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

Area of Science:

• Pharmacy Practice
• Patient Safety
• Medication Error Analysis

Background:

• Mandated reporting of medication errors in community pharmacies serves as a crucial learning opportunity.
• Incidents include inappropriate medication use and near misses intercepted before patient administration.

Purpose of the Study:

• To examine reporting uptake, trends, and initial learnings from medication errors reported by community pharmacists.
• Focus on the Assurance and Improvement in Medication Safety (AIMS) Program in Ontario, Canada (April 2018–June 2021).

Main Methods:

• Descriptive analysis of all events reported to the AIMS Program during the study period.
• Utilized a web-based reporting form with mandatory and optional fields.
• Medications were grouped into broader classes for analysis.

Main Results:

• Over 31,768 event reports from 2856 community pharmacies (19,639 incidents, 12,129 near misses).
• Reporting increased rapidly after program expansion in 2018; ~60% of pharmacies reported at least one event.
• Most frequent errors involved incorrect drug (19.5%), concentration (17.2%), or quantity (14.5%); 90.5% reported no patient harm.
• Antihypertensives, opioids, and antidepressants were common in events.
• Staffing issues and interruptions were frequent contributory factors.

Conclusions:

• The study offers insights into community pharmacy engagement with the AIMS Program.
• Identified circumstances and medications involved in incidents and near misses.
• Aids in developing strategies to prevent future medication-related events.