How to Minimize Dispensing Errors?

Pharmacists are multi-tasking professionals. Most of the pharmacy work is done and accomplished by a registered pharmacist. From management down to client care, a pharmacist is always needed in a pharmacy to effectively provide optimum service to the community with good quality and effective medicines. A pharmacist's important role is to interpret prescription orders, dispense drug orders, and counsel patients regarding all information needed to know about their medicine. But because pharmacists are multi-tasking individuals sometimes the most important key function they must be is disregarded. Due to this circumstance, dispensing errors occur.

Dispensing Errors

• Dispensing Errors are errors committed by pharmacists, pharmacy technicians, and/or any personnel who are involved in dispensing medicines before, during, and after the transaction with the client. Errors can be either human error, technical, procedural or machine errors. These errors could be associated with drug errors, labeling errors, and issuance errors.

Classification and Type of Dispensing Errors

Drug Error

1. Incorrect drug dispensed
2. Incorrect strength dispensed
3. Incorrect dosage form dispensed
4. Expired/deteriorated/substandard drug
5. Failure to supply drug

Labeling Error

1. Incorrect drug name on the label
2. Incorrect strength on the label
3. Incorrect dosage form on the label
4. Incorrect directions/warning on the label
5. Incorrect patient name on the label
6. Incorrect ward/cost center/ prescriber
7. The completely wrong label on a bottle

Issuance error

1. Incorrectly given to the wrong patient
2. Incorrectly bagged

Contributory Factors Affecting Dispensing Procedure Leading to Errors and Possible Remedies to Prevent Them.

Workload and Pressure

Prevention: Take each work at a time. Finish one task before engaging to another task. This can help you to prevent errors. Focusing on a single work can eradicate error. Relax from time to time to remove the pressure.

Similar drug names and levels

Prevention: Separate drugs with the most similar names away from each other to avoid confusion. When sorting out a drug and finding out that the drug has a similar drug name or packaging style try to read the label's information to differentiate between the required drugs. The best thing to do is to consult your superior or supervisor regarding this.

Incorrect display or storage area

Prevention: See to it that the medicines are properly displayed in an arrangement of either therapeutically, alphabetically or an arrangement desired that can be easily memorized and remembered. Shelves and storage areas should be free from any blockage or barrier that can hinder identification and acquisition.

Staffing levels and job dissatisfaction

Prevention: Poor benefits and incentives can insecure staff. Poor basic provisions such as drinking water rest days and breaks can lead to personnel inefficiency. Conflict about seniority and superiority can also be a problem. It can be fixed by discussing the problems in an open forum meeting or one-on-one discussion.

Poor eyesight, handwriting, and listening skills

Prevention: Poor eyesight can be corrected using eyeglasses or contact lenses. Instead of cursive writing, one may choose all capital letters to clearly understand what is being indicated. Poor listening can be corrected through the use of earphones, headsets or noise-reduction gadgets when using phones to minimize noise. When communicating with each other physically speak clearly and be near to each other to understand what is being talked.

Interruptions/distractions and Noise

Prevention: Avoid too much conversation and gossip among each other if the topic is not related to work. Television, loud radio sounds, or even social media visits must not be done during work time.

Lack of space or design of dispensary

Prevention: A pharmacy with a scarce area to work on can lead to confusion, so preparations and dispensing of medicines will commit errors. The same as for the design of the dispensary, when the design is inappropriate errors may occur. The best thing to do is to maximize the area. Provide storage area for other stocks, fluids, and boxes. If the space is just enough and a storage area cannot be provided, shelves and gondolas can be affixed to walls. This will help to occupy other spaces around your pharmacy that are not being used much. Other products can be stored there and free floor spaces with unnecessary boxes, stocks, and others. The dispensary must complement the design of the pharmacy to maximize its use of it.

Lack of staff knowledge, staff inexperience, and inflexibility

Prevention: Conduct assessment tests regarding their performance. This will help you to identify who of your staff and personnel really need special training, seminars or even attending another crash course. These solutions can eliminate incompetency, inexperience, lack of knowledge, and inflexibility of your staff.

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Misread and complex prescriptions and ambiguous directions

Prevention: Approach other's opinions regarding a doubtful prescription. Two heads are better than one! Interview the patient to find clarity to the order. The best way to do is to communicate with the patient's attending physician and clarify his medication order for his patient.

Failure to check

Prevention: Should be included in the standard operating procedures that every time a drug is to be dispensed checking should be done, at any step in the procedure, so that the drug to be dispensed will correspond to the prescription order given to the patient. The best time to check is when the patient will pick up the medicines. The pharmacist can itemize the medicines in front of the patient. In this case, the patient sees the product's completeness and the pharmacist double or triple-checks the medicines.

Lack of procedures and/or failure to follow standard operating procedures

Prevention: Should provide and mandate every staff to follow step-by-step procedures. Everyone must have a copy of it and must be obedient to it.

Poor communication

Prevention: Avoid the use of communication barriers such as earphones, loudspeakers, television, jammers, and like during work. If possible to do so pharmacies should not be placed along traffic and highways.

Computer software

Prevention: Should be user-friendly, easy to manipulate and access, and have the highest security protection against hackers, malware, adware, and alike.

The proximity of drugs on shelves

Prevention: Medicines should be reachable. Fast-moving drugs should be placed where can be easily accessed. Package names should be visible always. If the medicine is located on the highest level on the shelves provision of a footstool or small ladder must be available.

No breaks

Prevention: Exhaustion can lead to dispensing errors. Break or recess can help to refresh one's mind and body. Relaxation for a moment can re-energize and revitalize staff again.

Hunger, Fatigue, and Stress

Prevention: Breaks can help to resolve hunger, fatigue, and stress. Weekly rest for at least 2 days may lessen fatigue and stress from work.

Lack of concentration

Prevention: Avoid daydreaming, gossiping, and other materials that can take away your concentration from your work.

Lighting

Prevention: The pharmacy should be well-lighted, especially in the dispensary, counter, and shelf areas where the drugs are mostly located. A well-lighted pharmacy can improve the identification and acquisition of the right drug without any mistakes.

Lack of support/assistance and lone worker

Prevention: Chief pharmacists and supervisors should be available at all times when a pharmacy technician or other pharmacy staff needs their assistance. Do not let personnel work alone, especially when the prescription filling is too much. There must be at least two or three personnel on every shift to complement the gravity of the work.

Lack of cleanliness and orderliness

Prevention: The pharmacy must always be clean and neat. Empty boxes, bottles, scrap papers and other clutters should not be messed up or mixed with good stocks to avoid mistakes. Sometimes when the pharmacy is not orderly and neat the personnel's minds can attract disorganization. Regularly cleaning the pharmacy is very important.

Personal and Family problems

Prevention: Personal and family problems are the most common cause of errors during dispensing. Because when a person has a problem his focus is divided between work and the problem. He can think about his problem while working, thus, causing him to errors. The best way to do this is to ask for leave or vacation. During this time off you can resolve your personal or family problems and come back to work with full concentration again.

• Errors and mistakes are sometimes inevitable and unavoidable. They usually happen unexpectedly. Pharmacists are also human beings and tend to err also. But because of the seriousness and gravity of their function and responsibility that can lead to patient harm or even death mistakes have no room in their profession.
• I, too, had experienced dispensing errors twice before but not that serious. I believe that every pharmacist has experienced it. Nobody is exempted from it. Maybe in your entire career at least once or twice you have committed it. Instead of errors staying on you, you can turn that into a positive perspective. Take your dispensing error experience as your learning lesson. 
• This a lesson that should not be committed anymore and teaches you to be prudent and to love your work even more. Everybody deserves a second chance. Remember that you have earned your degree with hardship and you do not want to take it from you that easily. Or worst of all you can be penalized for your wrongdoings and be sentenced and thrown against bars you do not want to happen to you. Love your work, be happy always, and smile each time a customer enters your pharmacy. Happy dispensing!

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