Reducing the risk

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Melbourne researchers have investigated the best ways to reduce dispensing errors

Pharmacy researchers from Alfred Health in Melbourne reviewed 11 studies on interventions in the hospital setting to address the rate or incidence of dispensing errors.

According to results published in the Journal of Pharmacy Practice and Research, dispensing errors were detected during the final verification stage of the dispensing process in five studies, for example, near‐miss incidents or prevented dispensing errors.

Five studies identified errors following completion of the dispensing process, referred to as dispensing errors, external errors or unprevented dispensing errors.

One study evaluated both.

Meta‐analysis was conducted with 2,295,539 dispensed items in the control group and 2,381,253 in the intervention group. The interventions resulted in a 53% reduction in the risk of dispensing error (risk ratio [RR] 0.47, 95% CI 0.34–0.67).

Stratified analysis demonstrated a 34% reduction in risk of prevented errors (RR 0.66, 95% CI 0.46–0.93) and a 68% reduction in risk of unprevented errors (RR 0.32, 95% CI 0.24–0.43).

Trained technicians performing final verification of the dispensing process provided the most significant reduction in the risk of dispensing errors.

The majority of studies reported the implementation of technological interventions, such as barcode scanning, automated dispensing machines or pharmacy carousels. One study that assessed interventions to address look‐alike medications identified a small but statistically significant reduction in the risk of errors.

There was a high risk of detection bias in most studies due to the absence of blinding in the assessment of outcomes and knowledge of exposure status.

Addressing confounding factors, such as differences in staff experience between intervention and control groups, was not discussed in the majority of studies, the authors pointed out.

One study was assessed to be of high quality, seven were rated acceptable, and the final three studies were rated as low quality.

The pooled error rate in the intervention group was 0.00043 (0.43 errors per 1000 dispensed items).

“While this rate is small, when taken into context of the number of daily dispensed items, it takes on a new significance,” said the Alfred Health researchers.

In Australia approximately 792,000 prescriptions are dispensed each day under the PBS and RPBS, the authors pointed out.

“A dispensing error rate of 0.00043 equates to 124,000 errors per year or 340 dispensing errors per day nationally. If the volume of dispensed inpatient medications was added to this total, then the potential risk to patients is substantial.”

Read the full article in the JPPR (published 8 February 2021)

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