Microcomputer-assisted monitoring of medication-dispensing errors. 1989

J N Hayman
Department of Pharmacy Services, Parkland Memorial Hospital, Dallas, TX 75235.

A microcomputer-based program for collecting and monitoring data on medication-dispensing errors made by pharmacy personnel is described, along with the policies and procedures for dealing with the responsible employees. The program was implemented at a 964-bed teaching hospital. When a medication-dispensing error is suspected, the director of pharmacy initiates a medication discrepancy follow-up report form. The appropriate supervisor fully investigates the incident, completes the form, and returns it to the director, who assigns a point value to the error on the basis of whether it injured or had the potential to injure the patient. Information from the report is then entered into an automated file. Data are sorted by the computer, allowing the performances of pharmacy personnel to be monitored. Progressive educational or disciplinary actions are taken depending on the number of points accumulated annually. Responsibility for an error is not assigned unless there is absolutely no question as to its origin, and dispensing-error points are not carried over from year to year. Since the program was implemented more than three years ago, the average number of reported medication-dispensing errors has decreased from 20 to 6 per month. Departmental procedures for monitoring and analyzing dispensing errors and for initiating disciplinary actions against personnel who commit many dispensing errors have been successful in creating greater awareness of the need to prevent such errors and in reducing their number.

UI MeSH Term Description Entries
D008508 Medication Errors Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. Drug Use Error,Errors, Medication,High-Alert Drug Error,High-Alert Medication Error,LASA Medication Errors,Look-Alike Drug Name Errors,Look-Alike Sound-Alike Drug Errors,Look-Alike Sound-Alike Drug Substitution Errors,Look-Alike Sound-Alike Medication Errors,Lookalike Drug Name Errors,Lookalike Soundalike Drug Errors,Lookalike Soundalike Drug Substitution Errors,Lookalike Soundalike Medication Errors,Drug Error, High-Alert,Drug Use Errors,Error, Drug Use,Error, LASA Medication,Error, Medication,High Alert Drug Error,High Alert Medication Error,High-Alert Drug Errors,High-Alert Medication Errors,LASA Medication Error,Look Alike Drug Name Errors,Look Alike Sound Alike Drug Errors,Look Alike Sound Alike Drug Substitution Errors,Look Alike Sound Alike Medication Errors,Medication Error,Medication Error, High-Alert,Medication Error, LASA,Medication Errors, High-Alert,Medication Errors, LASA
D008838 Microcomputers Small computers using LSI (large-scale integration) microprocessor chips as the CPU (central processing unit) and semiconductor memories for compact, inexpensive storage of program instructions and data. They are smaller and less expensive than minicomputers and are usually built into a dedicated system where they are optimized for a particular application. "Microprocessor" may refer to just the CPU or the entire microcomputer. Computers, Personal,Microprocessors,Computer, Personal,Microcomputer,Microprocessor,Personal Computer,Personal Computers
D010380 Peer Review An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients. Review, Peer,Peer Reviews,Reviews, Peer
D010607 Pharmacy Service, Hospital Hospital department responsible for the receiving, storing, and distribution of pharmaceutical supplies. Clinical Pharmacy Service,Hospital Pharmacy Service,Pharmacy Service, Clinical,Hospital Pharmaceutic Service,Hospital Pharmaceutical Service,Hospital Pharmacy Services,Pharmaceutic Service, Hospital,Pharmaceutical Service, Hospital,Service, Clinical Pharmacy,Service, Hospital Pharmaceutic,Service, Hospital Pharmaceutical,Service, Hospital Pharmacy,Clinical Pharmacy Services,Hospital Pharmaceutic Services,Hospital Pharmaceutical Services,Pharmaceutic Services, Hospital,Pharmaceutical Services, Hospital,Pharmacy Services, Clinical,Pharmacy Services, Hospital,Services, Clinical Pharmacy,Services, Hospital Pharmaceutic,Services, Hospital Pharmaceutical,Services, Hospital Pharmacy
D003199 Computer Systems Systems composed of a computer or computers, peripheral equipment, such as disks, printers, and terminals, and telecommunications capabilities. Computer Architecture,Computer System,Computer Systems Development,Computer Systems Evaluation,Computer Systems Organization,Real Time System,Real-Time Systems,Organization, Computer Systems,Architecture, Computer,Architectures, Computer,Computer Architectures,Computer Systems Evaluations,Development, Computer Systems,Evaluation, Computer Systems,Evaluations, Computer Systems,Real Time Systems,Real-Time System,System, Computer,System, Real Time,System, Real-Time,Systems, Computer,Systems, Real Time,Systems, Real-Time,Time System, Real,Time Systems, Real
D006746 Hospital Bed Capacity, 500 and over The number of beds 500 or more which a hospital has been designed and constructed to contain. It may also refer to the number of beds set up and staffed for use. Hospital Bed Capacity 500 Over
D013781 Texas State bounded on the north by Oklahoma, on the east by Arkansas and Louisiana, on the south by Mexico, and on the west by New Mexico.

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