Geometric probability distribution for modeling of error risk during prescription dispensing.

Brian J. Carnahan; Saeed Maghsoodloo; Elizabeth A. Flynn; Kenneth N. Barker

Study

Geometric probability distribution for modeling of error risk during prescription dispensing.

June 14, 2006

Carnahan BJ, Maghsoodloo S, Flynn EA, et al. Am J Health Syst Pharm. 2006;63(11):1056-61.

View more articles from the same authors.

Investigators observed pharmacy staff to determine the probability of at least one dispensing error per work day and found that a geometric probability distribution could model rates of dispensing errors.

PubMed citation

Available at

Related Resources From the Same Author(s)

Dispensing errors and counseling quality in 100 pharmacies.

July 15, 2009

The impact of dedicated medication nurses on the medication administration error rate: a randomized controlled trial.

March 27, 2005

Frequency of passive EHR alerts in the ICU: another form of alert fatigue?

July 27, 2016

Out-of-hospital medication errors: a 6-year analysis of the national poison data system.

September 2, 2009

Variation in the reporting of elective surgeries and its influence on patient safety indicators.

July 6, 2022

Fatigue, performance and the work environment: a survey of registered nurses.

January 30, 2005

Creating a fellowship curriculum in patient safety and quality.

September 17, 2014

Incidence- versus prevalence-based measures of inappropriate prescribing in the Veterans Health Administration.

September 30, 2015

Risk of mistaken DNR orders.

March 22, 2006

A new tool to give hospitalists feedback to improve interprofessional teamwork and advance patient care.

November 28, 2012

Managing the care of patients discharged from home health: a quiet threat to patient safety?

April 4, 2007

The simulated ward: ideal for training clinical clerks in an era of patient safety.

May 9, 2012

A nursing home’s 64-day Covid siege: ‘They’re all going to die’.

June 24, 2020

Does teamwork improve performance in the operating room? A multilevel evaluation.

March 3, 2010

Fatigue risk management: the impact of anesthesiology residents' work schedules on job performance and a review of potential countermeasures.

December 13, 2017

An evaluation of a collaborative, safety focused, nurse–pharmacist intervention for improving the accuracy of the medication history.

November 20, 2013

Comparing the variability of ingredient, strength, and dose form information from electronic prescriptions with RxNorm drug product descriptions.

August 31, 2022

Automated communication tools and computer-based medication reconciliation to decrease hospital discharge medication errors.

April 8, 2015

A culture of civility: positively impacting practice and patient safety.

April 25, 2018

Maximizing smart pump technology to enhance patient safety.

July 29, 2015

Enhance patient safety by identifying and minimizing risk exposures affecting nurse practitioner practice.

November 20, 2013

Improving teamwork on general medical units: when teams do not work face-to-face.

October 3, 2012

Pharmacy–nursing intervention to improve accuracy and completeness of medication histories.

April 28, 2010

Prevalence and predictors of adverse events in older surgical patients: impact of the present on admission indicator.

July 14, 2010

Nurses' clinical reasoning: processes and practices of medication safety.

September 28, 2011

Time motion study in a pediatric emergency department before and after computer physician order entry.

December 10, 2008

Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system.

August 18, 2010

Review of patient safety incidents reported from critical care units in North-West England in 2009 and 2010.

May 2, 2012

Systemic error in radiology.

August 9, 2017

A July spike in fatal medication errors: a possible effect of new medical residents.

June 16, 2010

Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection.

January 31, 2006

Direct observation approach for detecting medication errors and adverse drug events in a pediatric intensive care unit.

April 4, 2007

The role of cognitive bias in breast radiology diagnostic and judgment errors.

May 27, 2020

Implementing a perioperative handoff tool to improve postprocedural patient transfers.

March 7, 2012

A multidisciplinary teamwork training program: The Triad for Optimal Patient Safety (TOPS) experience.

October 15, 2008

Cost implications of actual and potential adverse events prevented by interventions of a critical care pharmacist.

December 5, 2007

Electronic health record-based triggers to detect potential delays in cancer diagnosis.

August 28, 2013

Implementing peer evaluation of handoffs: associations with experience and workload.

February 27, 2013

Strategies for improving patient safety culture in hospitals: a systematic review.

August 15, 2012

Realistic distractions and interruptions that impair simulated surgical performance by novice surgeons.

July 25, 2012

Review of patient safety incidents submitted from critical care units in England & Wales to the UK National Patient Safety Agency.

December 2, 2009

Error reduction through team leadership: applying aviation's CRM model in the OR.

February 22, 2006

Pharmacist work stress and learning from quality related events.

November 9, 2016

Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study.

June 12, 2019

Clinical questions raised by clinicians at the point of care: a systematic review.

July 16, 2014

Achieving rapid door-to-balloon times: how top hospitals improve complex clinical systems.

March 8, 2006

Adverse drug events and medication problems in "Hospital at Home" patients.

October 10, 2018

A patient safety dilemma: obesity in the surgical patient.

February 15, 2017

February 1, 2012

Driving improvement in patient care: lessons from Toyota.

March 6, 2005

Hospital medication errors: a cross sectional study.

December 23, 2020

Outcomes of daytime procedures performed by attending surgeons after night work.

September 2, 2015

A multi-stakeholder consensus-driven research agenda for better understanding and supporting the emotional impact of harmful events on patients and families.

July 11, 2018

The Safer Delivery of Surgical Services Program (S3): explaining its differential effectiveness and exploring implications for improving quality in complex systems.

February 24, 2016

Antibiotic-resistant infection treatment costs have doubled since 2002, now exceeding $2 billion annually.

April 4, 2018

Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review.

April 6, 2011

A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs.

August 6, 2008

Comparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York.

February 27, 2008

Assessment of attitudes toward deprescribing in older Medicare beneficiaries in the United States.

December 19, 2018

The relationship between patients' perceptions of team effectiveness and their care experience in the emergency department.

May 1, 2013

Early diagnosis of cancer: systems approach to support clinicians in primary care.

April 5, 2023

Does simulator-based clinical performance correlate with actual hospital behavior? The effect of extended work hours on patient care provided by medical interns.

November 3, 2010

Frequency and severity of harm of medication errors related to the parenteral nutrition process in a large university teaching hospital.

August 19, 2009

Medication errors—new approaches to prevention.

May 25, 2011

The underappreciated role of habit in highly reliable healthcare.

September 23, 2015

Navigating care transitions: a process model of how doctors overcome organizational barriers and create awareness.

March 25, 2015

Patients' perceptions of safety if interpersonal continuity of care were to be disrupted.

March 11, 2009

Using care bundles to reduce in-hospital mortality: quantitative survey.

April 14, 2010

In situ simulation for adoption of new technology to improve sepsis care in rural emergency departments.

June 22, 2022

Is there a "July phenomenon" in pediatric neurosurgery at teaching hospitals?

November 1, 2006

Simulation as a tool to improve the safety of pre-hospital anaesthesia—a pilot study.

September 23, 2009

Application of human error theory in case analysis of wrong procedures.

June 16, 2010

Quality, patient safety, and the cardiac surgical team.

June 19, 2013

Blame: what does it look like?

November 14, 2018

Recognizing the ordinary as extraordinary: insight into the "way we work" to improve patient safety outcomes.

August 2, 2017

Recognizing and managing errors of cognitive underspecification.

March 19, 2014

Patient safety and technology.

May 20, 2009

Unreported errors in the intensive care unit: a case study of the way we work.

November 14, 2007

Determining a patient's comfort in inquiring about healthcare providers' hand-washing behavior.

June 12, 2013

The medical emergency team as a safety net.

November 8, 2006

The evolution of a safety culture.

October 7, 2015

Effectiveness of a computerized system for intravenous heparin administration: using information technology to improve patient care and patient safety.

May 11, 2005

Understanding the "Swiss cheese model" and its application to patient safety.

July 21, 2021

An educational and audit tool to reduce prescribing error in intensive care.

October 29, 2008

Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system.

June 25, 2014

Using an online quiz-based reinforcement system to teach healthcare quality and patient safety and care transitions at the University of California.

January 10, 2018

A health system–wide initiative to decrease opioid-related morbidity and mortality.

September 26, 2018

Practice makes perfect: planning considerations for medical simulation centers.

December 5, 2012

Postoperative opioid prescribing: Getting it RIGHTT.

March 21, 2018

The costs of adverse drug events in hospitalized patients.

March 27, 2005

The high cost of low-frequency events: the anatomy and economics of surgical mishaps.

March 27, 2005

Randomized trial to improve prescribing safety during pregnancy.

July 11, 2007

A pediatric medical emergency team manages a complex child with hypoxia and a worried parent.

March 28, 2007

Effectiveness of a pharmacist–nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care.

December 9, 2009

Automated adverse event detection collaborative: electronic adverse event identification, classification, and corrective actions across academic pediatric institutions.

December 18, 2013

Patient safety incidents associated with airway devices in critical care: a review of reports to the UK National Patient Safety Agency.

February 18, 2009

Safety in home care: a broadened perspective of patient safety.

January 30, 2008

Residents' response to duty-hour regulations—a follow-up national survey.

June 6, 2012

Patient safety event reporting in a large radiology department.

September 21, 2011

Assessment of fidelity in interventions to improve hand hygiene of healthcare workers: a systematic review.

March 16, 2016

Related Resources

ISMP Targeted Medication Safety Best Practices for Community Pharmacy.

April 19, 2023

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

February 22, 2023

ASHP Guidelines on Preventing Diversion of Controlled Substances.

December 14, 2022

Concerns regarding tablet splitting: a systematic review.

December 7, 2022

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

November 16, 2022

Start the year off right by addressing these top 10 medication safety concerns from 2021.

February 9, 2022

Important Actions Community Pharmacists Need to Take Now to Reduce Potentially Harmful Dispensing Errors.

October 26, 2021 - October 26, 2021

WebM&M Cases

Medication Errors in Retail Pharmacies: Wrong Patient, Wrong Instructions.

July 28, 2021

Medication incident recovery and prevention utilising an Australian community pharmacy incident reporting system: the QUMwatch study.

May 5, 2021

Wrong drug and wrong dose dispensing errors identified in pharmacist professional liability claims.

November 4, 2020

Key potentially inappropriate drugs in pediatrics: the KIDs list.

June 24, 2020

WebM&M Cases

The Lost Start Date: an Unknown Risk of E-prescribing

October 30, 2019

Ten ways to improve medication safety in community pharmacies.

August 7, 2019

How often do prescribers include indications in drug orders? Analysis of 4 million outpatient prescriptions.

July 10, 2019

Work overload is related to increased risk of error during chemotherapy preparation.

May 29, 2019

Community Pharmacy Survey on Patient Safety Culture: 2019 User Comparative Database Report.

April 17, 2019

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

February 6, 2019

Detection of potential look-alike/sound-alike medication errors using Veterans Affairs administrative databases.

November 28, 2018

Community-acquired and hospital-acquired medication harm among older inpatients and impact of a state-wide medication management intervention.

November 14, 2018

I-PASS checklist: a powerful tool for patient handoffs.

October 24, 2018

How to prevent the top 4 medication errors.

October 17, 2018

Evaluation of the frequency of dispensing electronically discontinued medications and associated outcomes.

August 15, 2018

Preventing dispensing errors by alerting for drug confusions in the pharmacy information system—a survey of users.

August 8, 2018

Board of pharmacy practices related to medication errors and their potential impact on patient safety.

August 1, 2018

WebM&M Cases

Mixup Beyond the Medication Label

August 1, 2018

Necessity for a pathway for "high-alert" patients.

May 23, 2018

Promising roles for pharmacists in addressing the U.S. opioid crisis.

February 14, 2018

Using failure mode and effects analysis to reduce patient safety risks related to the dispensing process in the community pharmacy setting.

January 24, 2018

Using prospective risk analysis tools to improve safety in pharmacy settings: a systematic review and critical appraisal.

August 2, 2017

The effects of bar-coding technology on medication errors: a systematic literature review.

April 19, 2017

See More About The Topic

Epidemiology of Errors and Adverse Events

Geometric probability distribution for modeling of error risk during prescription dispensing.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Geometric probability distribution for modeling of error risk during prescription dispensing.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site