Kenneth N. Barker

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.

This study conducted with the support of ABC News PrimeTime Live, found four clinically significant dispensing errors in 100 prescriptions processed

Abstract A disguised-patient technique was used to study the nature and frec^jency of dispensing errors and quality of patient medication counseling in 100 randomly selected community pharmacies. Analysis of 100 prescription orders dispensed detected 24 dispensing errors, of which 4 were clinically significant. Oral counseling was provided to 64 of the patients, covering an average of 3 of the 14 categories of drug information that the Omnibus Budget Reconciliation Act of 1990 (OBRA 90׳) requires pharmacists to consider when counseling Medicaid patients. In addition to pre- scriber׳s label instructions, pharmacists provided written counseling information, including auxiliary labels and receipts, to 98% of the patients, but it covered only an average of six OBRA 90׳ categories. The results suggest that problems with the quality of community pharmacy medication counseling and dispensing accuracy require immediate attention.

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-

Comparison and Analysis of the National Drug Code Systems among Drug Information Databases

National Drug Codes (NDC) is a drug identification code that is widely used to identify each unique commercially available drug product in the computerized health care industry. Various NDC database systems are currently used for the drug claims process, inventory control, and drug utilization review in the industry. Using a relational database, comparison and analysis were performed among eight major NDC database sources from the Food and Drug Administration, the Health Care Financing Administration, Medicaid, Redbook®, Medi-Span®, First DataBank®, Bergen Brunswig-Durr Fillauer®, and the Department of Veteran Affairs pharmaceutical information systems. A large discrepancy of comparability among those major NDC database sources was found with the percentage of matched rates ranging from 29.8–99.3%. The study suggests that a public central repository of a completed NDC database system is needed as a standard NDC reference for the health care industry in order to improve the comparability, accessibility, and quality of drug information.

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.

Incidence of Intravenous Medication Errors in a Chinese Hospital

OBJECTIVES The purpose of this study was to explore intravenous (IV) medication errors in a Chinese hospital. The specific objectives were to 1) explore and measure the frequency of IV medication errors by direct observation and identify clues to their causes in Chinese hospital inpatient wards and 2) identify the clinical importance of the errors and find the potential risks in the preparation and administration processes of IV medications. METHODS A prospective study was conducted by using the direct observational method to describe IV medication errors on two general surgery patient wards in a large teaching hospital in Beijing, China. A trained observer accompanied nurses during IV preparation rounds to detect medication errors. The difference in mean error rates between total parenteral nutrition (TPN) and non-TPN medications was tested by using the Mann-Whitney U test. RESULTS A final total of 589 ordered IV doses plus 4 unordered IV doses as prepared and administered to the patients was observed from August 3, 2010, to August 13, 2010. The overall error rate detected on the study ward was 12.8%. The most frequent errors by category were wrong dose (5.4%), wrong time (3.7%), omission (2.7%), unordered dose (0.7%), and extra dose (0.3%). Excluding wrong time errors, the error rate was 9.1%. Non-TPN medications had significantly higher error rates than did TPN medications including wrong time errors (P = 0.0162). CONCLUSIONS A typical inpatient in a Chinese hospital was subject to about one IV error every day. Pharmacists had a very limited role in ensuring the accuracy of IV medication preparation and administration processes.

Development of a Visualized Drug Information Database for United States Pharmacopeia Dispensing Information

A long-term project to visualize the medical terminology contained in the United States Pharmacopeia (USP) Dispensing Information (DI) is described. In the process of completing the project, several technologies were used and user response was evaluated. A database that covers the visualization of over 7,800 prescription, nonprescription, and medical devices has been completed. Several applications which were produced in interactive computer format to achieve patient outcomes are described. A review of the current interactive, patient education technology is also discussed.

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

Contribution of Computerized Content Analysis to Visualization of USP DI

335, followed by liposomal amphotericin B (US

Medication errors observed in 36 health care facilities

310) and voriconazole (US