Elizabeth A. Flynn

National observational study of prescription dispensing accuracy and safety in 50 pharmacies.

OBJECTIVES To measure dispensing accuracy rates in 50 pharmacies located in 6 cities across the United States and describe the nature and frequency of the errors detected. DESIGN Cross-sectional descriptive study. SETTINGS Chain, independent, and health-system pharmacies (located in hospitals or managed care organizations). PARTICIPANTS Pharmacy staff at randomly selected pharmacies in each city who accepted an invitation to participate. INTERVENTION Observation by a pharmacist in each pharmacy for 1 day, with a goal of inspecting 100 prescriptions for dispensing errors (defined as any deviation from the prescribers order). MAIN OUTCOME MEASURE Dispensing errors on new and refill prescriptions. RESULTS Data were collected between July 2000 and April 2001. The overall dispensing accuracy rate was 98.3% (77 errors among 4,481 prescriptions; range, 87.2%-100.0%; 95.0% confidence interval, ± 0.4%). Accuracy rates did not differ significantly by pharmacy type or city. Of the 77 identified errors, 5 (6.5%) were judged to be clinically important. CONCLUSION Dispensing errors are a problem on a national level, at a rate of about 4 errors per day in a pharmacy filling 250 prescriptions daily. An estimated 51.5 million errors occur during the filling of 3 billion prescriptions each year.

Dispensing errors and counseling quality in 100 pharmacies

OBJECTIVE To evaluate the dispensing accuracy and counseling provided in community chain pharmacies. DESIGN Cross-sectional study. SETTING Community chain pharmacies in large metropolitan areas of Florida, Georgia, New Jersey, and New York. PARTICIPANTS Community chain pharmacies and trained shoppers. INTERVENTIONS Trained shoppers presented a new prescription order for one of five study drugs to each randomly selected pharmacy, and all encounters with pharmacy staff were recorded on video by ABC News 20/20 staff using hidden cameras. MAIN OUTCOME MEASURES Dispensing errors on prescriptions for selected medications were the indicator of prescription dispensing accuracy. Frequency of verbal counseling and information categories discussed or included in written information were used to assess the quality of counseling. RESULTS Of 100 prescriptions dispensed, 22 had one or more deviation from the physicians written order, for a 22% dispensing error rate. Three of the errors were judged to be potentially harmful when dispensed to a typical patient requiring these therapies. A total of 43 shoppers (43%) received verbal counseling, including 16 cases in which the shopper prompted counseling. All shoppers received written information with their prescription, covering an average of 90% of the required topics. Some 68% of the warfarin shoppers purchased aspirin without the pharmacist verbally warning about taking the drugs simultaneously. CONCLUSION The dispensing error rate of more than one in five prescriptions is similar to the rate found in a similar study conducted 14 years ago, but counseling frequency has decreased significantly during the period.

Effect of barcode technology with electronic medication administration record on medication accuracy rates

PURPOSE The effect of barcode-assisted medication administration (BCMA) with electronic medication administration record (eMAR) technology on the occurrence of medication administration errors was evaluated. METHODS A pretest-posttest nonequivalent comparison group was used to investigate the effect of BCMA-eMAR on the medication administration accuracy rates at two community-based hospitals. Patient care units included three matched pairs in the two hospitals-two medical-surgical, two telemetry, and two rehabilitation units-plus a medical-surgical intensive care unit, an emergency department, and both an inpatient oncology unit and an outpatient oncology service at one of the hospitals. Medication administration accuracy rates were observed and recorded before (phase 1) and approximately 6 and 12 months after (phases 2 and 3, respectively) the implementation of BCMA-eMAR. RESULTS The overall accuracy rate at hospital 1 increased significantly from phase 1 (89%) to phase 3 (90%) (p = 0.0015); if wrong-time errors are excluded, the accuracy rate improved from 92% in phase 1 to 96% in phase 3 (p = 0.000008). The overall accuracy rate did not change significantly from phase 1 to phase 3 at hospital 2; when wrong-time errors were excluded from consideration, the accuracy rate improved from 93% in phase 1 to 96% in phase 3 (p = 0.015). CONCLUSION Implementation of BCMA-eMAR in two hospitals was associated with significant increases in total medication accuracy rates in most study units and did not introduce new types of error into the medication administration process. Accuracy rates further improved when wrong-time errors were excluded from analysis. The frequency of errors preventable by BCMA-eMAR decreased significantly in both hospitals after implementation of that technology. BCMA-eMAR and direct observation were more effective than voluntary reporting programs at intercepting and recording errors and preventing them from reaching patients.

Consensus development conference statement on the safety of intravenous drug delivery systems: Balancing safety and cost

As cost-containment pressures on health care systems continue, traditional practices are searching for ways to deliver care less expensively. Intravenous drug delivery systems have become a targeted area for cost savings in many health care institutions because they are so extensively used. Benchmark systems that have been shown to improve safety, such as unit-dose drug distribution and IV admixture programs, are now being viewed as costly alternatives. Likewise, technologies and innovations that have the potential to improve efficiency and safety are being critically scrutinized. The decision matrix for selection of IV drug delivery systems needs to carefully balance cost, quality, efficiency, and safety—relative to the medication use process as a whole. This article presents the final statement of the Consensus Development Conference on the Safety of Intravenous Drug Delivery Systems, held on September 27–28, 1999, in Phoenix, AZ. The purpose of the conference was to provide a balanced assessment of available IV drug delivery systems.

Medication-administration errors in an emergency department

Observation of nurses administering medications in hospitals has been performed to determine the accuracy of the drug distribution process.[1][1] While such studies have been conducted on hospital nursing units since 1962, emergency departments (EDs) have been excluded because the medication-

Medication Dispensing Errors in Community Pharmacies: A Nationwide Study

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

A multi-centre comparison of nursing staff time required for the preparation and administration of liposomal amphotericin B and amphotericin B deoxycholate vs. voriconazole.

AIMS AND OBJECTIVES To compare the nursing time and cost required for preparation and administration of liposomal amphotericin B, amphotericin B deoxycholate and voriconazole. DESIGN Cost comparison study. METHODS Nurse activities associated with the preparation and administration of the three study drugs were divided into 11 tasks and timed by observers at five hospitals. Target tasks were defined as those likely to be affected by the differences between drugs and excluded those tasks likely to differ owing to site-specific factors. Mean times for administration of a single day of therapy for each study drug were compared. Costs of preparation and administration of a 14-day regimen were estimated. RESULTS Sixty-nine patients were observed receiving a total of 256 doses of study medications. Labour times were 20, 16, 14 and 3 minutes per day for liposomal amphotericin B, amphotericin B deoxycholate, intravenous voriconazole and oral voriconazole, respectively. Administration time was significantly lower for intravenous voriconazole compared with liposomal amphotericin B (p < 0.05), and for oral voriconazole compared with all intravenous regimens (p < 0.05). Preparation of medications took the longest time for intravenous formulations and was longer for liposomal amphotericin B than for the other drugs by 3-5 minutes. Average non-drug costs associated with preparation and administration of a 14-day regimen were greatest in the amphotericin B deoxycholate arm at US

Medication errors observed in 36 health care facilities

335, followed by liposomal amphotericin B (US

Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities

310) and voriconazole (US

Observation method of detecting medication errors

180). CONCLUSION Intravenous voriconazole required less time to prepare and administer on a daily basis than liposomal amphotericin B, and was similar to amphotericin B deoxycholate. Measurements of intravenous vs. oral voriconazole administration suggest the opportunity to save 10-17 minutes per day with the oral formulation. RELEVANCE TO CLINICAL PRACTICE Oral voriconazole may provide significant savings in terms of nursing time compared with intravenous antifungal drugs.