Automated Dispensing Cabinet Functionality Expansion to Reduce Controlled Substance Inventory Discrepancies

Background: Automated dispensing cabinets have the potential to create technology-induced errors that can arise during controlled substance medication dispensing. Despite enhancements made to the medication use process, the impact of ADC functionality on technology-induced controlled substance discrepancies have yet to be described. Objective: To evaluate the impact of ADC functionality expansion on technology-induced errors such as controlled substance discrepancies created during “blind inventory counts” and cassette dispensing errors. Methods: This quasi-experimental study was conducted over 18 months that evaluated the expanded use of dispensing cassettes within 8 ADCs at the University of Chicago Medicine. Unit-dose controlled substances with high usage were directed for inventory reassignment to cassettes. Controlled substance dispenses, blind inventory counts discrepancies and cassette dispensing errors were evaluated before and after cassette expansion. ADC discrepancy and Cassette Dispensing Error rates were calculated using 1-week segments across the study period. Results: Of the 64 040 dispenses during the study period, the proportion of cassette dispenses increased from 16% to 72% after cassette expansion. Controlled substance discrepancies decreased from 11 to 7 discrepancies for every 1000 dispenses ( P < .0001). After cassette expansion, cassette dispensing errors increased to roughly 28 errors for every 1000 dispenses ( P < .0001). Conclusion: Expansion of ADC functionality created opportunities for reduced technology-induced controlled substance discrepancy rates at the expense of increased cassette dispensing errors.

Medication errors in a health care facility in southern Saudi Arabia

Purpose: To identify medication errors at Aseer Central Hospital (ACH, Abha) in the southern province of Saudi Arabia. Methods: A cross-sectional retrospective study was conducted by reviewing adult patients’ records (> 15 years old) at ACH’s inpatient and outpatients settings over an 8-week period in October and November 2015. Results: We identified 113 medication errors, including 112 prescribing errors and 1 dispensing error. Most medication errors (91.2 %) in this study were for inpatient prescriptions. The most common prescribing error was medication duplication (31.2 %) followed by missing patient identifying information (25 %). Conclusion: Medication errors, mainly in inpatient prescriptions, have been fully identified at ACH. Educational interventions such as workshops could help minimize and prevent medication errors.

Medication Error pada Tahapan Prescribing dan Dispensing di Apotek “X” Denpasar Periode Januari-Desember 2019

Medication error menurut National Coordination Council forMedication Error Reporting and Prevention (2017) adalah setiap kejadian yang dapat dihindari yang dapat menyebabkan atau berakibat pada pelayanan obat yang tidak tepat atau membahayakan pasien. Penting sebagai petugas kefarmasian dalam menidentifikasi Medication error yang terjadi terkait kemanan dalam pemberian pelayanan kefarmasian di Apotek “X” Denpasar. Tujuan dari penelitian ini untuk mengetahui medication error yang terjadi pada tahap prescribing dan dispensing Apotek “X” Denpasar dan Persentase Medication error pada proses pelayanan resep di Apotek “X” Denpasar. Jenis penelitian ini adalah deskriptif kualitatif dengan metode observasi dengan desain retrospektif. Metode sampling yang digunakan yaitu purposive sampling sesuai inklusi dan eksklusi. Instrumen penelitian berupa resep yang diterima oleh Apotek “X” Denpasar dan tabel observasi pada prescribing error dan dispensing error. Resep yang dianalisis sejumlah 910 resep dari tanggal 02 Januari 2019 sampai 31 Desember 2019. Persentase prescribing error yaitu 14,06 % dan persentase dispensing error dari total 910 resep yaitu 2,41 %. Dengan rata-rata kategori index medication error NCCMERP adalah kategori B yaitu kesalahan sudah terjadi namun dapat diperbaiki oleh farmasi sebelum obat sampai ke pasien. Dengan Medication error pada fase prescribing error di Apotek “X” Denpasar yang paling banyak yaitu tidak ada umur pasien (39,84%), tidak ada dosis sediaan (10,16%), resep tidak lengkap ( tidak ada tanggal resep dan nama dokter) (19,53%). Pada fase dispensing error di Apotek “X” Denpasar yang terjadi yaitu kesalahan etiket/label (18,18%), kejadian salah peracikan (40,91%).

Robotic Pharmacy Implementation and Outcomes in Saudi Arabia. A Twenty-One Month Review. (Preprint)

BACKGROUND We describe the introduction, use and evaluation of an automation and integration pharmacy development program in a private facility in Saudi Arabia. The project was undertaken to meet specific challenges of increasing throughput, reducing medication dispensing error, increasing patient satisfaction, and freeing up pharmacists’ time for increased face-to-face consultations with patients. OBJECTIVE To reduce outpatient waiting times for dispensing of medications, to help to free up time to meet patient expectations for pharmacy services including medication education, to reduce the volume of non-value-added pharmacist tasks, to reduce dispensing error rates, and to aid with the rapid development of a reputation in the served community for patient-centred care for a new facility. METHODS Pre-implementation data for patient wait-time for dispensing of prescribed medications as one measure of patient satisfaction, pharmacist activity and productivity in terms of patient interaction time were gathered. Reported and discovered dispensing errors per 1,000 prescriptions were also aggregated. All pre-implementation data was gathered over an eleven- month period. Initial project goals were set as a 50% reduction in the average patient wait-time, a 15% increase in patient satisfaction regarding pharmacy waiting time and pharmacy services, a 25% increase in pharmacist productivity and zero dispensing errors. This was expected to be achieved within ten months of go-live. RESULTS From go-live, data was gathered on the above metrics in one-month increments. At the 10-month point there had been a 53% reduction in the average waiting time, a 20% increase in patient satisfaction regarding pharmacy waiting time, with a 22% increase in overall patient satisfaction regarding pharmacy services, and a 33% increase in pharmacist productivity. There was a zero-rate dispensing error reported. CONCLUSIONS The robotic pharmacy solution studied was highly effective, but upstream supply chain is vital to throughput maintenance, particularly when automated filling is planned. The automation solution must also be seamlessly and completely integrated into the facility’s software systems for appointments, medication records and prescription in order to garner its full benefits. Patient overall satisfaction with pharmacy services is strongly influenced by waiting time and follow up studies ae required to identify how to use this positive effect and how to optimally use ‘freed-up’ pharmacist time. The extra time spent with patients by pharmacists, and the complete overview of the patient’s medication history, that full integration gives, creates opportunities for tackling challenging issues such as medication nonadherence. Reduced waiting times may also allow for smaller prescription fill volumes, and more frequent outpatient department visits, allowing increased contact time with pharmacists.

Perbandingan Dispensing Error di Ruang Perawatan dengan Sistem Unit Dose Dispensing (UDD) dan Non Unit Dose Dispensing (Non UDD) di RSM Ahmad Dahlan Kota Kediri

Abstrak Latar belakang: Unit Dose Dispensing (UDD) adalah metode pelayanan farmasi dimana sediaan obat oral dan injeksi pada pasien diberikan dalam bentuk dosis tunggal. Kelebihan dari metode UDD adalah terdapat profil pengecekan obat untuk pasien sehingga insiden medication error tahap dispensing dapat dihindarkan atau dikoreksi terlebih dahulu. Penelitian ini bertujuan untuk mengetahui perbandingan dispensing error di ruangan dengan sistem UDD dan non UDD di RSM Ahmad Dahlan Kediri.Metode: Penelitian ini bersifat observasi analitik studi komparasi dengan desain cross-sectional pada unit rawat inap dengan sistem UDD dan Non UDD di RSM Ahmad Dahlan Kediri selama periode 15-17 November 2018.Hasil: Didapatkan jumlah sampel penelitian sebanyak 336 sampel dengan distribusi 147 (43,2%) sampel dari ruang Non UDD dan 189 (56,8%) sampel dari ruangan UDD. Terjadi dispensing error pada 58 sampel yaitu sebanyak 39 (67%) sampel di ruang Non UDD dan 19 (33%) sampel di ruang UDD. Dispensing error meliputi pemberian etiket yang tidak lengkap sebanyak 40 (69%) kejadian, adanya pemberian obat di luar instruksi sebanyak 15 (24%) kejadian, dan omission atau obat yang kurang sebanyak 4 (7%) kejadian. Pada uji chi-square didapatkan p-value 0,009 (<0,05) yang berarti terdapat perbedaan yang bermakna pada kejadian dispensing error di ruangan dengan sistem UDD dan Non UDD.Kesimpulan: Medication error pada fase dispensing di unit rawat inap dengan sistem UDD lebih rendah dibandingkan dengan unit rawat inap dengan sistem Non UDD.Kata kunci: Dispensing error, Unit Dose Dispensing (UDD), FarmasiAbstractBackground: Unit Dose Dispensing (UDD) is a pharmaceutical service method wherein oral and injection preparations in patients are given in the form of a single dose. The advantage of the UDD method is that there is a profile of drug checking for patients so that the incidence of medication errors in the dispensing phase can be avoided or corrected first. This study was aimed to determine the comparison of dispensing errors in the ward with the UDD and non UDD systems at Ahmad Dahlan Kediri Hospital.Method: This research is analytical observation comparative study with cross-sectional design in the ward with a system of UDD and Non UDD in Ahmad Dahlan Muhammadiyah Hospital Kediri for the period November 15-17th 2018.Result: There were 336 total samples with 147 (43.2%) distribution from Non-UDD ward and 189 (56.8%) from UDD ward. There were 58 dispensing errors namely 39 (67%) samples in the Non-UDD ward and 19 (33%) samples in the UDD ward. Dispensing errors include the administration of incomplete etiquette of 40 (69%) samples, the presence of drugs outside the instructions of 15 (24%) samples, and omission or less of drugs of 4 (7%) samples. In the chi-square test the p-value is 0.009 (<0.05) which means that there were significant differences in dispensing error in the UDD and Non-UDD ward.Conclusion: Dispensing error in the ward with UDD system is lower compared to the ward with Non-UDD system.Key words: Dispensing error, Unit Dose Dispensing (UDD), Pharmacy

Nature of dispensing errors in selected hospitals providing free healthcare: a multi-center study in Sri Lanka

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.

IDENTIFIKASI MEDICATION ERROR FASE DISPENSING PADA PASIEN ANAK DI RSUD LABUANG BAJI MAKASSAR

Dispensing error adalah kesalahan yang terjadi atau berpotensi terjadi sejak proses penyiapan hingga penyerahan obat kepada pasien. Dispensing error merupakan salah satu komponen medication error yang terjadi di Rumah Sakit yang dapat merugikan pasien. Tujuan penelitian ini untuk mengidentifikasi kejadian medication error fase dispensing pada pasien anak. Penelitian ini merupakan penelitian observasional deskriptif dengan rangcangan cross sectional study. Sampel sebanyak 100 lembar resep pasien anak yang ditentukan secara probability sampling. Penelitian ini dilaksanakan pada bulan Mei – Juli 2019 di RSUD Labuang Baji Makassar. Hasil penelitian menemukan bahwa terjadi kesalahan pada parameter salah mengambil obat (2%), ada obat yang kurang (5%), sedangkan untuk parameter pemberian obat diluar instruksi, obat rusak/kadaluarsa, pemberian etiket yang tidak lengkap, salah pasien, informasi obat kepada pasien salah tidak ditemukan dispensing error. Hasil penelitian menyimpulkan bahwa terjadi dispensing error pada kategori salah mengambil obat dan obat kurang.Kata kunci : medication error, dispensing error, pediatric patient, RSUD Labuang Baji

Integration of a Commercial Barcode-Assisted Medication Dispensing System in a Teaching Hospital

Objectives A commercial barcode-assisted medication administration (BCMA) system was integrated to secure the medication process and particularly the dispensing stage by technicians and the administration stage with nurses. We aimed to assess the impact of this system on medication dispensing errors and barriers encountered during integration process. Methods We conducted a controlled randomized study in a teaching hospital, during dispensing process at the pharmacy department. Four wards were randomized in the experimental group and control group, with two wards using the system during 3 days with dedicated pharmacy technicians. The system was a closed loop system without information return to the computerized physician order entry system. The two dedicated technicians had a 1-week training session. Observations were performed by one observer among the four potential observers previously trained. The main outcomes assessed were dispensing error rates and the identification of barriers encountered to expose lessons learned from this study. Results There was no difference between the dispensing error rate of the control and experimental groups (7.9% for both, p = 0.927). We identified 10 barriers to pharmacy barcode-assisted system technology deployment. They concerned technical (problems with semantic interoperability interfaces, bad user interface, false errors generated, lack of barcodes), structural (poor integration with local information technology), work force (short staff training period, insufficient workforce), and strategic issues (system performance problems, insufficient budget). Conclusion This study highlights the difficulties encountered in integrating a commercial system in current hospital information systems. Several issues need to be taken into consideration before the integration of a commercial barcode-assisted system in a teaching hospital. In our experience, interoperability of this system with the electronic health record is the key for the success of this process with an entire closed loop system from prescription to administration. BCMA system at the dispensing process remains essential to purchase securing medication administration process.

Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993–2015

ImportanceWhile much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates.ObjectiveThe aim of this study was to determine the rate of community pharmacy dispensing errors in the USA.MethodsEnglish language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature. Studies with a denominator reflecting the total number of prescriptions in the sample were necessary for inclusion in the meta-analysis. A random effects meta-analysis was conducted to estimate an aggregate community pharmacy dispensing error rate. Heterogeneity was assessed using the I2 statistic prior to analysis.ResultsThe search yielded a total of 8490 records, of which 11 articles were included in the systematic review. Two articles did not have adequate data components to be included in the meta-analysis. Dispensing error rates ranged from 0.00003% (43/1 420 091) to 55% (55/100). The meta-analysis included 1 461 128 prescriptions. The overall community pharmacy dispensing error rate was estimated to be 0.015 (95% CI 0.014 to 0.018); however, significant heterogeneity was observed across studies (I2=99.6). Stratification by study error identification methodology was found to have a significant impact on dispensing error rate (p<0.001).Conclusion and relevanceThere are few published articles that describe community pharmacy dispensing error rates in the USA. Thus, there is limited information about the current rate of community pharmacy dispensing errors. A robust investigation is needed to assess dispensing error rates in the USA to assess the nature and magnitude of the problem and establish prevention strategies.