Community Pharmacy Dispensing Errors: A Comprehensive Systematic Review on Trends and Solutions

Dispensing errors in outpatient and community pharmacies pose significant safety risks and contribute to increased global healthcare costs. Despite their frequency, comprehensive studies on rates, causes, and interventions remain limited. This review examines current evidence on dispensing error prevalence, key risk factors, and the impact of mitigation strategies. Following PRISMA guidelines, we systematically searched PubMed, Embase, and CINAHL for studies on dispensing error rates in community and outpatient pharmacies, covering the period from January 2010 to June 2025, including English-language studies and grey literature. Eligible studies reported calculable prevalence using cross-sectional, cohort, or longitudinal designs. Two reviewers independently assessed records, extracted data, and evaluated bias using the NHLBI and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tools. In 22 studies (13 from developing, 9 from developed countries), dispensing error rates ranged from 0.001% to 11.53%, higher in community (mean 4.12%) than in outpatient pharmacies (1.85%). Common errors were wrong dose/ strength (58.6%) and look-/sound-alike drugs (47.90%). Key contributors were workload (55%), staff shortages (22%), and illegible prescriptions (30.70%). While one study reported a modest 1.40% decrease with electronic prescribing, another observed up to a 98.20% reduction using automated systems. GRADE evaluation found very low confidence in the data due to variability in study settings and methods. Dispensing errors remain a major issue, particularly in community pharmacies and underserved areas. Multimodal strategies - integrating technology, standardizing workflows, and training staff - represent a potentially effective approach to reducing errors. Although the certainty of the evidence is very low, the findings may still help guide future policies aimed at introducing error reporting systems, adopting technology, and improving consistency in research methods.