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Medication selection errors made by pharmacy technicians in filling unit dose orders.

J Taylor, M Gaucher

The Canadian Journal of Hospital Pharmacy

|January 10, 1986

Summary

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Pharmacy technicians made selection errors in 1.7% of unit dose orders, with significant ward-based variability. Incorrect dosage was the most common error type, highlighting potential patient harm from medication selection mistakes.

Area of Science:

Pharmacy Practice
Patient Safety
Medication Errors

Background:

Unit dose drug distribution systems are crucial for medication safety in hospitals.
Pharmacy technician selection errors can lead to medication administration errors.
Understanding error rates and types is essential for targeted quality improvement.

Purpose of the Study:

To determine the percentage error rate of pharmacy technician selection in unit dose orders.
To categorize the types of selection errors encountered.
To examine error variations across hospital wards and over time.

Main Methods:

Systematic recording and categorization of selection errors made by pharmacy technicians.
Errors classified as incorrect medication, dosage, dosage form, omitted, or extra medication.

Related Experiment Videos

Analysis of error rates in relation to specific hospital wards and time of order filling.

Main Results:

An overall selection error rate of 1.7% was observed across all studied time periods.
Significant variability in error rates was found between different hospital wards, ranging from 0.4% to 4.5%.
The most frequent error was 'incorrect dosage', followed by 'omitted medication', 'incorrect medication', 'extra medication', and 'incorrect dosage form'.

Conclusions:

Medication selection errors by pharmacy technicians represent a critical risk for patient safety.
Ward-specific interventions may be necessary to address the observed variability in error rates.
Continuous monitoring and categorization of errors are vital for improving medication dispensing accuracy.