Medication dispensing errors in community pharmacies

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Terry Regan

Director and Head of Medical and Clinical Negligence

Published - 27/09/2023

Getting the right medication is crucial for many patients, particularly for acute or severe conditions where a lack or change in medication could result in severe patient harm. Medication safety is of utmost importance in hospitals because medication administration errors are one of the common types of medical error. However, community pharmacies must still uphold the highest level of patient care or they could be in breach of the law surrounding clinical negligence.

This article discusses the common medication errors in community pharmacies, particularly who can be held responsible and how patients, staff or authorities can resolve and prevent dispensing errors in community pharmacies.

What are common errors in community pharmacies?

When a medication error occurs in a community pharmacy, the consequences are potentially severe. Several of the most common types of dispensing error involving prescription drugs are as follows:

  • Providing the wrong medication: If the patient receives an ineffective drug, one they are allergic to, or a medicine that could lead to an adverse drug interaction poses a significant risk to patient safety.
  • Wrong dosages: the consequences of providing the correct drug in the wrong dose could also be severe. A low amount may not resolve the patient’s symptoms, while an excessive dosage could cause adverse side effects.
  • Not receiving prescription medication altogether: Technical or communication failures can delay patients getting the necessary medicines.
  • Providing unauthorised medication: unpleasant side effects, an allergic reaction or a harmful drug interaction could occur if a patient receives an unauthorised prescription. The prescriber may not have taken the patient’s medical history into account.

Dispensing errors can result from the following:

  • Mislabelling medication
  • Failure to double-check dosages
  • Communication errors
  • Human errors
  • Technological faults
  • Failure to double-check patient details
  • Failure to double-check the prescription and prescribing doctor’s details

How common are dispensing errors in community pharmacies?

How common are dispensing errors in community pharmacies?

The rate of dispensing errors in community pharmacies is thankfully low, but it is estimated, according to MHRA, that the error rate in community pharmacies is anywhere between 0.001 and 3.32%. The NHS dispenses roughly 2.7 million items daily, so as many as 89,640 dispensing errors can occur daily. Fortunately, there is a much lower rate of severe harm or death resulting from pharmacy errors. Several factors can affect this rate, such as the frequency of training programs for pharmacy staff, the amount of data automation or the working environment.

What can lead to mistakes in a community pharmacy?

We outline some common problems that can lead to distribution errors relating to working conditions, training, or systematic errors.

Workload and fatigue

Human error is unavoidable in all professions, particularly when staff deal with workplace stress and inadequate staffing. Community pharmacists working long shifts in stressful environments make more mistakes; unfortunately, the consequences can be severe.

Inadequate training

In every workplace, processes and protocols continually change, and ongoing training programs can help keep community pharmacists and pharmacy technicians up to date. Poorly trained staff may not be able to follow the correct protocols consistently. With accurate reporting of medication mistakes, authorities can decipher where more training is required.

Flawed systems

Systematic errors can occur in a community pharmacy when the pharmacists use outdated software, hardware or inefficient processes. Electronic prescriptions (over handwritten prescriptions), and automated dispensing processes, are ways to avoid potential errors in community pharmacies and prevent miscommunications.

What are the consequences of dispensing errors?

Some severe consequences of dispensing errors include:

  • Adverse drug interactions
  • A worsening of the patient’s medical condition
  • Allergic reactions
  • Adverse side effects

You could be eligible to make a clinical negligence claim if you have received the wrong drug and caused you significant harm. You need to prove that a pharmacist failed to take adequate care when dealing with your request and that this solely contributed to a personal injury independent of any other cause.

Preventing medication errors in a community pharmacy?

The first way of preventing potential errors in community pharmacies is by implementing safeguards to ensure safe medication practices.

  1. Ensure that all community pharmacists double-check every medication and their dosages against the prescription and the packaging.
  2. Digitisation and automation, such as electronic prescribing and dispensing, are additional layers of protection against patient safety incidents. QR codes, for example, can make accurate dispensing simple.
  3. Adequate staffing reduces pressure and the need for excessively long shifts.
  4. Training on the dispensing process
  5. Accurate reporting of pharmacy errors to the correct authorities helps to guide effective training programs.

Patients should report every single medication error, however minor. Reporting errors helps community and hospital pharmacies prevent potential errors and guide training programs. Sometimes, community pharmacists can miss little mistakes.

What to do about a medication error that affected you

As mentioned, you should report a medication error immediately to the pharmacy practice, your general practitioner, or the prescribing doctor.

If you have been significantly affected by a medication error, you may also want to bring a clinical negligence claim. You have three years from the incident date or the date you learned of the incident to make a compensation claim against the pharmacy practice responsible.

You will need evidence of the following:

A - Evidence of clinical negligence – the pharmacist failed to uphold an adequate patient and social care standard.

B - Evidence of independent causation – that negligence directly and independently caused you harm.

You should give your solicitor as much detail as possible, including the error dates, the pharmacy staff involved, details of the medication and the mistakes made. Wake Smith solicitors will do the groundwork to uncover the evidence to support your claim. We understand that it can be difficult to remember and gather all the information you need. Wake Smith can represent you under a no-win, no-fee agreement and they will fully explain this to you in plain language.

Get in touch with our specialist medical negligence team today!

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Terry Regan

Director and Head of Medical and Clinical Negligence

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