CPOE-ADS and no-CPOE-ADS, stock out/supply problems; CPOE-UDDS, inexperienced personnel and deficient communication system between professionals; no-CPOE-UDDS, deficient communication system between professionals. CONCLUSIONS Applying new technologies to the dispensing process has increased its safety, particularly, implementation of CPOE has enabled to reduce dispensing errors.
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Affiliation(s)
- A M Alvarez Díaz
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Cheung KC, Bouvy ML, De Smet PAGM. Medication errors: the importance of safe dispensing. Br J Clin Pharmacol 2010; 67:676-80. [PMID: 19594537 DOI: 10.1111/j.1365-2125.2009.03428.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
1. Although rates of dispensing errors are generally low, further improvements in pharmacy distribution systems are still important because pharmacies dispense such high volumes of medications that even a low error rate can translate into a large number of errors. 2. From the perspective of pharmacy organization and quality assurance, pharmacists should intensify their checking of prescriptions, in order to reduce prescription errors, and should implement strategies to communicate adequately with patients, in order to prevent administration errors. More and better studies are still needed in these areas. 3. More research is also required into: dispensing errors in out-patient health-care settings, such as community pharmacies in the USA and Europe; dispensing errors in hospitals and out-patient health-care settings in middle- and low-income countries; and the underlying causes of dispensing errors.
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Affiliation(s)
- Ka-Chun Cheung
- Scientific Institute of Dutch Pharmacists, The Hague, The Netherlands
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