Medication errors account for a significant amount of patient care errors in the United States. Specifically, dispensing errors in the administration of pharmaceuticals create a significant risk to the patient’s health and well-being. Due to the large volume of pharmaceuticals dispensed annually world-wide, even small levels of dispensing errors can result in a significant amount of patients receiving the wrong medication. In the U.S., approximately 98,000 individuals die annually as a result of medical error. Approximately 6% of reported hospital errors are medication dispensing errors. Obviously, reducing the risk of dispensing errors could result in a significant improvement in mortality and morbidity in patients (Tzeng, Yin, & Scheider, 2013, p. 13).
A literature review on the topic revealed a wealth of data. A dispensing error is defined as ‘any discrepancy between dispensed medications and physician orders (for patient-specific doses) or replenishment reports (for automated dispensing cabinets) or any deviation from standard pharmacy policies’ (Cina, Gandhi, Churchill, Fanikos, McCrea, Mitton, Rothschild, Featherstone, Keohane, Bates, & Poon, 2006, p. 74). Approximately one out of every ten hospitalized patients experiences an adverse outcome during their stay. Of these adverse events, 15.1% were medication related (Tzeng, Yin, & Scheider, 2013, p. 13). However, one must realize that many medication-related errors remain undetected, indicating that the true rate of errors may be significantly higher. According to Cina et al (2006), errors not caught by the pharmacist account for 0.75% of all medications filled in the hospital pharmacy. Of this amount, approximately 23% would potentially result in potential adverse drug events (ADEs). Twenty-eight percent are serious adverse events and 0.8% potentially life-threatening (Cina et al, 2006, p. 73). Newer methods to verify medications, including a barcode system have shown promise in reducing the incidence of dispensing errors. One study indicated that the rate of dispensing errors decreased from 1.6% to 0.4% of all prescriptions with the use of technology (Cheung, Bouvy, & DeSmet, 2009, p. 679).
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The problem of dispensing errors creates a significant risk to the safety and health of patients. The sheer volume of medications dispensed by pharmacies and administered by nurses indicates that even a small decrease in dispensing errors may vastly improve the health and safety of patients. The causes of medication dispensing error are varied. One cause that also results in a number of potential patient risks involves inadequate staffing in the nursing department. One study indicated that nursing overload often resulted in dose omission errors. The authors recommended that human capital improvements need to be considered as well as technological advancements. As registered nurses (RNs) decreased, medication errors increase. Also, as the staffing of licensed practical nurses (LPNs) increase to replace RNs, so do medication errors. Medication errors in nursing also result from fatigue, unit environment, inadequate staffing levels and time management. Therefore, nursing administration needs to play an active role in decreasing medication errors (Frith, Anderson, Tseng, & Fong, 2012, pp. 289-292).
Reducing the rate of dispensing errors requires a multifactorial approach. Obviously, nursing administration needs to ensure that there is a proper level of RNs to staff. While LPNs reduce payroll costs, ‘the cognitive work of medication administration may not be appropriate for the educational preparation of LPNs’ (Frith et al, 2012, p. 292). Therefore, nursing administration should consider increasing the level of RNs available for direct patient care. Technological advancements to reduce the risk of a dispensing error include a barcode system. A computerized system for prescription entry also helps to reduce the rate of dispensing errors. Computerized provider order entry (CPOE) systems allow providers to electronically enter prescriptions for patients. As of 2008, thirty-four percent of U.S. acute hospital settings had implemented a CPOE system to reduce the rate of dispensing errors. The system removes a significant cause of medication errors.
Poor penmanship on the part of the provider or misinterpreting the order on the part of the pharmacist often results in a dispensing error. When using a CPOE system, the risk of an error on any particular prescription is reduced by 48%. Furthermore, at the current rate of adoption of CPOE systems, the systems are anticipated to reduce the rate of dispensing errors by 12.5% annually. This amounts to approximately 17.4 million prescription errors prevented every year (Radley, Wasserman, Osho, Shoemaker, Spranca, & Bradshaw, 2013, p. 1). Obviously, improving the staffing of RNs and implementing a CPOE system together offer a significant method to reduce the risk of medication errors to patients. The reduction in these errors should offer a significant cost savings. These changes should be accomplished over an approximate two-year time frame. The reduction in errors by this time would be substantial.
Medication dispensing errors account for a significant cause of increased mortality and morbidity to patients. The cause of these errors is multifactorial, including prescriptions that are difficult to read. Furthermore, inadequate nursing staffing accounts for an increase in dispensing errors due to both temporal and educational components. In an effort to reduce the rate of dispensing errors, increased staffing among RNs and a computerized provider order entry system are recommended. Combined, these two actions would prevent errors at two important parts of the medication dispensing. Pharmacists would be less likely to dispense an incorrect dose or medication. Nurses would also be less likely to administer the wrong medication or to omit the medication administration.
