Objective The objective of this study was to record medication error against specific categories identified through community pharmacies in Southern Derbyshire.Method A piloted diary-based reporting instrument was used with defined medication error incident type related to who identified the error and the stage in the process when the error was discovered.Setting Community pharmacies in Southern Derbyshire (UK) between October 2002 and October 2003.Key findings Seventeen pharmacies over 104 months supplied 485 940 prescribed items and provided data on 987 medication errors. A large variation in error reporting between pharmacies was noted. Pharmacists identified 72% of reported errors. This has implications for system change, clinical governance and the evolving role of the pharmacy technician. Critically, 23% of reported errors were identified after medicines were issued to patients or carers. This begs a question as to the effectiveness of current practice in identifying error early in the process. Of 968 recorded errors for which full data were available, 70% were classed as dispensing errors. This compared with 24.1% of recorded errors being prescribing and 6.0% as 'other' types of error. While 25.2% of identified errors concerned the wrong strength or form of medication, more worryingly, 11.0% of identified errors involved the wrong drug being potentially or actually dispensed.Conclusions We conclude that medication error will occur in current practice. There are identifiable deficiencies in practice that leave patients potentially exposed. This study provides benchmark figures on reported error and concludes that there are specific areas of concern for future research.
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