On May 16-18, URAC’s Quality, Research and Measurement Team and Kiser Healthcare Solutions were pleased to present a poster session at the Pharmacy Quality Alliance (PQA) Annual Meeting held in in Baltimore, MD.  Our topic was, “Dispensing Accuracy of Specialty Pharmacies” and you can view the poster that our team created here.

The safety and accuracy of dispensing prescriptions are essential in ensuring the right patient receives the right medication at the correct dosage.  According to Consumer Reports, a typical pharmacist fills approximately 13,000 prescriptions per year, which equates to approximately 60 prescriptions per day (1999).  In 2003, Flynn et. al. conducted a study of dispensing accuracy rates in 50 pharmacies located in 6 cities across the United States.  They found an overall dispensing accuracy rate of 98.3%, or 77 errors among 4, 481 prescriptions (2003).  The researchers concluded that pharmacy dispensing errors are a problem at a national level at about a rate of 4 errors per day in a pharmacy filling 250 prescriptions daily (Flynn et.al., 2003).

While the number of medication errors is small, even in the best managed pharmacies, errors will and do occur.  Errors include many “wrongs.”  According to Dusen and Pray, “the wrong drug may have been prescribed or dispensed, the wrong strength dispensed, or the wrong directions placed on the label” (February 2011: 36).  A medication error, as defined by the National Coordinating Council for Medication Error Reporting and Prevention, 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 healthcare professional, patient, or consumer.  Such events may be related to professional practice; healthcare products, procedures, and systems, including prescribing; order communication; product labeling; packaging; nomenclature; compounding; dispensing; distribution; administration; education or monitoring; and use” (December 2005).

A study by Flynn, Barker, and Carnahan investigated questions such as “Is there a dispensing error problem and if so, what is the magnitude of the problem?  In the past, case studies have demonstrated an error rate ranging from 0.2 percent to 10 percent (McGhan, et al., Guemsey, et al., Buchanan, et al., Kistner, et al.)  The study by Flynn et al., used direct observation to identify errors in dispensing medications among different types of pharmacies, e.g., chain, independent and health systems.  They found that the overall dispensing accuracy rate was 98.3% (77 errors among 4,481 prescriptions) with a range of 87.2% to 100%, with no significant difference between pharmacy types.  The most frequent source of error was wrong label information (Flynn et al., 2003).

URAC’s dispensing accuracy measure assesses the percentage of prescriptions that were dispensed inaccurately e.g., incorrect drug, incorrect recipient, incorrect strength, incorrect dosage form, incorrect instructions, and incorrect quantity.  For this study, data was collected from July 1, 2017 through September 30, 2017 via the URAC web portal for the 2016 measurement year.  Prior to analysis, the data was reviewed for accuracy, then types of errors and trends were identified and analyzed.  The 2016 aggregate summary rate is 0.02335%, or 23.4 drug dispensing defects per 100,000, with a mean of 0.05722% and a median of 0.02874%.  (n=55).  The most frequent source of error was wrong quantity of medication, followed by incorrect drug dispensed.  Incorrect label information was third.