Medication errors are a well-recognized source of preventable patient harm and result from mistakes made during medication prescribing, transcribing, dispensing, and administration processes. This study looked at the impact of several factors on reducing medication errors in critical access hospitals. Investigators found that dispensing by an onsite pharmacist and the use of barcode technology for administration were both associated with a statistically significant reduction in medication errors.

Medication administration errors are common and are often associated with interruptions. This study reviews data from a recent study on medication safety in critical access hospitals and recommends organizational strategies to improve the safety of medication administration.

One major safety advantage of computerized provider order entry (CPOE) systems lies in their ability to prevent adverse drug events due to prescribing errors. In the outpatient setting, use of electronic prescriptions is growing thanks to studies demonstrating that e-prescribing reduces medication errors. However, as with CPOE in general, increasing use of e-prescribing is leading to greater recognition of new types of errors associated with this new technology. This study analyzed the frequency of unintended discrepancies in e-prescriptions from three primary care clinics by comparing the prescription information in the prescribing physician's note with the order entered into the e-prescribing system and the medication ultimately dispensed by the pharmacy. The investigators found that errors occurred at each stage of the process, with a small but significant rate of discrepancies between both physician notes and e-prescriptions and between e-prescriptions and the medication dispensed. These errors often occurred when providers entered free-text instructions into the e-prescribing system, as found in prior research. The potential safety benefits and hazards of e-prescribing are discussed in detail in an AHRQ WebM&M commentary.

Approaches to reducing medication errors have not been uniformly implemented in rural hospitals. This study used direct observation to monitor medication safety in nine small rural hospitals. The authors evaluated the benefits of onsite pharmacy support and bedside bar coding in preventing medication errors. Hospitals with more than 40 hours per week of onsite pharmacy staffing and bedside bar-coding technology had fewer errors than hospitals that had less pharmacist time and no bedside medication bar coding. The most common error types were omission and wrong dose. These findings suggest that increased pharmacy support and bar coding should be implemented in rural acute care settings.

The authors share case reports that demonstrate how bar-code medication administration (BCMA) systems prevented errors in some cases but caused them in others.