Dispensing errors: A current problem in Pharmacy practice

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Pharmacists have one of the most difficult jobs in the world. Their day to day job includes dispensing of drugs, monitoring patient drug therapies, and counseling of patients by thoroughly reviewing their medications and finding best ways to minimize drug-related costs and damages. Pharmacists mostly work in hospitals, retail pharmacy stores, and pharmaceutical companies and they have direct constant communications with medical doctors because the medical doctors diagnose a patient’s sickness and prescribe the right drugs for the patient before sending them to the pharmacist to dispense the drug and to advise the patient on dosage administration. Nevertheless, it is the pharmacist’s job to check the prescription from the doctor and ensure that the patient is given the right drugs and also ensure that the patient takes the right amount of drugs to minimize drug negative effects. Having established the job description of pharmacists, we therefore circle full back to the question, what type of problem is being faced by pharmacists today? It is well known that one of the major problems being faced by pharmacists today is the problem of Dispensing errors. According to the Academies’ Institute of Medicine’s report, “deaths from dispensing errors increased 2.5-fold in inpatient settings between 1983 and 1993 and increased almost 8.5-fold in outpatient settings.” This report shows that no strong effort have been made so far to combat this problem. Similarly, a survey by the Academies’ institute of medicine also shows that Americans and people all over the world are very concerned about their risk of being given the wrong medicine. Dispensing errors is the current problem in pharmacy practice and to solve this, pharmacy companies and hospitals should implement the use of electronic filing system.

            Dispensing errors is a major problem in pharmacy practice and it have been present for many years. It affects the pharmacy industry, the pharmacist, and the general public. “Dispensing errors refer to errors in the dispensing process that are not detected or corrected prior to the patient leaving the pharmacy, and which may lead to sub-optimal outcomes of treatment for the patient” (Peterson et al. 58). When dispensing errors are made and detected, the patient may eventually require constant expensive treatment or even hospitalization. Dispensing errors can occur anywhere within the pharmacy practice, either during communicated prescription or during distribution. This problem is present in many pharmacies worldwide and it have adverse impact and effect on the pharmacists and the general public. This type of error made by the pharmacists have the potential to cause death or have a permanent negative effect on the patient’s health. According to a report by the Academy of Managed care pharmacy, “dispensing errors harm at least 1.5 million people every year.” This shows the high effect dispensing errors have in the society. Also, the AMCP reports that the number of deaths caused by dispensing errors is increasing every year.  Many of these patients lost their lives because they received medications that contained substances they were allergic to or they were given two drugs that magnifies the side effects. It is also good to point out that dispensing errors have significant impact on health care costs. According to the National Academies’ Institute of Medicine (IOM) report, established by Gerald Gianutsos, “the total annual costs related to dispensing errors is estimated at $37 to $50 billion.” These figures are really huge and shows the cost and expenses being made on drug-related issues only.

Dispensing errors is mostly caused by many factors. The causes range from the prescription process down to the dispensing process. Many studies have shown that the major causes of dispensing errors are distractions in the workplace, heavy workloads, incorrect diagnosis and prescribing errors, dose miscalculations, poor drug distribution and failed communication, lack of patient education, illegible handwritten prescriptions, high prescription volume, shortage of support personnel, look-alike/sound-alike drug names, etc. It is however known that the volume of prescriptions is constantly rising and this has caused the workload for pharmacists to increase. This has led many healthcare professionals including pharmacists, to believe that patient safety and care may be hugely impacted as a result.

Although the issues with dispensing errors is rising, the menace can be managed and controlled. The first approach would be to reduce interruptions to the pharmacist during prescription filling. It is very important that assistants and other pharmacy personnel minimize interruptions to the pharmacist while the pharmacist is filling prescriptions.  According to Peterson et al, “Interruptions to the pharmacist should be reduced, as they break up the attention on the prescription at hand.” Interruptions are potentially dangerous. Although this solution might lead to pharmacy technicians/assistants independently making decisions or take matters into their own hands, it can still prove to be very effective.

The second approach to solving dispensing errors would be for pharmacies to be encouraged to start faxing and emailing prescription electronically. As pointed out by Peterson et al, “The use of faxes, answering machines and emails should be encouraged to reduce distractions from answering telephone calls (7).” This particular solution would help give the pharmacist enough time to counsel patients properly and dispense properly without worrying about receiving telephone calls that might halt the dispensing process hereby causing errors to occur. The pharmacist can also refer back to the faxed or emailed prescription for reference and for accuracy, hereby helping the pharmacist provide an adequate and reliable service to the patients being served. However, most experts may argue that this solution may be very costly.

The third possible solution would be for pharmacies to enact ways by which they would store sound-alike and look alike drugs separately to avoid dispensing the wrong drug to a patient.  This could be caused by illegible handwriting or similar packaging/labelling. This solution has been lauded by many as the most effective solution because sound-alike look-alike drugs accounts for a high percentage of dispensing errors. Pharmacists are hereby advised to use means like tall man lettering, or use warning labels to separate those drugs in an effort to ease identification. It is however essential to point out that this solution might lead to the pharmacist having a hard time finding drugs hereby causing the pharmacist to spend much time in filling a prescription. Experts Kohn et al. notes that standardized drug packaging, labelling, and storage can help reduce confusion of medications that occur because of look-alike or sound-alike drug names (151). Nevertheless, storing of look-alike sound-alike drugs separately would adequately help in creating a safe environment for the patient and also reduce drug related costs and damages.

The solution that has the greatest likelihood of success would be electronically filing, faxing or emailing of patient’s prescription and information. This strategy attacks the issue in many ways. First, electronically faxing prescription would help the pharmacist see the patient’s information clearly. By electronically filing prescriptions, the pharmacist can always reference back to the fax or email to ensure accuracy in the dispensing process.  Some experts might argue that this solution sounds very logical in theory, and that creating an electronic information technology system in every hospital and pharmacy can be very costly. By using this approach, pharmacists can work to prevent active and latent dispensing errors. This solution helps reduce long phone calls and eliminates prescribing over the phone which might lead to wrong spellings hereby causing dispensing errors. According to expert Cohen, “E-prescribing and CPOE can reduce medication errors by eliminating illegible and poorly handwritten prescriptions, ensuring proper terminology and abbreviations, and preventing ambiguous orders and omitted information (196).” This system also allows the pharmacist access the prescription order at the time of dispensing hereby incorporating additional patient safety features. Kohn et al. also states that, “having physicians enter and transmit medication orders on-line (computerized physician order entry) is a powerful method for preventing medication errors due to misinterpretation of hand-written orders” (191). Finally, implementing this approach can also help pharmacists intercept prescription errors in a timely manner.

In conclusion, dispensing errors is a major problem in pharmacy practice. It affects the pharmacy industries, the pharmacists, and the general public.it accounts for many deaths and drug-related damages. Dispensing errors also costs the American government and individuals affected billions of dollars every year. Continuing professional education will be an active and effective way many pharmacy industries and companies can combat dispensing errors. The assistants and other staff personnel should be strongly educated on how to minimize interruptions and distractions to the pharmacists during prescription filling or patient counselling. Electronic filing or E-prescribing could be a very effective approach to preventing dispensing errors. E-prescribing promotes patient safety in many ways. It also helps improve accuracy in the prescribing and dispensing process including counselling process too. These recommendations calls healthcare industries/organizations, and health care professionals to continuously make efforts towards substantially eliminating dispensing errors and improving patient safety.          The system of in-house dispensing error reporting should be introduced to our pharmacies. This is a process whereby dispensing errors are documented and discussed with the staff in bid to manage errors and prevent future occurrence. This can be said to be a more ideal way of managing errors. Some of the major factors aiding the reduction of dispensing errors includes reducing work load of the pharmacist, doctors improving their handwriting, having at least one pharmacist on duty,  providing privacy while counseling patients, and counseling patients at the time of supply, updating drug knowledge, checking of original prescription, avoiding interruption,  development of a systematic dispensing work flow, improving packaging and labeling and performance of physical dispensing by pharmacy assistants..

 

Work cited

Cohen, M.R. Medication Errors. 2nd ed. Vol. 13. Washington: American Pharmacists Association, 2006. 194-196. Print.

Gianutsos, Gerald. “Identifying Factors That Cause Pharmacy Errors.” Uspharmacist.com. Jobson Medical Information, 1 Dec. 2008. Web. 21 Nov. 2014.

Kohn, Linda T., Janet M. Corrigan, and Molla S. Donaldson. To Err Is Human Building a Safer Health System. Washington, D.C.: National Academy, 2000. Print.

Peterson, G. M., et al. “Pharmacists’ attitudes towards dispensing Errors: Their causes and prevention.” Journal Of Clinical Pharmacy & Therapeutics 24.1 (1999): 57-71.  Academic Search Complete. Web. 25 Nov. 2014.