Class of 2005 Abstract / Objectives: 1) Determine the compliance rate with 12 dispensing workflow criteria; 2) note if any dispensing errors occurred; and 3) summarize characteristics of the pharmacies studied (pharmacy staffing, dispensing workload, presence of a drive-through window, etc.). Methods: At least fifty out-window (i.e., pharmacy prescription pick up window) transactions per store were observed within 18 community retail pharmacies. Based on the historic pharmacy error incidence reports, pharmacies were categorized as being either high- or low-risk pharmacies. The compliance rates for the dispensing workflow criteria were observed between high- and low-risk pharmacies and also between different employee categories. Employee categories included pharmacists, pharmacy interns, and pharmacy technicians who were involved in the dispensing process. Results: Between August 2004 and January 2005, a total of 950 out-window transactions were observed. There were statistically significant differences seen between high- and low-risk pharmacies and between the various categories of employees. The lack of the verification of patients’ name and number of prescriptions being picked up were procedures that were more commonly associated with pharmacies reported to have high dispensing error rates. Implications: This study identified several areas where the dispensing workflow criteria were not being performed. Based on this study, the lack of the verification of patients’ name and number of prescriptions being picked up were procedures that were more commonly associated with pharmacies reported to have high dispensing error rates.

Quality in pharmacies includes aspects such as error management and safety issues. The objective of this thesis was to explore these aspects of quality in Swedish community phar-macies. The specific aims were to compare a paper-based and a web-based reporting system for dispensing errors, regarding reporting behaviour and data quality. The impact of an intervention; a technical barrier, for preventing dispensing errors was evaluated. A survey tool, the Safety Attitudes Questionnaire (SAQ), was adapted to Swedish pharmacies and used to describe the safety culture in these pharmacies. The potential relationship between safety culture and dispensing errors was also explored. Data was retrieved from the paper- and web-based reporting systems, semi-structured interviews as well as from a survey, using SAQ. The change in reporting system for dispensing errors increased the reporting of errors and enhanced the completeness of reported data. The web-based system facilitated follow-up and identification of preventive measures, but was associated with implementation problems. The intervention was associated with a significant decrease in the overall number of dispensing errors and, specifically, reports on errors with the wrong strength, and errors caused by registration failure in the pharmacy computers. The Swedish version of the survey tool, SAQ, demonstrated satisfying psychometric properties. No correlation between the SAQ Safety Climate dimension and dispensing errors was seen, while a positive relationship between the SAQ Stress Recognition dimension and dispensing errors was established. A number of other pharmacy characteristics, such as number of dispensed prescription items and employees, displayed positive relationships with dispensing errors. Staff age demonstrated a negative relationship with dispensing errors while other demographic variables such as national education background showed a positive relationship.

Background: Concern has been raised that the workload of community pharmacists (CPs) is linked to the occurrence of dispensing errors (DEs). One aspect of workload that has not yet been measured in this setting, but has been linked to errors in other industries, is mental workload (MWL). Aims: (1) Measure the relationship between MWL and DEs during a routine pharmacy task, the final accuracy check, which research suggests is critical to DE prevention. (2) Quantify the role that expertise plays in this relationship. (3) Explore CPs and pharmacy students’ experiences of MWL and DEs. Methods: A mixed methods approach was taken and three studies were conducted. In study one, CPs (n=104) and students (n=93) checked dispensed items for DEs. Participants took part in one of four conditions (distraction, no distraction, dual-task or single-task) and their DE detection and MWL was measured. Study two was a diary study of CPs’ (n=40) MWL during a day in their “real-life” practice. Study three presented an interpretative phenomenological analysis of CPs’ (n=14) and students’ (n=15) experiences of MWL and DEs. Main findings: Study one found that high MWL was related to reduced DE detection, but only for students, confirming the important role of expertise. Distractions did not affect DE detection but was linked to increased MWL. Study 2 highlighted specific times of the day when CPs’ MWL was exceptionally high. Study 3 found several factors which increased MWL, including the lack of control CP’s had over their workload, difficulties communicating with prescribers and targets. Conclusions: MWL has been found to be a useful tool for measuring the impact of workload on pharmacy safety. The findings are linked to current work design and human factors theory and suggestions are made for how CPs’ work could be redesigned to reduce their MWL and improve safety.

Background: Dispensing medication is a chain of multiple stages, and any error during the dispensing process may cause potential or actual risk for the patient. Few research studies have investigated the nature and contributory factors associated with dispensing errors in hospital pharmacies. Aim: To determine the nature and severity of dispensing errors reported in the hospital pharmacies at King Saud Medical City (KSMC) hospital in Saudi Arabia, and at Luton and Dunstable University Hospital (L&D) NHS Foundation Trust in the UK; and to explore the pharmacy staff perceptions of contributory factors to dispensing errors and strategies to reduce these errors. Materials and Methods: A mixed method approach was used and encompassed two phases. Phase I: A retrospective review of dispensing error reports for an 18-month period at the two hospitals. The potential clinical significance of unprevented dispensing errors was assessed. Data was analysed using descriptive statistics in SPSS and A Fisher's test was used to compare the findings. Phase II: Self-administered qualitative questionnaires (open-ended questions) were distributed to the dispensary teams in KSMC and L&D hospitals. Content analysis was applied to the qualitative data using NVivo qualitative analysis software. Result: Dispensing the wrong medicine or the incorrect strength were the most common dispensing error types in both hospitals. Labelling errors were also common at the L&D pharmacy dispensary. The majority of the unprevented dispensing errors were assessed to have minor or moderate potential harm to patients. Look-alike/sound-alike medicines, high workload, lack of staff experience, fatigue and loss of concentration during work, hurrying through tasks and distraction in the dispensary were the most common contributory factors suggested. Ambiguity of the prescriptions was a specified factor in the L&D pharmacy, while poor pharmacy design and unstructured dispensing process were specified contributory factors in the KSMC pharmacy. Conclusions: Decreasing distractions and enhancing the pharmacy design and the dispensing workflow are necessary to reduce dispensing errors. Furthermore, monitoring and reporting errors and educating the dispensary team about these errors is also needed. Automation and e-prescribing systems may improve dispensing efficiency and safety. The findings of this study reemphasise the fact that dispensing errors are prevalent in hospital pharmacies. Efficient interventions need to be implemented to mitigate these errors.