Compounding and Dispensing Errors Before and ...

Peer Reviewed

Compounding & Dispensing Errors Before and After Implementing Barcode Technology in a Nuclear Pharmacy Wendy Galbraith, PharmD, BCNP Jill Shadid, DPh, MBA The authors are affiliated with the University of Oklahoma, College of Pharmacy, Oklahoma City, Oklahoma. Wendy Galbraith is a Clinical Assistant Professor within the Nuclear Pharmacy Department of the Department of Pharmaceutical Sciences, and Jill Shadid is the Director of Pharmacy Operations and a Clinical Assistant Professor within the Department of Clinical and Administrative Sciences.

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International Journal of Pharmaceutical Compounding Vol. 16 No. 3 | May/June 2012

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Peer Reviewed

Abstract

The objective of this study was to determine whether the incidence of compounding and dispensing errors changed significantly in a nuclear pharmacy after the pharmacy adopted a barcode assistance system. Nuclear pharmacy dispensing errors are extremely low compared to that of busy traditional pharmacies, but there is no data available describing the use of barcoding assistance on the rate of dispensing errors in nuclear pharmacy. A retrospective review of dispensing errors pre-barcode assistance system implementation (2001 through 2004) and post-barcode assistance system implementation (February 2005 through 2009) was conducted using data from a nuclear pharmacy that dispenses approximately 500 prescriptions per day to nuclear medicine clinics and hospitals. Data was obtained from pharmacy error logs filed by the pharmacy as reported by an end user receiving the compounded preparation or the pharmacist having recognized the error before it reached the end user. Dispensing errors were defined as any deviation in the dispensed preparation from the prescribed order. Categories identified as incorrect were: dosage, drug, volume,

Prescription drugs are a substantial part of the healthcare picture with over 3.6 billion prescriptions being dispensed in the U.S. from outpatient facilities, including mail-service, in 2009.1 This represents almost 260 billion dollars in expenditures for that same time period.1 With the vast number of prescriptions being dispensed, medication dispensing errors are an unfortunate reality. Dispensing errors fall into the following categories: 1. Drug (may include incorrect drug, strength, or form) 2. Labeling (e.g., incorrect directions, warnings, drug name, patient name) 3. Issuing to the wrong patient The incidence of dispensing errors has been studied and documented in detail for outpatient, mail-service, and hospital pharmacies, not only in the U.S. but in other countries as well.2 It has been documented that technological assistance, such as automation and robotics, as well as barcoding, is associated with lower error rates in the outpatient, hospital, and mail order settings.2-3 Preparation of compounded prescriptions is an additional area for dispensing errors to occur. In one study, compounding errors accounted for 7.5% of all dispensing errors

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procedure, patient, and delivery destination. Implementation of the barcode assistance system included installation of computers, software, barcoding devices, and training of personnel. The barcode assistance system provided barcodes for each compounding component, final preparation, syringe label, prescription, and shipping material. The barcode assistant system communicated directly with the dose calibrator, enabling the dose calibrator settings to automatically change according to time of administration and isotope required. The average error rate pre- and post-barcode assistance system was 0.012% and 0.002%, respectively (P