Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 185629

AbstractMaterial and MethodsResultsDiscussionConclusionKey MessageAcknowledgementReferencesTable and FiguresDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : November | Volume : 5 | Issue : 6 | Page : 1214 - 1218 Full Version

An Observational Study to Evaluate The Factors which Influence The Dispensing Errors in The Hospital Pharmacy of A Tertiary Care Hospital


Published: November 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1610
Tinsy Thomas, Leelavathi D Acharya, Venkatraghavan S, Sureshwar Pandey, Rama Mylapuram

Corresponding Author M.Pharm, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University Manipal – 576104 M.Pharm, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University Manipal – 576104 M.Pharm, Ph.D., Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University Manipal – 576104 Pharm D., Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University Manipal – 576104

Correspondence Address :
Leelavathi D Acharya
Selection Grade Lecturer, Department of Pharmacy Practice
Manipal College of Pharmaceutical Sciences, Manipal
University, Manipal – 576104 Karnataka, India.
Phone : (0820) 2922403
E-mail : leela.da@manipal.edu

Abstract

Introduction: Dispensing errors are any discrepancies between the written instructions which are found on the prescription order form and the accomplishment of these instructions by the pharmacy, when the drug is dispensed to the wards or hospital services.

Objective: The hospital pharmacy of a tertiary care hospital in southern India has four satellite pharmacies and has more than 7900 medicine brands in its formulary. These pharmacies handle more than thousand prescriptions per day. There are chances of errors during the dispensing of the medications. Based on this, the present study aimed to study and evaluate the rate of occurrence of the dispensing errors and the factors which contributed to the dispensing errors.

Materials and Methods: A prospective observational study was carried for a period of eight months, at two pharmacies of the hospital (out-patient/ in-patient pharmacy), at various stages of dispensing and time schedules.

Results: A total of 160 dispensing errors were found in 12,340 prescriptions that were monitored, out of the 57,109 prescriptions which were received in both the pharmacies during the study period. The overall rate of the dispensing errors which was found in both the pharmacies was 1.29%. It was seen that 11am-3pm was the peak time at the hospital, when the maximum numbers of errors occurred. The stage of the dispensing process where the maximum numbers of dispensing errors occurred was at the filling stage. It was observed that the maximum number of errors occurred in the in-patient pharmacy, in comparison to the outpatient pharmacy. The different types of dispensing errors that were observed during the study were drug omission, wrong quantity of the drugs, wrong drugs, wrong strength of the drugs and wrong dosage form of the drugs.

Conclusion: This study concludes that during peak hours, an insufficient number of pharmacists was found to be the most important factor which contributed to the dispensing errors. This also shows the need for a sufficient number of pharmacists to be posted during the peak hours at the filling section and in the in-patient pharmacy to minimize the dispensing errors.

Keywords

Dispensing Errors, Factors influencing, Pharmacists, Time, Inpatient Pharmacy, Dispensing stages

INTRODUCTION
Mistakes are unfortunately a part of every human activity, including health care. Throughout the course of any drug therapy, medication mishaps can occur at different stages of the process, such as prescribing, dispensing, administering or monitoring (1). The goal of drug therapy is the achievement of defined therapeutic outcomes that improve a patient’s quality of life, while minimizing patient risk. There are inherent risks which are known and unknown, which are associated with the therapeutic use of drugs and other pharmaceutical agents. The incidents (or) hazards that result from such risks have been defined as adverse drug misadventures and they include adverse drug reactions and adverse errors. But at times, harm to the patient may occur due to errors in the prescribing, dispensing and the administration of the drugs. These errors are known as medication errors. They are not inevitable and can be prevented (2).

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient or consumer. Such events may be related to the professional practice, health care products and procedures and systems, including prescribing, order communication, product labeling, packaging, nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use (3).

A dispensing error is defined as the discrepancy between the written order in a medical prescription and the following of this order. These errors are made by the pharmacy staff (including the pharmacist) when dispensing to hospital units (4), (5), (6).

Dispensing is an integral part of the quality use of the medicines and together with the patient counselling, form the core professionalactivities of a pharmacist. Many prescription errors are made during the various phases of medication usage in the hospital environment; dispensation is one of the most sensitive phases of the process. Safe, organized and effective dispensing systems are therefore, fundamental to ensure that the drugs will be properly dispensed according to the prescription order forms and to reduce the possibility of errors. In a study which was carried out in 1994 in the US, it was demonstrated that the transcription and administration of drugs could be responsible for 50% of the medication errors, considering that 39% of the errors involved prescription errors and 11% involved dispensing errors (7).

Today, there are different drug dispensing systems in hospital units and a different expectation of errors is associated with each of them. It is known that in American, British and Canadian hospitals where the unit dose [UD] system is used, the rate of medication errors has been reduced from one error/patient/day to two or three errors/patient/week (7). It has been observed that the rates of drug dispensing errors in work environments with high leads of interruption, distraction, noise and overload are higher (3.23%) as compared to environments with lower levels of these aspects (1. 23%) (8).

The published literature is limited in the number of studies which evaluate medication errors that occur during the dispensing stage or in non-hospital pharmacy settings such as community or ambulatory care. Observational studies which were performed in the community or ambulatory care settings found error rates that occurred between 1%- 24%. Other studies determined that the rate of potentially harmful errors ranged from 1.5-4% (9).

Based on this, the present study aimed at finding out the factors which contributed to the dispensing errors so that a necessary action could be advised to reduce the same.

Material and Methods

This study was conducted in the hospital pharmacy of Kasturba Hospital, Manipal, which is located in southern India. Kasturba Hospital is a 2200 bedded super specialty, tertiary care, teaching hospital, having main and satellite pharmacies. A prospective observational study was carried out for a period of eight months [October 2008 to May 2009]. The sources of the data were the patients’ prescription forms, indent forms and the pharmacy bills. A dispensing error documentation form was prepared, based on a standard reporting form that was obtained from Dr. Cheng Chi Man on the common dispensing errors which were experienced in clinical settings and necessary changes were made to suit the study. It included the different types of errors which occur at the different stages of dispensing. In order to study and understand the dispensing errors, the Main Pharmacy and the Satellite Pharmacy were selected for the study. The Main Pharmacy mainly handled the out-patient prescriptions and the timing of this pharmacy was from 9am-5pm. Nearly 800 prescriptions were dispensed from this pharmacy per day. The Satellite Pharmacy handled the in-patient prescriptions and it was a 24hr service outlet. The number of prescriptions which were dispensed per day from this pharmacy was approximately 2000. The number of pharmacists working at both the pharmacies together was 36.

For the present study, three areas in the pharmacy were selected to study and evaluate the dispensing errors. The three areas were selected so as to observe at which area the maximum number of errors would occur. The three areas which were chosen were the billing area where the prescriptions were received and billed,the filling area where the medications were taken from the shelves according to the prescriptions and the dispensing area where the medications were dispensed to the patients. The study areas were divided into different time slots in order to study the correlation between the time and the occurrence of the dispensing errors. Approximately 20% of the total prescriptions were checked and evaluated at each area of both the pharmacies at different time schedules.

The investigator, who was a clinical pharmacist, was posted to evaluate the prescriptions and medications intensively, as per the following schedules, in both the pharmacies at different areas. In the Main Pharmacy, at the billing area, the investigator checked and evaluated the prescriptions that were received by the pharmacist, to find the errors. The prescriptions were evaluated before and after they were billed. The errors which are found after billing the prescriptions are known as dispensing errors.

At the filling area, each pharmacist who was filling the prescriptions was followed to analyze whether the filling process was done correctly i.e. taking medications from the shelves according to the prescriptions, billing them and keeping them ready for dispensing.

At the dispensing area, the investigator checked the prescriptions and medications that were filled by the pharmacist. If an error was found and the dispensing pharmacist supplied the medications to the patient, the investigator would tell the pharmacist about it and make an intervention.

Similarly, in the Satellite Pharmacy, the three areas were intensively monitored by the investigator as per the schedules. In addition, the indents that were received from the wards were analyzed by going to the respective wards and checking whether the medications which were dispensed to the wards by the pharmacy were correct.

If any errors occurred at different areas of both the Main pharmacy and Satellite pharmacy, they were documented in the documentation form which was developed for the study purpose and were evaluated for the following parameters: rate of occurrence of the dispensing errors, impact of time/area/pharmacy (out-patient/ in-patient) on the dispensing errors and the types of dispensing errors.

Results

During the study period, the prescriptions and the medications at various stages of the dispensing process, that is billing, filling and dispensing in both the Main as well as the Satellite pharmacies, were intensively monitored. In the 12,340 prescriptions that were viewed at both the pharmacies, a total of only 160 dispensing errors were identified.

The overall rate of the dispensing errors that were found in both the Main and the Satellite pharmacies during the study period was 1.29%. Out of the 160 dispensing errors, 53 (33.1%) were found in the Main Pharmacy and the number of the dispensing errors which were found in the Satellite Pharmacy were 107 (66.9%).

Both the Main and the Satellite pharmacies were screened at different areas such as billing, filling and dispensing, in order to find out at which stage of the dispensing process, the maximum number of errors occurred. The maximum number of errors was found to occur at the filling stage. The overall rate of the dispensing errors which was found at the billing area was 0.16%, while the rate of the dispensing errors which was found at the filling area was 0.42%.

In the Main Pharmacy, a total of 2709 prescriptions were monitored in the billing area and no errors were found. At the filling area, in the 771 prescriptions which were monitored, a total of 37 [4.7%] errors were found. In the dispensing area, 1508 prescriptions were monitored. In these 16 [1.06%] errors were found.

In the Satellite Pharmacy, around 2751 prescriptions were monitored at the billing area and 9 [0.32%] errors were detected. A total of 85 [4.1%] errors were found at the filling area, in the 2057 prescriptions that were monitored. In the dispensing area, 2544 prescriptions were monitored and 13 [0.5%] errors were found, which has been represented in (Table/Fig 1).

On the evaluation of the impact of the timings on the dispensing errors, it was found that the errors were more in number between 11am -3pm of the day. The total number of errors which were found at both the pharmacies between 9am-11am were found to be 28 (17.5%), while the number of errors which were found between the time period from 11am-1pm were 51 (31.9%). The number of errors which were found between 1pm-3pm were 52 (32.5%), whereas the number of errors which were found between the time period from 3pm-5pm were 29 (18.1%), as shown in (Table/Fig 2).

Next, the 160 dispensing errors which were found at both the pharmacies during the study period were classified into, drugs not taken- 51 (31.9%), wrong quantity taken -45 (28.1%), wrong drug taken -15 (9.4%), wrong quantity given -12 (7.5%), wrong strength taken- 11 (6.9%), wrong strength given- 9 (5.6%), wrong drug given -5 (3.1%), drug not printed- 4 (2.5%), wrong dosage form given- 2 (1.3%), wrong strength printed- 2 (1.3%), wrong dosage form printed- 2 (1.3%), wrong quantity printed- 1 (0.63%) and drug not given -1 (0.63%). The types of errors which were not found were, wrong drug printed, double entry, wrong dosage form taken, expired drugs taken, double dispensing, wrong label information, expired drugs issued and wrong patient given, which are shown in (Table/Fig 3).

Discussion

One of the objectives of the present study was to find out the rate of the dispensing errors. In the 12,340 prescriptions which were viewed, 160 dispensing errors were identified at both the pharmacies. The overall rate of the dispensing errors was found to be 1.29%. Among these, 53 (33.1%) dispensing errors were found in the Main Pharmacy and in the Satellite Pharmacy, there were 107 (66.9%) dispensing errors.

This observation was found to be consistent with those of the study which was conducted by Dominica MG (10) et al. on the analysis of the prescription, transcription and the dispensing quality, through the information which was gathered in a pharmacy service, in which it was found that the overall rate of the dispensing errors was 0.7% and that the rate of the prescription errors was found to be 4.1%. The dispensing error rate was found to be more in the present study, which may be due to the shortage of pharmacists working at the pharmacies and increased workload. The study also showed that in the Satellite Pharmacy which handled in-patient prescriptions, a high rate of dispensing errors occurred, in comparison to the Main Pharmacy which handled only out-patient prescriptions.

Another major observation of this study was, finding out at which stage of the dispensing process the maximum errors would occur. In the Main Pharmacy, a total of 2709 prescriptions were viewedin the billing area and no errors were found. At the filling area, in the 771 prescriptions which were viewed, a total of 37 [4.7%] errors were found. In the dispensing area, 1508 prescriptions were viewed. In these, 16 [1.06%] errors were found. In the Satellite Pharmacy, around 2751 prescriptions were viewed at the billing area and 9 [0.32%] errors were detected. 85 [4.1%] errors were found at the filling area, in the 2057 prescriptions that were viewed. In the dispensing area, 2544 prescriptions were viewed and 13 [0.5%] errors were found. In both the pharmacies, the area or the stage of the dispensing process at which the maximum numbers of errors occurred was the filling area. This may be due to lack of space and the arrangement of the medication in the shelves. Another reason for the occurrence of the errors was the shortage of staff.

This observation was found to be consistent with that of the study which was carried out by Darren MA (11) et al. which was a prospective study of the incidence, nature and the causes of the dispensing errors in community pharmacies, in which 125, 395 prescribed items were dispensed during the study period and 330 incidents were recorded, of which the selection errors were more common [199 (60.3%).

This study also evaluated the occurrence of the dispensing errors, based on the time schedules. The total number of errors which was found at both the pharmacies between 9am-11am was found to be 28 (17.5%), while the number of errors which was found between the time period from 11am-1pm was 51 (31.9%). The number of errors which was found between 1pm-3pm was 52 (32.5%), whereas the number of errors which was found between the time period from 3pm-5pm was 29 (18.1%). The maximum errors that occurred at both the pharmacies were during the time period from 11am-3pm, which were considered to be the peak hours of our hospital pharmacy.

This observation was found to be consistent with that of the study which was carried out by Kistner UA (12) et al. on the accuracy of dispensing in a high volume, hospital based out-patient pharmacy, which showed that error peaks were noted during the lunch hour. In the Main pharmacy, the patients would come to the OPD at around 9am and by the time the prescriptions were received at the pharmacy, it would be 11am. Similarly, in the Satellite pharmacy, the doctors would go for their daily rounds at 8am and if there was a change in the therapy, the nurses would give the prescription to the patient party or directly sent it to the pharmacy at 11am. During this time, the pharmacists would have more workloads as compared to those during the non-peak hours and the chances of the dispensing errors would be more.

The types of errors which occurred at various stages of the dispensing process were evaluated. Drug not taken -51 (31.9%), wrong quantity taken -45 (28.1%), wrong drug taken- 15 (9.4%), wrong quantity given- 12 (7.5%), wrong strength taken- 11 (6.9%), wrong strength given- 9 (5.6%), wrong drug given- 5 (3.1%), drug not printed -4 (2.5%), wrong dosage form given- 2 (1.3%), wrong strength printed -2 (1.3%), wrong dosage form printed -2 (1.3%), wrong quantity printed -1 (0.63%) and drug not given -1 (0.63%) were the different types of dispensing errors which were found in both the pharmacies at different stages of the dispensing process.

In a study which was conducted by Dominica MG (10) et al. on the analysis of the prescription, transcription and the dispensing quality through the information which was gathered at a pharmacyservice, the types of transcription errors which were found were drug omission (6.4%) and wrong dosage form (1.2%). This study was found to be consistent for wrong dosage form, but in the case of drug omission, the above mentioned study showed a higher percentage of errors when compared with the present study.

A study which was carried out by Cina JL (13) et al. on how many hospital pharmacy medication dispensing errors went undetected, showed that the most common filling error types were wrong quantity (59%), wrong strength (11%) and wrong medication (11%), which were found to be more than in the present study.

Our study showed that the overall rate of the dispensing errors that were found in both the Main and the Satellite pharmacies during the study period was (1.29%). While assessing the factors which contributed to the dispensing errors, it was observed that in the Satellite Pharmacy which handled the in-patient prescriptions, more errors occurred as compared to the Main Pharmacy which handled the out-patient prescriptions. It was found that among the stages of the dispensing process, the filling area was the stage at which the maximum numbers of errors had occurred, as compared to the billing and dispensing stages of the dispensing process. This study also showed that the peak hours (11am -3pm) was another factor which was assessed, that was the timing at which more numbers of errors had occurred, as compared to the non-peak hours (9am-11pm and 3pm-5pm).

Conclusion

Dispensing errors are a part of the medication errors which play an integral role in maintaining the quality use of medications. The different types of dispensing errors that were observed during the study were drug omission, wrong quantity, wrong drug, wrong strength and wrong dosage form. Since the hours from 11am-3pm are considered to be the peak hours of our hospital pharmacy, the administrator should post more pharmacists during these hours, so as to minimize the occurrence of the dispensing errors, which in turn will help in better patient care. Also, it is necessary to post more number of pharmacists at the filling area of the dispensing process and at the In-patient pharmacy (satellite pharmacy), to reduce the workload of the pharmacists and thereby, to reduce the occurrence of the dispensing errors.

Key Message

Dispensing plays an integral role in maintaining the quality use of the medicines. Minimizing the dispensing errors improves the integrity of the dispensing. Dispensing is a challenging task for the pharmacist and it is also a connecting step with the patients; It is also helping in providing an optimized care.

Acknowledgement

We would like to thank all the pharmacists who are working in Kasturba Hospital, Manipal, for their co-operation in conducting this study.

References

1.
Rheinskin PH, McGinnis TJ. Medication errors. Am Fam Physician, June 1992.
2.
American Society of Hospital Pharmacists. ASHP guidelines on Preventing Medication Error in Hospital. Am J Hosp Pharm 1993; 50:305-14.
3.
Taxonomy of medication errors. National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP). [Internet] Available from: http://www.nccmerp.com.
4.
Cohen MR. Medication Error. Washington. American Pharmaceutical Association. 1999.
5.
Flynn A, Baker KN, Carnahan BJ. A national observational study on the prescription dispensing accuracy and safety in 50 pharmacies. J Am Pharm Assoc 2003; 43:191-200.
6.
Anacelto TA, Perini E, Rosa MB, Cesar CC. Medication errors and drug-dispensing systems in the hospital pharmacy. Clinics. 2005; 60(4):325-32.
7.
Anacelto TA, Perini E, Rosa MB, Cesar CC. Drug-dispensing errors in the hospital pharmacy. Clinics. 2007; 62(3):243-50.
8.
Flynn AE, Baker KN, Gibson JT, Pearson RE, Berger BA, Smith LA,et al Impact of the interruptions and the distractions on the dispensing errors in an ambulatory care pharmacy. American J Health Syst. Pharm. 1999; 56:1319-25.
9.
Hilker H, Taylor N. The causes, identification and the reduction of the medication errors: Focus on the Pharmacy Perspective. [Internet] Available from: http://www.MyWalgreensCE.com.
10.
Dominica MG, Ceruelo J, Romero MV, Dominquez A. Analysis of the prescription, transcription and the dispensing quality through the information which was gathered in a pharmacy service. EJHP Science 2005; 4:91-3.
11.
Darren MA, Paul Q, Alison B. A prospective study on the incidence, nature and the causes of the dispensing errors in a community pharmacy. Pharmacoepidemiol Drug Saf 2004; 14:327-32.
12.
Kisner UA, Keith MR, Sergent KA, Hokanson JA. Accuracy of dispensing in a high-volume, hospital-based out-patient pharmacy. American J Hosp Pharm 1994; 51(22):2793-7.
13.
Cina JL, Gandhi TK, Churchill W, Fanikos J. How many hospital pharmacy medication dispensing errors go undetected? JCAHO 2006; 32:73-80.

DOI and Others

JCDR/2011/1610

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com