Dispensing Errors.

Newspaper/Magazine Article

Dispensing Errors.

December 16, 2020

Phipps D, Ashour A, Riste L, et al. The Pharmaceutical Journal. 2020;305(7943, 7944). November 10, December 1, 2020.

Dispensing mistakes are a common contributor to preventable adverse events in community pharmacies. Part 1 of this two-part series discusses factors that contribute to dispensing errors and summarizes methods for managing risks stemming from missteps. Part 2 focuses on preventing situations that enable errors and the role pharmacists have in minimizing dispensing errors in daily practice.

Part 1: Available at

Part 2: Available at

Related Resources From the Same Author(s)

Journal Article

Study

Patient Safety Innovations

Predicting dispensing errors in community pharmacies: an application of the Systematic Human Error Reduction and Prediction Approach (SHERPA).

November 16, 2022

Reducing inappropriate polypharmacy in primary care through pharmacy-led interventions.

January 22, 2020

Cancer diagnostic delay in Northern and Central Italy during the 2020 lockdown due to the coronavirus disease 2019 pandemic.

October 21, 2020

There is a vulnerable group we must not leave behind in our response to COVID-19: people who are dependent on illicit drugs.

May 13, 2020

Organizational conditions for engagement in quality and safety improvement: a longitudinal qualitative study of community pharmacies.

February 6, 2019

The safety of health care for ethnic minority patients: a systematic review.

July 29, 2020

Personality traits and traumatic outcome symptoms in registered nurses in the aftermath of a patient safety incident.

July 22, 2020

Preventing the tragedy of misdiagnosis.

December 13, 2006

Healthcare Simulation Dictionary, Second Edition.

November 23, 2016

The effect of a transitional pharmaceutical care program on the occurrence of ADEs after discharge from hospital in patients with polypharmacy.

April 27, 2022

Errors in nurse-led triage: an observational study.

December 2, 2020

A description of medical malpractice claims involving advanced practice providers.

July 15, 2020

National statutory reporting: not even ticking the boxes? The quality of 'Learning from Deaths' reporting in quality accounts within the NHS in England 2017-2020.

March 1, 2023

Understanding factors that could influence patient acceptability of the use of the PINCER intervention in primary care: a qualitative exploration using the Theoretical Framework of Acceptability.

November 9, 2022

Improving allergy documentation: a retrospective electronic health record system-wide patient safety initiative.

January 1, 2022

Transformational improvement in quality care and health systems: the next decade.

November 25, 2020

Is anybody 'Learning' from deaths? Sequential content and reflexive thematic analysis of national statutory reporting within the NHS in England 2017-2020.

February 22, 2023

The effect of implementing bar-code medication administration in an emergency department on medication administration errors and nursing satisfaction.

October 21, 2020

Impact of pharmacist-led multidisciplinary medication review on the safety and medication cost of the elderly people living in a nursing home: a before-after study.

February 12, 2020

Surgical teams' attitudes about surgical safety and the surgical safety checklist at 10 years: a multinational survey.

November 17, 2021

The neglected barrier to medication use: a systematic review of difficulties associated with opening medication packaging.

November 16, 2022

Improving medication appropriateness in nursing homes via structured interprofessional medication-review supported by health information technology: a non-randomized controlled study.

February 24, 2021

Attending to the emotional well-being of the health care workforce in a New York City health system during the COVID-19 pandemic.

August 26, 2020

Second victims among baccalaureate nursing students in the aftermath of a patient safety incident: an exploratory cross-sectional study.

September 22, 2021

What do patients and their carers do to support the safety of cancer treatment and care? A scoping review.

December 14, 2022

Why do hospital prescribers continue antibiotics when it is safe to stop? Results of a choice experiment survey.

September 2, 2020

Adaptive design: adaptation and adoption of patient safety practices in daily routines, a multi-site study.

August 12, 2020

Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology.

August 5, 2020

Hospital mistakes kept secret.

November 30, 2011

NHS ‘Learning from Deaths’ reports: a qualitative and quantitative document analysis of the first year of a countrywide patient safety programme.

July 21, 2021

Systemic safety inequities for people with learning disabilities: a qualitative integrative analysis of the experiences of English health and social care for people with learning disabilities, their families and carers.

March 2, 2022

The use of anatomical side markers in general radiology: a systematic review of the current literature.

August 26, 2020

Patient misidentification events in the Veterans Health Administration: a comprehensive review in the context of high-reliability health care.

October 21, 2020

Keeping patients at risk for self-harm safe in the emergency department: a protocolized approach.

December 2, 2020

Private patient rooms and hospital-acquired methicillin-resistant Staphylococcus aureus: hospital-level analysis of administrative data from the United States.

August 5, 2020

Publication of inspection frameworks: a qualitative study exploring the impact on quality improvement and regulation in three healthcare settings.

October 6, 2021

Factors influencing family member perspectives on safety in the intensive care unit: a systematic review.

December 9, 2020

Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study.

October 21, 2020

Complications associated with the anesthesia transport of pediatric patients: an analysis of the Wake Up Safe database.

October 14, 2020

Use of simulation to measure the effects of just-in-time information to prevent nursing medication errors: a randomized controlled study.

January 27, 2021

The problem with 'My Five Moments for Hand Hygiene'.

August 25, 2021

Quest for the ideal: a redesign of the medication use system.

January 31, 2007

The potential of artificial intelligence to improve patient safety: a scoping review.

March 31, 2021

Patient safety implications of wearing a face mask for prevention in the era of COVID-19 pandemic: a systematic review and consensus recommendations.

February 15, 2023

Advanced medication reconciliation: a systematic review of the impact on medication errors and adverse drug events associated with transitions of care.

June 16, 2021

Striving for high reliability in healthcare: a qualitative study of the implementation of a hospital safety programme.

June 22, 2022

Teamwork in the time of COVID-19.

March 3, 2021

For patients, a list of hospital hazards.

January 14, 2009

The biggest mistake doctors make.

November 27, 2013

To what extent is the World Health Organization's Medication Safety Challenge being addressed in English hospital organizations? A descriptive study.

February 16, 2022

Performance of a trigger tool for detecting drug-related hospital admissions in older people: analysis from the OPERAM trial.

February 16, 2022

Coronavirus disease 2019 (COVID-19) pandemic, central-line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): the urgent need to refocus on hardwiring prevention efforts.

February 7, 2022

The effectiveness of improving healthcare teams' human factor skills using simulation-based training: a systematic review.

August 3, 2022

Application of human factors methods to understand missed follow-up of abnormal test results.

November 11, 2020

2022 Updated Results for the AHRQ Surveys on Patient Safety Culture Workplace Safety Supplemental Item Set for Hospitals.

December 7, 2022

Closing the loop on test results to reduce communication failures: a rapid review of evidence, practice and patient perspectives.

November 25, 2020

Promoting patient and nurse safety: testing a behavioural health intervention in a learning healthcare system: results of the DEMEANOR pragmatic, cluster, cross-over trial.

March 2, 2022

Enhancing teamwork communication and patient safety responsiveness in a paediatric intensive care unit using the daily safety huddle tool.

March 18, 2020

How satisfied are patients and surgeons with telemedicine in orthopaedic care during the COVID-19 pandemic? A systematic review and meta-analysis.

February 10, 2021

Implementation of simulation training during the COVID-19 pandemic: a New York hospital experience.

February 24, 2021

The randomized AMBORA trial: impact of pharmacological/pharmaceutical care on medication safety and patient-reported outcomes during treatment with new oral anticancer agents.

April 21, 2021

Fatal mistakes: why do ten-fold medication errors in children keep happening?

May 5, 2021

Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study.

May 19, 2021

Lifetime prevalence and correlates of patient-perceived medical errors experienced in the U.S. ambulatory setting: a population-based study.

November 18, 2020

Health care providers’ negative implicit attitudes and stereotypes of American Indians.

March 31, 2021

Patients' perceptions of safety in emergency medical services: an interview study.

December 2, 2020

Preventing wrong-site surgery in Minnesota: a 5-year journey.

December 19, 2012

The impact of the built environment on patient falls in hospital rooms: an integrative review.

June 16, 2021

Lessons learned from a systems approach to engaging patients and families in patient safety transformation.

February 12, 2020

Finding the right balance: an evidence-informed guidance document to support the re-opening of Canadian nursing homes to family caregivers and visitors during the coronavirus disease 2019 pandemic.

October 28, 2020

Effects of interorganisational information technology networks on patient safety: a realist synthesis.

December 9, 2020

Higher incidence of adverse events in isolated patients compared with non-isolated patients: a cohort study.

November 18, 2020

Oncologic errors in diagnostic radiology: a 10-year analysis based on medical malpractice claims.

November 10, 2021

Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study.

September 13, 2017

Bracing for the storm: one health care system's planning for the COVID-19 surge.

November 11, 2020

Knowledge, attitudes, and expectations of medical staff toward medical error management policies in humanitarian medicine: a qualitative study.

February 10, 2021

Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project.

October 20, 2021

Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study.

June 29, 2022

Exploring nurses' attitudes, skills, and beliefs of medication safety practices.

August 24, 2022

Reported clinical incidents of children with intellectual disability: a qualitative analysis.

June 15, 2022

The reduction of race and gender bias in clinical treatment recommendations using clinician peer networks in an experimental setting.

December 15, 2021

Associations between double-checking and medication administration errors: a direct observational study of paediatric inpatients.

August 26, 2020

Outcomes from Wake Up Safe, the pediatric anesthesia quality improvement initiative.

February 3, 2021

Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial.

July 29, 2020

Two pandemics, same story: the potentially dangerous overuse of antibiotics and 'the road to medical hell'.

September 9, 2020

Patient perspectives on the usefulness of an artificial intelligence-assisted symptom checker: cross-sectional survey study.

March 11, 2020

Characteristics of critical incident reporting systems in primary care: an international survey.

January 19, 2022

Adaptation and implementation of the WHO Safe Childbirth Checklist around the world.

November 3, 2021

Impact of remote consultations on antibiotic prescribing in primary healthcare: systematic review.

December 2, 2020

How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis.

December 2, 2020

A mixed-methods analysis of patient safety incidents involving opioid substitution treatment with methadone or buprenorphine in community-based care in England and Wales.

November 11, 2020

Insurance claims for wrong-side, wrong-organ, wrong-procedure, or wrong-person surgical errors: a retrospective study for 10 years.

February 8, 2023

Safety in pediatric hospice and palliative care: a qualitative study.

September 23, 2020

Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review.

September 16, 2020

Association of unexpected newborn deaths with changes in obstetric and neonatal process of care.

January 20, 2021

Design and implementation of an analgesia, sedation, and paralysis order set to enhance compliance of pro re nata medication orders with Joint Commission medication management standards in a pediatric ICU.

December 9, 2020

Implementing high-reliability organization principles into practice: a rapid evidence review.

November 11, 2020

Development and validation of a deep learning model for detection of allergic reactions using safety event reports across hospitals.

December 9, 2020

Development of rapid response capabilities in a large COVID-19 alternate care site using Failure Modes and Effect Analysis with in situ simulation.

November 18, 2020

Nurse-reported bullying and documented adverse patient events: an exploratory study in a US Hospital.

June 24, 2020

Related Resources

A narrative review of the well-being and burnout of U.S. community pharmacists.

April 3, 2024

Designing human-centered AI to prevent medication dispensing errors: focus group study with pharmacists.

March 20, 2024

Dispensing error rates in pharmacy: a systematic review and meta-analysis.

March 13, 2024

A multi-method exploratory evaluation of a service designed to improve medication safety for patients with monitored dosage systems following hospital discharge.

October 25, 2023

Pharmacy e-prescription dispensing before and after CancelRx implementation.

September 20, 2023

California pharmacies are making millions of mistakes. They’re fighting to keep that secret.

September 20, 2023

The state of health, burnout, healthy behaviors, workplace wellness support, and concerns of medication errors in pharmacists during the COVID-19 pandemic.

August 23, 2023

Status of patient safety culture in community pharmacy settings: a systematic review.

August 23, 2023

Risk Evaluation and Mitigation Strategy (REMS) Programs and Medication Safety: Parts I and II.

August 9, 2023

The impact of language barriers on patient care: a pharmacy perspective.

May 24, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

ISMP Targeted Medication Safety Best Practices for Community Pharmacy.

April 19, 2023

Creating a stronger culture of safety within US community pharmacies.

April 12, 2023

The relationship between patient safety culture and the intentions of the nursing staff to report a near-miss event during the COVID-19 crisis.

April 5, 2023

WebM&M Cases

Duplicate Therapies in Retail Pharmacy

March 15, 2023

Medication errors in community pharmacies: evaluation of a standardized safety program.

March 15, 2023

Pharmacists reducing medication risk in medical outpatient clinics: a retrospective study of 18 clinics.

March 8, 2023

Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety.

February 22, 2023

Latent and active failures perfectly align to allow a preventable adverse event to reach a patient.

February 1, 2023

Prevent administration of ear drops into the eyes.

December 14, 2022

Concerns regarding tablet splitting: a systematic review.

December 7, 2022

Journal Article

Study

Patient Safety Innovations

Predicting dispensing errors in community pharmacies: an application of the Systematic Human Error Reduction and Prediction Approach (SHERPA).

November 16, 2022

ISMP survey on tall man (mixed case) lettering to reduce drug name confusion.

November 16, 2022

Walgreens will stop judging its pharmacy staffers by how fast they work.

November 9, 2022

The impact of electronic communication of medication discontinuation (CancelRx) on medication safety: a pilot study.

October 5, 2022

Adopt strategies to manage look-alike and/or sound-alike medication name mix-ups.

June 15, 2022

Mapping the resilience performance of community pharmacy to maintain patient safety during the Covid-19 pandemic.

February 16, 2022

Failure to rescue following emergency surgery: a FRAM analysis of the management of the deteriorating patient.

February 2, 2022

Including the reason for use on prescriptions sent to pharmacists: scoping review.

January 26, 2022

Mix-ups between the influenza (Flu) vaccine and COVID-19 vaccines.

October 20, 2021

See More About The Topic

Outpatient Pharmacy

Quality and Safety Professionals

Community Pharmacy

Dispensing Errors

Latent Errors